OUTAPATIENTS' DEPARTMENT

OUTPATIENTS' DEPARTMENT

THE OUTPATIENT CENTRE OF THERAPY AND REHABILITATION OF PSYCHOSES
performs a key function in our system as it assures the continuity and stability of the relation with one therapist. It provides a longstanding individual programme that is adapted to the patient’s needs and the stage of his/her therapy.

	INDIVIDUAL CONTACT
	DISCUSSION GROUP
	ART THERAPY GROUP
	PSYCHODRAMA GROUP
	PSYCHOTHERAPEUTIC WOMEN'S GROUP
	EDITORIAL GROUP
	RELIGION & PRAYER GROUP
	DANCE GROUP
	THEATRE GROUP
	STUDY OF FOREIN LANGUAGES

INDWIDUAL CONTACT

Individual psychotherapy forms the basis of the treatment of mentally disordered patients. In our system the relation between the patient and therapist is the vital element of the treatment. If this relation is formed and if it is perceived by both parties as beneficial, it influences the whole course of the treatment and its results. Therefore each patient has the same therapist from the moment of his/her admission to the inpatient ward. When the patient leaves the ward, individual psychotherapy is continued by the same therapist in the outpatient ward, often for many years. So for the patient, the therapist is the person who integrates all the treatment: pharmacotherapy, individual psychotherapy and possibly family therapy, the rehabilitation programme, etc. In our health care system the function of the therapist may be performed by a doctor, psychologist or nurse. When individual psychotherapy is provided by, for instance, a psychologist, then the patient is referred to a doctor for his/her pharmacotherapy. Most frequently individual psychotherapy is of the supportive kind, less frequently of the explorative kind. The choice depends on the stage of the illness and the overall treatment as well as on the needs and capabilities of the patient. At the moment the outpatient care embraces 700 patients from Kraków and its neighbourhood.

DISCUSSION GROUP

The discussion group holds its meetings every Wednesday at 4 p.m. It is a semi-open group, supervised by two therapists. It has functioned for fifteen years. The number of participants is between 8 and 10. Their common experience is that of mental illness. The similarity of experience allows to reduce the fear of intolerance and rejection and to reduce the sense of isolation from the world, caused by the difference of one’s experience. It also enables the patients to share practical, tried solutions of the problems that arise as a result of the illness, hospitalisation and treatment.
The discussion topics are suggested by the participants. Often they are related to their current individual problems, conflicts and plans. They may signify a return to the experiences of the illness, an attempt to order and understand them and to find out how to cope with recurring or never completely disappearing symptoms.
The participation in the discussion group is an opportunity to get to know oneself better, to manage the illness in a better way, to develop essential skills such as the ability to listen, to speak about oneself and to observe the emotional states of others.

ART THERAPY GROUP

The art therapy group works in an arts studio. The Miodowa studio (Pracownia Miodowa), which co-operates with the Adult Psychiatry Clinic, was established in the summer of 1996 by the patients participating in art therapy, who have been working together for eight years. The group includes fifteen people for whom art is of utmost importance: it gives them strength and a sense of significance, it opens up new spaces. They work together once a week in a specially furnished studio. They use various art techniques and talk about their sensitivity in the language of art.
The workshops are led by the painter Małgorzata Bundzewicz, a graduate of the Academy of Fine Arts in Kraków. The participants learn new techniques in painting and graphic arts. They work in an academic-style studio, use high-quality materials, brushes and paper. They paint landscapes, portraits, still lifes, and make sketches, that is, they do whatever shapes their imagination. The works are on display in the patients’ art gallery "Miodowa Gallery"(Galeria Miodowa), which exhibits also the works of professional artists both from Poland and abroad. The patients show their works also in other galleries in Kraków, such as the Goethe Institute gallery, the Nuremberg House (Dom Norymberski) gallery, the Inkwizytor gallery.
Thanks to a small publishing house (Mini Oficyna Miodowa) that functions at the studio we intend to publish a professional catalogue of the patients’ works of art.

