Engaging in group therapy for distressing voice hearing

OBJECTIVE: Person Based Cognitive Therapy (PBCT) is a promising group treatment for distressing psychosis. However, fostering engagement in group therapies can be challenging, and no theory of engagement in PBCT groups exists to guide practice or research. This study employed Grounded Theory Method (GTM) to build a theory of engagement in group PBCT.

METHOD: Ten service-users and three therapists were interviewed about their experiences of participating in PBCT groups. GTM, following the procedures outlined by Corbin and Strauss (2008) was used to analyse the interview transcripts and build a theory of engagement.

RESULTS: The model that was developed involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers were often overcome through individual and group efforts, but sometimes compromised participants’ perceived safety to the point of dropout. For others, participating in the group, and incorporating learning into life, led to rewards, some of which were integrated beyond group termination.

CONCLUSIONS: Group engagement can be encouraged by establishing universality around voice-hearing early, reducing uncertainty, communicating with clients between sessions and mapping group progress to create a cohering sense of collaboration on the tasks of therapy.