By Marc Sage

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As time passed, a trend consolidated toward more directive group therapy models. Thus, Kripke and Robinson (1985), for example, based their group therapy on problem-solving strategies and checked plasma lithium levels to ensure drug adherence. The relapse rate and social adjustment improved. In 1986, Foelker et al. designed the first psychotherapeutic program for elderly bipolar patients from an integration of traditional therapeutic approaches and psychoeducation, monitoring of lithium levels, and case management.

For us it is important to mention this explicitly to our patients, both in the initial interview as well as in the first group session. That way we do not create any false expectations or generate unfounded fears. Both of these things, expectations and fears, are very common when the psychiatrist invites the patient to participate in “group therapy,” because most of our patients imagine that they are going to be enrolled in some spectacular, dynamic-oriented group where the dramatization of their emotions will take place, or in some type of humanistic group that has cathartic purposes and tendency toward multiple hugs.

We know that there is a wide variety of logistical limitations, from not having an appropriate room for the treatment to not having trained psychologists, as well as the problem of adherence with the group’s schedules by many patients. Such difficulties as these can prevent the incorporation of this program into the normal clinical practice. In any case, it would be possible to work with reduced psychoeducation programs, although it is still yet to be shown that they can achieve an effectiveness similar to a program of 21 sessions.

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