Multidisciplinary intervention, offered in a collaborative approach with the young person and their loved ones, aims first to stabilize symptoms and the person's life situation, including problems related to housing, social relationships, income, and so on. Gradually, the intervention then aims to increase the young person's autonomy by reintegrating them into a social role that is meaningful to them. To achieve this, activities in the community and in the young person's social environment are favoured. Young adults also receive support to help them return to school or work as quickly as possible. In addition to medication, the individualized treatment plan for each patient and their family combines the following:

• Individual follow-up with a psychiatrist and a mental health professional;
• Supportive and/or cognitive-behavioural psychotherapy (CBT); and
• Participation in therapeutic groups.

The objectives of the therapeutic groups are to help people adapt to the psychotic episode by developing social and functional skills, gaining a better understanding of themselves, working toward life goals, and increasing personal autonomy. Group approaches are favoured because they have a great deal to offer through the strength of the peer group, shared experience, and breaking isolation.

Counselling and psychological therapy, that is, having a clinician to talk to about the situation, is an important part of treatment. The type of discussion and the frequency of meetings may vary to better suit the patient and the phase of their illness. For example, someone with acute symptoms may simply want someone to reassure them that they are recovering well. Later, once the episode of psychosis has resolved, the person may want to talk about managing stress, preventing relapse, recognizing early warning signs, or returning to school or work.

Each patient receives intensive services from a case manager, usually an occupational therapist or social worker, and a psychiatrist for follow-up lasting 2 to 5 years. They are then referred to other services according to their needs, such as a family physician or adult mental health services. As soon as possible, the young person's life plan is reviewed with them in psychological sessions, to help them develop the skills needed to pursue it or to reassess it if necessary.

At the start of treatment at Clinique JAP, each young patient has one or two individual meetings a week. That frequency then gradually decreases to about once every two weeks, and rarely less often than once a month. They also have access to weekly therapy groups based on their goals:

Interventions take into account the delicate balance between the family and community support needed for the young person's recovery, and the importance of encouraging separation/individuation and the development of their autonomy. The philosophy at the heart of treatment is to see this young adult or adolescent as someone with life plans and potential who must adapt to an illness they need to learn to better “master,” rather than as a “vulnerable sick young person” who must be shielded from life's stresses. This view allows the young person to cultivate hope and reach their full potential while taking their limitations into account.

CBT helps the person better understand what is happening and make sense of this event in the course of their life. It also aims to identify why this event is happening at this particular stage of their life, and strategies to adapt to it or to the stress they are experiencing.  It also highlights the individual's strengths and protective factors as well as their vulnerability factors.  It helps the person see the link between external events, their emotions and their thoughts, and to “rectify” certain ways of thinking that cause distress or difficulties in functioning.

Cognitive behavioural therapy for psychosis has the following three objectives:

• reduce distress and problems with functioning associated with psychotic symptoms,
• reduce anxiety reactions and improve how they manage their emotions, and
• promote the person's active participation in managing their risk of relapse.

Cognitive behavioural therapy is tailored to the needs of each individual and to the phase of their illness. The different stages are guided by a formulation of each person's problems.   The number of sessions, the duration, and the time required for therapy will depend on the complexity and severity of the problems presented, as well as on each person's degree of involvement. Typically, therapy lasts six months, with sessions once a week.

COGNITIVE BEHAVIOURAL THERAPY FOR DELUSIONS AND HALLUCINATIONS

Cognitive therapy focuses specifically on delusions, paranoid interpretations, and beliefs about voices. Depending on each individual's desire to consider alternative explanations for the nature of such experiences, the therapist may offer more scientific explanations or work with each person's beliefs. It can also help to rename the experiences and put the situation in perspective, as it is often tied to very intense emotions for the patient.

WORKING ON COGNITIVE PROBLEMS ABOUT THE SELF AND OTHERS

Cognitive therapy for psychosis aims to address problems in how people think about themselves and others. The kinds of thoughts typically addressed are those that imply the patient has no worth, is bad or dangerous, or that others are essentially untrustworthy or likely to harm them.

