点击显示 收起
佛罗里达大型照护机构、迈阿密犹太年长者居家与住院心智服务负责人Mark Agronin医师表示，对个人治疗和/或心理药物治疗无反应的那些有行为异常的年长者，一种门诊病患组织计划所进行的团体治疗可以有神奇的效果。
在此间举行的美国老年精神医学会第21届年会中，Agronin医师形容他的中心正进行崭新的计划，且发表Frieda这名案例，此案例在其他治疗失败之后迅速治愈。
Frieda是一名84岁的妇女，在西伯利亚流放之后存活，尽管给予治疗，仍感到忧郁和专注在自体的病痛；她相当聪明，且坚持她并无忧郁，不过，她唯一的快乐似乎只有在生活辅助机构的唱诗班唱歌时。
Agronin医师表示，当Frieda又再度让他们治疗师感到无力时，机会来了；他们开始这个崭新的计划，每天有架构的为其他治疗方法无效的心智异常精神病患进行6至8周的进行治疗计划，这些病患病情稳定且可以参与团体讨论。
Agronin医师表示，该计划包括每天2次50分钟的背对背团体治疗，中间有10分钟的休息。
他表示，我试着说服Frieda 加入此团体，这花了一点功夫；该团体的领导人－有点像啦啦队长、又有点像教育班长－第一周必须加入协助送Frieda来参加计划，但是在第2周，事情开始改变；Agronin医师表示，团体的成员都喜爱Frieda，因为她挑战我们给她的所有标签 —年老、沮丧、紧张；其他成员围绕在她身边，Frieda就像明星，她笑了、她的穿着比较明亮了，且她变得比较早出席。
Agronin医师表示，在接着1周的某一天发生戏剧性的改变，Frieda 打断了有关忧郁和焦虑的谈话，表示：不要再聊这些了，我们来唱歌，她抓住两侧2位妇女的手，并且开始大声唱Hava Nagila这首歌，这首歌的意思是“让我们一起高兴”；几秒钟之后，一群妇女围绕着她，每个人举高手臂、满脸愉悦的一起唱歌；歌唱结束之后，Frieda感谢每个人并且大步跨出圈外。
他表示，那是她来这团体的最后一天，但在往后的一个月，她有了些许改变，她比较热衷参与活动且看比来比较快乐、有更多内涵。
Agronin医师表示，我了解我们藉由该团体完成了其他方式无法完成的任务；Frieda融入此团体且感到关爱与关心，并且获得正面注意力，且不再忧郁，而是满怀关心的人。
他观察发现，有时候在团体中会有很戏剧性的事情发生，这在个人治疗和药物是很难发生的。
【一个利他的机会】
Agronin医师表示，为老年人进行团体治疗和为年轻人进行团体治疗相比是种挑战；举例来说，团体中出现和讨论的题材，必须将大部分年长者体力和心智比较弱的情形纳入考量，场地必须适合轮椅进出，参加者也许需要交通接驳，团体治疗时的休息时间也是重要的，因为老年人更需要补充水分和营养。
不过，为老年人进行团体治疗可以提供许多比个人治疗更优的好处，这些包括与同侪进行结构式社交的机会、与其他人分享年纪相关的问题、付出与回收正向回馈的机会；他表示，这也给每个人一个利他的机会— 将他们自己奉献给其他人 — 我想这是所有改变的其中一项。
他指出，团体治疗利用此架构，以心理教育方式提供舒适的无威胁的环境，提供实用的资讯与策略，计划也为轻微认知缺损者和冷淡者设计心理刺激运动，这两种类型的病患也是老年人常有的。
美国老年精神医学会第21届年会：老年精神病跨文化创新研讨。2008年3月15日。
Group Therapy for the Elderly<
By Marlene Busko
Medscape Medical News
For elderly individuals with behavioral health disorders who are not responding to treatments such as individual therapy and/or psychopharmacological therapy, a structured outpatient program of group therapy can "work magic," said Mark Agronin, MD, director of mental health services at the Miami Jewish Home & Hospital for the Aged, Florida's largest long-term care facility.
In a talk here at the American Association for Geriatric Psychiatry 21st Annual Meeting, Dr. Agronin described his center's "New Beginnings" program and presented the case of Frieda, who went from treatment failure to rapid healing.
Frieda was an 84-year-old woman who had survived exile in Siberia and who remained depressed and preoccupied with somatic ailments despite treatment. She was highly intelligent and insisted that she was not depressed, although her only joy seemed to be singing in the choir in her assisted-living facility.
At a time when Frieda had "worn out" her latest therapist, an opportunity presented, said Dr. Agronin. The clinic had just started the "New Beginnings" program, a daily, structured, 6- to 8-week group therapy program for patients with psychiatric disorders such as mood disorders who showed a lack of improvement with other modalities but who were medically stable and able to participate in group discussions.
The program comprises 2 daily 50-minute back-to-back group therapy sessions separated by a 10-minute refreshment break, said Dr. Agronin.
"I tried to convince Frieda to come into the group, and it took a while," he said. The group leader, "part cheerleader, part drill sergeant," had to go in and help Frieda dress to get her to the program the first week, but in the second week, things began to change. "The group members loved Frieda, because she challenged all the labels that we gave them — being older, being depressed, being nervous," said Dr. Agronin. The others rallied around her, and Frieda "was a star." She was smiling, her clothes were brighter, and she showed up early.
Dr. Agronin described a dramatic incident that happened 1 day in the following week. Frieda interrupted a discussion about depression and anxiety by saying: "Enough talk about this. Let's sing." She grabbed the hands of the 2 women on either side and began belting out the song "Hava Nagila," which literally means "let's rejoice." Within seconds, she was surrounded by a group of women, all with their arms raised, singing together with joy on their faces. The song ended, and Frieda thanked everyone and strode out of the group.
"That was the last day that she ever came to the group, but in the months thereafter, there was a change in her. She was more engaged in activities and seemed a lot happier, more content," he said.
"I realized that what we had accomplished in the group was something that we were not able to accomplish in any other setting. It came down to Frieda really feeling cared for and feeling loved in this group and getting positive attention not for being depressed but for being a caring, strong person," said Dr. Agronin.
"Sometimes things happen in a group in a very magical way that is very difficult to achieve in individual therapy and with medication," he observed.
A Chance to Be Altruistic
Doing group therapy with the elderly has challenges that make it very different from working with younger individuals, Dr. Agronin noted. For example, the material that is presented or discussed in the group has to take into account the fact that most elderly individuals have some physical and cognitive disabilities. The location needs to be able to accommodate wheelchairs. The participants might need help with transportation. A refreshment break during the group therapy session is important because of hydration and nutrition issues in the elderly.
Group therapy for older adults can, however, offer several distinct advantages over individual therapy. These include the opportunity for structured socialization with peers, sharing age-related problems with others, and a chance to give and receive feedback and positive reinforcement. "It also gives individuals an opportunity to be altruistic — to give of themselves to other people — and I think that is one of the most transforming aspects of it," he said.
Group therapy using this type of structured, psychoeducational approach provides a comfortable and nonthreatening environment and provides practical information and strategies. The program is also designed to provide mentally stimulating exercises for individuals with mild cognitive impairment and apathy, which are common in geriatric patients, he noted.
American Association for Geriatric Psychiatry. 21st Annual Meeting: Innovative Research in Cross-Cultural Geropsychiatry. Presented March 15, 2008.