Adolescent Group Work in a Hospital In-Patient Setting with Spina Bifida Patients and Others

This paper describes a group which took place over a four year period on an eight-bedded adolescent surgical ward in a small children's hospital. The patients comprised mainly severely disabled adolescents, with conditions such as spina bifida, hydrocephalus and nephrotic syndrome, a number with complex orthopaedic problems who were less disabled, some with primary enuresis and encopresis, some general accident and emergency cases, a few psychiatric admissions and a number for specialist dental care. The age range was from thirteen to eighteen years, though many of the spina bifida patients were older, some as old as twenty three. The ward was served by a number of consultants to cover the different specialisms involved. There was a ward sister, three or four qualified nurses, and a large turnover of nurses in training and junior medical staff. A number of other professional and ancillary staff had contact with the ward. The ward had a diffuse set of systems of responsibility and power, and generally it fell to the ward sister to provide some cohesion.

A weekly group for the patients had been started three years before by the Consultant Child Psychiatrist as a response to increasing demand from ward staff for emotional help (not necessarily psychiatric intervention) for adolescents on the ward. It was initially formed then as a response to the presented multivariety of individual patients’ needs. Lead usually by a child psychiatrist and a teacher, the aim was to encourage the patients to express their feelings in the group and appreciate together common concerns. New staff extended the aim to include offering patients help to gain more psychological understanding of their medical conditions. I was asked to take over the group as a complex going concern with the same teacher who had been there all along when the child psychiatrist left for another post.

The ward group met weekly at a specified early afternoon time and it lasted an hour. We spent about