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Frontline Report   |    
Guided Peer Support Groups for Schizophrenia: A Nursing Intervention
Stynke Castelein, M.Sc.; Pieter Jan Mulder; Richard Bruggeman, M.D., Ph.D.
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.3.326
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The authors are affiliated with the University Center for Psychiatry, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands (e-mail: s.castelein@psy.umcg.nl). Ms. Castelein is a medical sociologist and researcher, Mr. Mulder is a nurse who specializes in care for people with schizophrenia, and Dr. Bruggeman is a psychiatrist and researcher.

Whereas peer support groups are frequently available for patients with all kinds of chronic diseases, they do not usually form part of the care program for people who have schizophrenia. Still, schizophrenia patients have a professed need to talk to each other in a group as peers and discuss daily life problems.

In the 1990s, we set up peer support groups for people with schizophrenia. These groups initially were guided by a nurse but with the idea that the participants would take over the guidance as soon as the group process had taken effect. However, in the absence of outside guidance, the groups tended to lose momentum. This development prompted us to create a "minimal guidance" group structure.

We developed our own manual—How to Support Peer Groups for Schizophrenia—because there was no methodology available. Furthermore, we did a pilot study, followed by a randomized controlled trial, to compare the effectiveness of peer support groups with groups receiving care as usual (article in press). Peer support groups should not be confused with self-help groups or self-help therapy in which the mental health professional has a more active role.

The aim of peer support groups for these patients is to share experiences with each other about how to cope with daily life after a psychotic episode. Our group involves 16 sessions of 90 minutes each, conducted once every two weeks. A group consists of about ten patients and one professional. The professional is preferably a nurse, as the intervention appeals most to people with a nursing background. The group sessions are offered as a service for both inpatients and outpatients.

The guided peer support group methodology acknowledges the problems that patients with schizophrenia encounter when they take part in a group session, which are associated with their cognitive and social disabilities. To this end, each session starts with asking the participants to form pairs, and this is followed by a plenary discussion. This procedure enables as many participants as possible to interact with each other, because people with schizophrenia often have difficulty talking in groups.

The presence of a nurse in the group is crucial. In all sessions, the nurse offers structure, continuity, and a sense of security, without actively interfering with the group process; the key point is to provide peer-to-peer interaction. Therefore, each nurse is trained in the guided peer support group methodology.

All sessions are structured in the same way. First, people are encouraged to work in pairs to exchange positive experiences from the previous two weeks (ten minutes). Next, all pairs share with the group the stories they just heard (ten minutes). Then the nurse initiates the general discussion by asking, "What have you just heard that could be of interest for the whole group?" Next, the participants choose the theme of the session (five minutes), briefly introduced by the nurse (two minutes). The themes should relate to the illness, for example: living with schizophrenia, telling others about your illness, or resuming your job. After a 15-minute break, they share their experiences about the theme in pairs (15 minutes), participants reconvene for the final plenary session (25 minutes). At the end, the nurse briefly summarizes the session (eight minutes).

Preliminary analysis of the data from five groups reveals that the participants and nurses evaluated the methodology positively. In their experience, the structure of the sessions supported the patients' participation in the group. Participants judged the presence of a nurse as meaningful and preferred this guidance above peer guidance. Also, they found the biweekly gathering to be convenient and the sessions of sufficient length. The intervention clearly met their expectations, and most of all, they felt supported by other participants. Nurses reported that the structure of the sessions provided participants the opportunity to tell their own story.

The manual sets out in detail the recruitment procedures and logistics and describes the protocol of each meeting. It is available for the cost of duplication and mailing through the first author.

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