GALLERY

MIODOWA

PSYCHODRAMA GROUP

This outpatient group which functions on the basis of the Moreno psychodrama meets twice a week for one or two years. It is a closed group, supervised by two therapists who received certificates of the Moreno psychodrama assistants in the Institute of Psychodrama for Europe (PIFE). The group consists of 8-12 patients diagnosed with schizophrenia, schizoaffective psychosis or personality disorders.
The patients are invited to participate in this group when the acute symptoms remit, when they have at least a partial insight in their psychotic experiences and some recognition of their emotional problems, and when their cognitive functioning is efficient (no dysmnesia or concentration disorders). The requirements for participation in this group are relatively high, but it must be stressed that it is only one of the groups in the broad offer of our outpatient care, which includes other, less demanding ones. It seems that for the patients who need deeper, more explorative therapy it is an acceptable and effective offer. The patient should participate in the meetings for at least one or two years. The objectives of this kind of therapy are to broaden the repertoire of social roles, to facilitate self-expression, to reinforce the patient’s identity.
Classically, psychodrama uses the techniques of swapping the roles, mirroring and doubling. The difficulties which accompany the introduction of these techniques in a group that includes post-psychotic patients are periodical lack of concentration, increased fatigability, ‘forgetting the role’. The task of the leader is to assure that the meeting should have a clear, perceptible structure and to work more closely with a resistant group or its particular members.
The observed therapeutic effects in those participating in the meetings of this group are:

more insight in one’s feelings and emotional conflicts;
increased motivation to co-operate during treatment;
reduction of negative symptoms;
attempts to transfer the corrective experiences from the group to one’s own life.

An important element of psychodrama is to allow for improvisation so as to release the patient’s spontaneity.

PSYCHOTHERAPEUTIC WOMEN’S GROUP
This group meets once a week (Mondays, 6 p.m.- 8 p.m.) and functions at the Adult Psychiatry Clinic, Collegium Medicum, Jagiellonian University, the outpatient ward at plac Sikorskiego 2/8. It has been active since 2 October 2000. It is a discussion group with some elements of the Moreno psychodrama introduced. At present it is an open group. In the future it may be transformed into a closed group, with a strictly defined period of activity.
The group was established especially for women who underwent psychosis, mothers of small children (aged one month to 15 years). In the future the group may embrace also those women who have no children and who adopted other social roles. The objective of this kind of therapy is to solve the following problems:

problems connected with the role of mother;
problems with bringing up children and educating them;
emotional problems connected with the relation between mother and child;
problems connected with the relation between mother and father and with the role of wife;
problems connected with the adoption (or non-adoption) of the role of a mental patient;
integration of all the adopted roles (woman, lover, wife, mother, etc.).

The group is supervised by a woman therapist certified by the Polish Psychiatric Association and the European Institute of Moreno Psychodrama.

EDITORIAL GROUP The editorial group "For Us" is one of many outpatient groups at the Outpatient Ward, Adult Psychiatry Clinic, Collegium Medicum, Jagiellonian University in Kraków. It includes people who underwent various psychic crises and who are willing and able to present on paper their thoughts, feelings and experiences connected either with general interest topics or the ones closely related to the problem of mental illness. Writing poems, essays and short stories allows them to shape a literary image of their sensitivity and to open themselves, literally and metaphorically, to the other man – one of the many potential readers.
The group is therapeutic in character because it joins the elements of autotherapy and group therapy with the expansion of one's creativity. Regular meetings of the editorial group provide an opportunity to exchange views as expressed through literature, poetry and art. During the meetings the participants present their own work and discuss it. Leaving their loneliness behind, they can be open before their listeners and they also wait for critical remarks, because any author’s work is subject to critical assessment.
The name "For Us" might suggest that the published pieces are targeted at a rather small circle of readers, that is people with psychic problems, but this interpretation is not appropriate. A nervous crisis broadens man’s experience. The poets and writers from the editorial group are not professional men of letters, but because of the special nature of their experience connected with mental illness they do not avoid topics such as fear, suffering, loneliness. They also write about love, the lack of it and the longing for it. Of course the first readers of their work are people of a similar background, that is those who have suffered or are suffering from mental illnesses. But these artists help to bridge the gap between their small circle and a broader group of readers as they do not want to write only "for us" or "for you", but for everybody. The editorial group issues the magazine entitled For Us, in which articles, essays, poems, short stories, sketches and drawings are published.

