Group psychotherapy/guided self help for patients with FNSD awaiting in-patient MDT programme treatment: a pilot study

ABSTRACT

BackgroundThe 4-week in-patient Multi-Disciplinary Team Service at Queen Square for patients with Functional Neurological Symptom Disorder (FNSD) has input from Neuropsychiatrists, Occupational Therapists, Physiotherapists, Cognitive Behavioural Therapists, and specialist nursing staff.The Queen Square Guided Self-Help (QGSH) was developed as a brief therapeutic intervention, which aims to ensure that, prior to admission, the patient understands (a) the diagnosis of FNSD and how their own diagnosis has been reached;(b) rehabilitation therapy, both physical and psychological, and (c) the use of goal setting in rehabilitation.The QGSH is a course of Internet-based guided self-help. It runs for up to 12 weeks and includes original videos and patient worksheets, as well as signposting to existing published resources. It involves therapists guiding the patient to use a range of psychoeducational resources and facilitating therapy activities, supported by one-to-one contact via email or phone-calls.With the emergence of the covid pandemic and the first lockdown (March 2020) plus the growing patient waiting lists, we decided to offer the QGSH (i) remotely via zoom (ii) to groups of patients instead of individuals. This required a complete review of the QGSH goals, format, aims and objectives which resulted in a number of modifications including extensive revisions to the current materials.Aim of this studyWe present a service evaluation of the first 8 months of running QGSH therapy groups remotely on zoom.Results(1) We present the modifications we made to the existing QGSH materials which were finalised in April 2021.(2) In the period 11-May-2021 to 31-Jan-2022 we ran three groups with a total of 16 participants.(3) We present challenges and advantages from the perspective of the patients and from the perspective of the QGSH therapists.(4) Drawing on the published literature (Rogers, Yalom) plus our experiences as senior therapists, we outline the specialist knowledge, skills and competencies required to run a therapeutic group with patients with FNSD.DiscussionFeedback from the patients who participated in the groups was overwhelmingly positive. From the patients’ comments, the group furnished 8/11 of Yalom’s curative factors. We outline our plans for the future development of the QGSH preparatory therapy and a new initiative the development of a ‘stand-alone’ group therapy for patients with FNSD.