CRISE - IASP 2013 - Maude Léonard & Virginie Hamel

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THE EXPERIENCE OF A GROUP THERAPY PROGRAM FOR ADOLESCENT SUICIDE SURVIVORS: WHAT WORKS

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CRISE - IASP 2013 - Maude Léonard & Virginie Hamel

  1. 1. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO THE EXPERIENCE OF A GROUP THERAPY PROGRAM FOR ADOLESCENT SUICIDE SURVIVORS: WHAT WORKS? Maude Léonard, M.Ps., Ph.D. candidate, CRISE, UQÀM Virginie Hamel, M.Ps., RRS du CSSS de Laval, CRISE 27/09/2013 1
  2. 2. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Presentation outline 27/09/2013 2 • Adolescent suicide survivors • Group therapy program for adolescent suicide survivors in Quebec, Canada • Evaluation research :Goals and design • What works? Main results • Overall program satisfaction
  3. 3. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO 27/09/2013 3 Family history of mental illness and suicide Socio-cultural environment Family environment Adolescent characteristics: development stages (cognitive, emotional, physical) Suicidal significant other characteristics Relationship characteristics Significant other’s suicide Changes in family environment Impacts on the adolescent: Depression symptoms At-risk behaviors Suicidal ideations and behaviors Post-traumatic stress disorder Feelings of guilt Isolation Decrease of self-esteem Loss of meaning Feelings of rejection and abandonment Extreme dependance or autonomy Belief disruption Shame Academic difficulties Feeling angry, rebellion Impacts on other family members Changes in family roles Grieving process: DPM of coping - Oscillation between loss oriented coping and restoration oriented coping Adolescent suicide survivors
  4. 4. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Group therapy program for adolescent suicide survivors MAIN GOAL To bring together adolescents suicide survivors aged between 13 to 18 years old OBJECTIVES ① To normalize grief reactions ② To break isolation ③ To increase adolescents’ social support networks and tools ④ To increase adolescents’ feelings of control ⑤ To allow the expression of distress ⑥ To better understand grief reactions in the context of a suicide ⑦ To reject suicide as a solution to distress 27/09/2013 4 Created by Virginie Hamel, M.Ps. for the «Ressource Régionale Suicide Laval du CSSS de Laval»
  5. 5. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Structure of the group therapy • Designed for 6 to 7 adolescents • Facilitated by 2 experienced psychotherapists • Psychoeducative and cognitivo-behavioral approaches • 12-Week sessions – 1-2 Getting to know each other and the person they lost by suicide – 3-4 Better understanding the grieving process in the context of suicide – 6 Exploring the relationship between the adolescent and the deceased – 7 Normalizing feelings of anger, guilt and shame – 8 Exploring problem resolution techniques – 9-10 Explore feelings of responsability for the suicide and secondary loss – 11 Saying goodbye to the person we lost – 12 Identifying the social support networks 27/09/2013 5
  6. 6. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Evaluation Research: Main goals and design ① To measure changes between pre-test and post-test ① Depression symptoms ② Problem solving skills ③ Coping strategies ④ Grief reactions ⑤ Perception of social provisions ② To evaluate subject’s perception about individual and collective goal attainment Mixed method design – Descriptive and content analysis ① Observation - two groups in different organizations ② 29 subjects (adolescents, parents, psychotherapists, key informants) – interviews and standardized questionnaire 27/09/2013 6
  7. 7. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO What works? I • The program helps reduce depression symptoms – Significant mean score diminution on the Beck Hopelessness scale PreT (M = 2,6 ; SD = 1,14) - PostT (M = 1 ; SD = 1), t(4) = 3,14, p = 0,04, d = 0,71 – Changes in the way sadness is manifested « That’s right. You tell yourself: I cry and it’s ok. And then you cry not for anything, but when it’s really appropriate » (Translated transcript – Poulet – 2nd interview) – Positive effects on self-esteem and confidence « She realized durind the activity that she was gaining in confidence » (Translated transcript – Charlotte – Clinical file ) 27/09/2013 7
  8. 8. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO What works? II • The program helps reduce depression symptoms – Significant mean score diminution on the Beck Depression Inventory (when controlled for extreme score) PreT (M = 14,8 ; SD = 6,46) - PostT (M = 6,6 ; SD = 5,77), t(4) = 8,95, p = 0,001, d = 0,95 27/09/2013 8
  9. 9. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO What works? III • The program helps reduce feelings of shame – Significant mean score diminution on the shame subscale of the Grief Experience Questionnaire PreT (M = 12,8 ; ÉT = 2,75) - PostT (M = 9,25 ; ÉT = 2,63), t(3) = 4,04, p = 0,03, d = 0,89 – Expressed by feelings of relief about not being alone « I got to know new people who were saying the same stuff. I was feeling so alone in this world and I’m not alone anymore. There are plenty of people in the same situation. » (Translated transcript – Melz – 2nd interview) – Linked with diminution of guilt feelings « He remembers that their fathers’ death was not their fault. » (Translated transcript – BSA – Clinical file) « Before, I felt maybe a little bit more guilty, that’s fo sure. It’s often the maximum guilt in the beginning. But, no, now it really changed for: I’m not responsible for this » (Translated transcript – Poulet – 2nd interview) 27/09/2013 9
  10. 10. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Overall satisfaction • In general, the program was a satisfactory experience for all respondents • Adolescents: – Find the activities to be relevant and helpful – Prefer interactive activities and pictural models of grief (instead of pure theoretical informations) – Really liked their group facilitators • Parents: – Have trust in the group facilitators – Are glad their child was able to participate in the program • Facilitators: – Rated their overall group experience from 7/10 to 9.5/10 27/09/2013 10
  11. 11. Maude Léonard, M.Ps. Centre for Research and Intervention on Suicide and Euthanasia IASP - OSLO Thank you Get my presentation at http://www.crise.ca/fr/iasp2013.asp For more information leonard.maude@uqam.ca 27/09/2013 11

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