FOR YOU

ABOUT US

RELIGION AND PRAYER GROUP

It is one of the outpatient groups at the Adult Psychiatry Clinic, Collegium Medicum, Jagiellonian University, the outpatient ward at plac Sikorskiego 2/8. The meetings are held every Tuesday at 5 p.m. and last for 1-1.5 hours. It is an open group which admits both believers and non-believers. The meetings are conducted by a therapist and a priest. The number of participants oscillates between 6 and 12. Their common experience is that of mental illness. The illness often involves religion-based delusions. The participation in the group is considered an element of the treatment, therefore it is decided upon chiefly by the patient’s individual therapist. The topic of the meeting is the text of the Gospel that was read in church on the preceding Sunday. The meeting starts with prayer, then the biblical text is read and discussed. The participants share their reflections, experiences and doubts, and they also try to find out how the excerpt is relevant for their own situation and illness. Each of the participants is encouraged to contribute to the meeting, to speak up and to view his/her mental illness in the biblical context. The patients (a group of frequent participants) are glad come to the meetings. For some of them they provide psychotherapy, for others it is a support group, a social gathering, etc. The meetings close with prayer again, during which particular participants express their wishes and give their thanks, while the priest gives them his benediction.

DANCE GROUP
Outpatient dancing group Amerta Movement

Amerta Movement is based on movement, analysis of sensations connected with the body and reception of sensations from the outside world. The objective of this kind of therapy is to integrate the internal with the external, to achieve harmony within oneself. The examples of specific exercises present the character of movement therapy.
That special kind of choreotherapy is offered to an outpatient group of schizophrenics within the Kraków programme of comprehensive treatment and rehabilitation of schizophrenia. The group has functioned since 1996 and consists, on the average, of 12 people, both men and women. It is a semi-open group.

Dynamics of the meetings.

Each meeting begins with a warm-up and is based on repeated bioenergetic exercises. Through deep breathing and stretching particular parts of the body one can become relaxed and more aware of the body. The achieved state of deep relaxation allows to find time and space in the way we move.
Then the technique of working with the body is selected, which is connected with what happens in the group. After several meetings, the instructor can structure sessions more precisely, suggests exercises and leads the discussion of meetings.
The discussion is always conducted by the leader and takes place after each technique exercise during the meeting. The concentration on the movement and on the ways in which it is experienced is allowed by the movement itself and by reflection.

*** Group activities help to face individual emotional problems and they also help to focus on interpersonal communication. They show how we respond to other people. The experience in applying this technique, now over three years long, proves its usefulness in the treatment and rehabilitation of patients with the dominating negative syndrome. It must be underlined that it brings several benefits to the patients, such as the improvement of concentration, a better recognition of one’s feelings and an increased ability to reflect on them. It seems that it is significant that the patients learn also about relaxation techniques.

AMERTA:EXERCICES ~CHOREOTHERAPY

THEATRE GROUP "PSYCHE"
[DRAMATHERAPY GROUP] Outpatient group of dramatherapy - which exist since autumn 1984 is dedicated to people who lived through a psychotic crises.
The group is conducted by a therapeutic tandem: professional theatre director Krzysztof Rogoż and psychologist Anna Bielańska who during several years directly participated in the group activities and at present acts as a supervisor not always present during activities of the group.
There are always one or two supporting therapists who participate in the group activities playing together with patients.
In average the group counts 12 to 15 people. Its composition changes. Every season certain number of participants, who have achieved their therapeutic goals, leaves the group to give place for the newcomers. This usually coincides with the beginning of the project which depending on the degree of difficulties takes 10 to 20 months.
The group meets once a week for two hour rehearsals. The dramatic material, chosen because of its therapeutic values, is characterised either by complexity of characters and conflicts (Shakespeare) or archetype situations (classical Greek theatre).

THEATRE		PSYCHE

STUDY OF FOREIN LANGUAGES

REFERENCES

OCCUPATIONAL THERAPY WORKSHOPS	DAY CENTER [REHABILITATION]	p."HOTEL"RESEARCH	DAY CENTER [TREATMENT]	OUTPATIENTS' DEPT
SHELTERED WORK PLACES	MAGAZINE "DLA NAS"		THERAPEUTIC CAMPS	FAMILY UNIT
OPEN THE DOORS	ASSOCIATIONS	THE TEAM H O S T E L	GALLERY "MIODOWA"	THEATRE "PSYCHE"