The Adult Residential Programme is a 25-bed sub-acute facility with a multi-disciplinary team at the client’s service. Sub-acute treatment is appropriate for clients who are medically stabilized but still require intense treatment for their condition. Papillon is the first psychiatric sub-acute facility in South Africa. Statistically sub-acute treatment over a period of 12 weeks prevents the chances of relapse significantly.
This is a 12 week programme which starts at 7am and ends at 7pm – individuals are placed in the groups relevant to their diagnosis which results in a rapid recovery. Complete diagnostic evaluations are performed, as indicated by individual client needs. The treatment programme routinely offers individual, relevant group therapies. All medication is dispensed centrally.
Family meetings are arranged as appropriate and where necessary family therapy is conducted by our social worker.
This is a two phase programme based on the MC Lean Hospital programme, which is a Harvard Affiliate.
The Three Phase Treatment Programme
When researching how to create a programme that, really works, we made a worldwide search – we discovered MCLean Hospital a Harvard affiliate’s Five Phase Programme. In conjunction with MCLean we developed the programme to suite our integrative and individual approach. The first two phases are the sub-acute phase of treatment, which takes three months. The last three phases focus on reintegration, which takes another three months. We must stress however that clients vary greatly in their development – due to our individual approach we tailor the programme to suite individuals, who sometimes stay for shorter or longer periods of time.
The first phase of treatment involves understanding and stabilising people’s illnesses. At this early stage we help them build therapeutic relationships with staff members, which is essential. Residents are also oriented to their new surroundings.
People with psychotic symptoms often have difficulty establishing a daily routine and following a schedule. Our goal during this second phase is to assess people’s capabilities and engage them in setting goals. The treatment team helps residents develop and work on comprehensive treatment plans.
In this third phase, residents begin to learn more about their symptoms, so they may actively participate in their own recovery. The work of treatment is balanced by a focus on enhancing social skills. In-house psychosocial educational groups, individual meetings with members of the treatment team, and outings in the community, facilitate these goals.
Individual Treatment Plans
Papillon provides individualised treatment plans, which are reviewed by clients and our social worker on a bi-monthly basis. The individual requirements of clients are met with comprehensive planning for during their stay – ranging from, personal therapy goal setting in subacute to assistance with finding employment once clients have begun the re-integration programme.
There is plenty of “canned” treatment on offer to people with mental illnesses worldwide – many forms of one-one therapy to choose from with an array of experts punting one form of treatment however; at Papillon we provide an eclectic approach for the treatment of populations with psychiatric and high functioning autistic disorders.
In conjunction with six to seven hours a day of group therapy; individual therapy is tailored to clients’specific requirements as explained below:
Mentalization the Papillon way…
To encapsulate all the therapies utilised at Papillon; one has to consider the practices of Mentalization, which according to the American Psychiatric Asociation’s (APA) definition in a handbook published 2012: “Refers to our ability to attend to mental sates in ourselves and others as we attempt to understand our own actions and those of others on the basis of intentional mental states.”
“Our individualised therapy therefore focuses on the individual developing an authentic internal mirror into their own behaviours and drives. Once clients are in touch with their inner selves the focus becomes an external reality with constant realistic checking into their inner worlds - this is both an authentic and realistic manner of living life, which is driven by realistic but also impassioned life plans;” says Yolandé Geyser the Founding Director of Papillon Psychiatric Recovery Centre.
1. Cognitive Behavioural Therapy:
Commonly known as CBT this therapy is focussed on moving individuals into a new unexplored reality with the emotional skills to cope with his / her life. CBT can be a very confrontational type of therapy involving “tough love” approach from the therapist. Although some clients are resistant at first to this process when they experience the benefits in a short period of time; clientsusualy become very motivated in the therapy process. As clients build a future based on their present circumstances their future becomes a positive planning experience based on their history of stay at Papillon.
2. Logo Therapy:
According to the Logo Therapy Institute Victor Frankla psychiatrist and Nazi concentration camp survivor isquoted as saying: "We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering" and that "everything can be taken from a man but one thing: the last of the human freedoms—to choose ones attitude in any given set of circumstances."
