CLINICAL REFLECTION: CLIENT-CENTRED SUPPORT GROUPS

Clinical Reflection: Client-Centred Support Groups

Carrie Minns

Trent University
CLINICAL REFLECTION: CLIENT-CENTRED SUPPORT GROUPS

My clinical placement this semester is in the mental health unit at Peterborough Regional Health

Centre. I have already had so many amazing opportunities to engage with clients experiencing

mental health challenges. I have been privileged enough to already learn from mental health

nurses, psychiatrists, and social workers different approaches to care, prevention, and

treatment strategies. Given all of this exposure, I have many experiences to reflect on, however

my experience attending a support group for clients transitioning back into their homes after

being in the hospital stands out for me. This experience exposed me to a type of therapy that

seemed very unique and kind of strange to me at first, opening my eyes to the wide range of

treatment options for people experiencing a mental illness.

I volunteered to go sit in on the support group where I would be the only nursing student

there, accompanied by a social worker and a therapist. Prior to attending the group, my clinical

instructor had told me that these clients were in a transition period and the purpose of the support

group is to be client led, which means that the support staff do not speak, unless to start or end

the group or mediate very briefly. Prior to entering the group, I thought it would be easy not to

say anything and just listen to the clients support each other. I pictured something like the

support groups portrayed in the media as a space where everyone seemed pretty talkative and by

the time the session was over there was clear improvement. It was to my surprise that the group

was very different than what I had expected, and it was one of the most challenging experiences I

have had in my clinical placements thus far.

When I entered the room with the social worker there were 6 chairs in a circle

surrounding a table with pamphlets discussing community resources. There was a woman

already in the room, experiencing schizophrenia and was crying non stop talking about the

voices telling her what an awful person she was. She was supposed to be leaving the clinic that
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day, but had to leave the group before it started because she was so emotionally and needed

further support. This was very hard for me to watch because she seemed like such an amazing

person whose mental illness had such a dramatic impact on how she was able to live her life.

While listening to her describe the voices she was hearing, I thought back to my previous week

in clinical where my instructor had done a hallucinations simulation for us so we could

experience what it might be like to live with these auditory hallucinations. One of the other

group members suggested she go talk to the nurse practitioner who performs injections for

clients experiencing psychosis. I found that really amazing that she was able to find support

without a staff member intervening.

Once she had left, there were 5 clients in the group who all knew each other from

previous sessions. The group started by going around introducing themselves and discussing

their goal that they had set the previous week. After this it was silent for a long time, and I had

expected the staff to strike up a topic or ask the group an open ended question that would get the

conversation going. I then remembered that the clients are supposed to lead the group, and staff

arent really supposed to say anything. The silence was dragging on, and I did not expect to feel

so uncomfortable, and it made me think of how uncomfortable the clients might feel as well.

After what seemed like 2 minutes of silence, one the group members started a discussion and

began to cry. After she was done speaking, one of the other members said something supportive

and seemed to help her a little, but then there was silence again as she cried. This pattern

continued, and as clients spoke I found the staff were not even looking at them which I found

incongruent with what I had learned about building therapeutic relationships with clients.

I began to question whether this method of therapy was truly beneficial. Clients would

discuss a really sensitive issue and sometimes there would be no response from the group and the
CLINICAL REFLECTION: CLIENT-CENTRED SUPPORT GROUPS

topic would change, which made me feel sorry for whoever opened up, because this could have

made them feel unheard or unimportant. During these silences, I felt the need to speak just to let

them know that they were heard and offer some sort of response to them opening up to the group.

I remember at one point I looked up at one of the clients during a silent moment and he seemed

jittery, uncomfortable, and a little confused. However, he then began to open up about some

really deep rooted topics that he clearly needed to express. The group provided really great

support to each other, although there were many silences and topics would change and go back to

previous ones, I began to understand the efficacy of this treatment approach.

After the hour was done and the clients had made new goals, they left. No one seemed

particularly happier and some actually seemed sadder than when they had entered the group at

the beginning of the hour. During debriefing with the therapist and social worker I told them how

I felt uncomfortable during the silent moments and asked the benefits to this type of therapy and

if they had individual counselling where the issues that they brought up in group could be

discussed more. The social worker explained that the silences are meant to get them to discuss

things that are really buried in their mind and it is meant to be uncomfortable. The group aspect

of it is meant to bring about triggers for the clients that they will be exposed to when they

transition into their everyday lives, they can learn to understand and cope with these triggers

from each other so that it gets easier. Payne, Liebling-Kalifani, and Joseph (2007) discuss the

efficacy of client-centered group therapy and suggest that it is beneficial for clients who have

experienced past trauma because it brings up triggering moments in a safe, supportive

environment. The authors do suggest that these types of groups are more beneficial for clients

who perceived the other group members and staff as empathetic, non-judgemental, and

supportive (Payne et al., 2007). If clients did not perceive the group in this way, then they found
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the groups to be unhelpful. This would be good information for staff to know to facilitate the

group in a way that clients do feel like they have been heard and that there is supportiveness and

empathy among the group members.

I now realize that therapy is not always about ending a conversation or a session with

everyone feeling instantly better. Overcoming any illness, especially a mental illness is a long,

intermittent process. This relates to one of the quotes my clinical instructor put on the wall that I

read the first day of placement, in that mental health nurses dont cover up wounds, they

uncover them. Going forward in my mental health placement, I will look at each encounter with

clients as a step in their journey toward overcoming their mental illness. In other areas of

nursing, some wounds can heal very quickly or pain can be managed quickly and easily so the

client immediately feels comfort. Often times in mental health nursing, improvements in health

are a lot harder to see and in some cases it may seem like the care nurses or other support staff

provide is beneficial. The most important things I have learned from this experience is that

mental health nursing requires patience and unconditional support. Not every client will respond

to therapy approaches equally, which means mental health nurses have to be creative, flexible,

and supportive to each client and the context surrounding their individual struggle.
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Payne, A., Liebling-Kalifani, H., & Joseph, S. (2007). Client-centred group therapy for survivors

of interpersonal trauma: A pilot investigation. Counselling and Psychotherapy

Research, 7(2), 100-105. doi:10.1080/14733140701343799