3. Occupational Therapy:
Occupational therapy is provided one on one to our lower functioning clients who are usually re-integrated into supported living circumstances. Commonly known as OT this is a practical approach to all dimensions of a person’s life such as sleeping or grooming habits. OT is very beneficial to this type of clientele who require the intervention on a bi-weekly basis. Papillon often makes use of a daily OT assistant in certain circumstances.
4. Social Work Interventions:
Besides the comprehensive treatment plans, which are performed by our social worker –a social work intervention can occur three times a week as required by clients. This is both a group and an individual intervention. The individual intervention utilises the tool of journaling as clients keep a daily journal expressing their needs, feelings and progress (or lack thereof). On group level a check –in is performed three times a week by our social worker, which assesses all the dynamics of the group and how the house is operating.
5. Recovery Coaching:
Once clients have reached a phase of treatment whereby they have developed insight into their thinking and behaviour the coaching process begins. This function is undertaken by a coach who has similar life experiences that mirror those of the client. The coach utilises his/her life as a point of reflection for a client to move forward – planning and execution is of the utmost importance to client’s healing at this stage.
6. Personalised Family Therapy:
This is generally a team function at the beginning of the treatment phase whereby the family meets with the core team as a panel and with the clients consent, gains a deeper insight into the client’s life and how their illness has affected individuals around them. Only if required is one on one therapy offered to the family at an additional cost. In general families are encouraged to join support and self-help groups in their demographic.
7. Dual Disorders Treatment:
Many clients diagnosed with psychiatric or emotional disorders battle an equally menacing disease – a substance use disorder. The symptoms of one condition may mask the symptoms of the other or even make them worse. Although everyone can change in certain ways, the greater the psychiatric impairment the more difficulty an individual has in achieving or maintaining sobriety and coping with life’s’ problems. There are several approaches to treating a client with a dual disorder, and so a structured treatment approach that has been individualised is essential.
Group Therapy Plans
Group therapy is a type of psychotherapy that involves one or more therapists working with several people at the same time. Group therapy is integrated into a comprehensive treatment plan that also includes individual therapy and medication. There are different group models in psychology that addressed different - the correct therapy is imperative for clients to heal and take control of their lives.
Types of groups:
1. Task-Orientated Groups:
These groups are specifically designed to address a specific objective. In recent years, the field of psychiatric rehabilitation has shifted from viewing the client as a passive recipient of treatment, to one who is actively involved in the management of his or her illness. Classes include development of relevant life skills, assertiveness training, social skills training and understanding thoughts and emotions. Task orientated group especially works well with individuals suffering from Schizophrenia.
2. Psycho-Education Groups:
In the past 10 years there has been growing interest in psychoeducational interventions delivered as adjuncts to conventional management. As part of their routine care, clients are given accurate information about their diagnosis, treatment and prognosis and about how they can help themselves to stay well. Families are often part of these personalised sessions.
3. Expressive Group Therapies:
Expressive therapy is nonverbal mental health therapy, based on a person's natural expression in art, dance, drama, music, poetry and colour, which reflects internal conflicts and emotional imbalances. These group are especially beneficial for individuals that need guidance in developing insight, coping and socialization skills. The non-threatening nature of these groups makes it suitable to address a variety of difficulties including anxiety, depression and trauma-related problems.
4. Dialectical Behaviour Therapy:
Dialectical behaviour therapy (DBT) treatment is a cognitive-behavioural approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friendship relationships. DBT theory suggests that some people's arousal levels in such situations can increase far more quickly than the average person's, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. These groups focus on enhancing individual's frustration tolerance, interpersonal effectiveness and emotional regulations and works well for individuals with personality and relational difficulties.
5. Equine Assisted Therapy:
This trauma-focused therapy uses a range of techniques for the purpose of dissipating the difficult feelings experienced by the trauma related to having a mental illness and other traumas. We work to change in client's thoughts, beliefs and behaviour. Equine assisted therapy is applied to engage with individuals who have suffered severe trauma and provide the safe space for the individuals to express the emotions that are often suppressed or avoided.
6. Support Groups - twelve- step groups:
A twelve-step programme is a set of guiding principles (accepted by members as "spiritual principles," based on the approved literature), outlining a course of action for recovery from addiction, compulsion, or other behavioural problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism, the Twelve Steps were first published in the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism in 1939. The method was then adapted and became the foundation of other twelve-step programmes. The programme is used to treat addiction and co-dependence.