Every component of the group program is seen as part of a continuum of recovery and of taking up a social role again. Groups are offered from the beginning of acute-phase treatment (whether inpatient or outpatient). Different skills are drawn on and practised:

• Punctuality,
• Attendance,
• Effort tolerance,
• Developing social skills linked to taking up a social role again (for example work, school, friendships),
• Building a daily routine, and
• Schedule management.

GROUP INTERVENTION

Groups are chosen according to each young person's needs and progress. Typically, young people take part in group interventions during the first weeks of treatment. The program then allows them to rejoin groups temporarily if symptoms return or if social or vocational functioning declines. The groups also aim to strengthen insight into mental health and into the demands and skills involved in returning to daily activities, work, or school. The groups draw on the strength of peers to foster motivation, hope, sharing, and insight.

GENERAL OBJECTIVES OF THE JAP GROUPS

• Meet other young people and encourage communication,
• Resume a routine and stay regularly engaged by taking part in structured activities,
• Improve punctuality and attendance; honour commitments by attending scheduled group sessions,
• Build comfort in group situations: feel more at ease around other people,
• Build frustration tolerance: improve how you react or think in difficult situations (with peers, therapists, or while doing an activity), and
• Improve social skills: initiate contact, share, express an opinion or experience, listen when someone else is speaking, and so on.

GROUP INTERVENTION BY TELECONSULTATION

Clinique JAP now offers group interventions by teleconsultation. If you have been invited to take part in a virtual group, please consult the following guides, available for download (PDF):

• Virtual Zoom Groups - Clinique JAP CHUM - Participant's Guide (Abbreviated)
• Virtual Groups on Zoom - Clinique JAP CHUM - Participant's Guide

A Facilitator's Guide for Virtual Groups on Zoom is also available for download by clicking here.

Some groups run on an ongoing basis and can be joined at any point in the person's course, depending on needs.

When you want to return to work, while you are looking for a job, or when you start working, many unforeseen difficulties can arise.

The objectives of this group are:

• Help you develop skills to understand and better manage these challenges, with the goal of having a positive work experience,
• Discover new tools and strengthen personal skills to better cope with stressful situations or psychotic symptoms.

Individual sessions or a group program can be offered to help these young people find strategies tailored to their needs.

Goal: to offer an out-of-the-ordinary experience in a natural therapeutic setting, through an outdoor activity held off the Island of Montreal in a nature park.

• Have a positive and rewarding experience,
• Encourage commitment to a project and seeing it through,
• Promote adherence to the treatment offered at Clinique JAP,
• Build better self-esteem and develop a sense of accomplishment,
• Develop their problem-solving skills, and
• Improve their social and interpersonal skills in a group.

The activity includes outing-planning and discussion groups as well as outdoor sports groups.

Click here for all the details or talk to your clinician.

The philosophy at the heart of treatment is to see this young adult or adolescent as someone with life plans and potential who must adapt to an illness they need to learn to “master,” rather than as a “vulnerable sick young person” who should be shielded from life's stresses because of a chronic disability. This view allows the young person to cultivate hope and reach their full potential while taking their limitations into account.

Here are examples of strategies used to support a prompt but gradual return to work:

1. Temporary change in the type of task and/or part-time work,
2. A less demanding job than the usual or previous one,
3. Vocational training (short-term at first),
4. A part-time return to school first (depending on the young person's profile), and
5. A change of direction if needed (if the former field causes too much stress).

Despite myths on this subject, early in the illness it is not advisable to “declare” a young person unfit for work for a long period without first trying, at the right time, a gradual return to a work, training, or school plan suited to their abilities and limits. Doing so avoids undermining the hope and motivation needed to realize each person's potential.

Starting a new job can be stressful, and too much stress is a risk factor for psychotic relapse. That is why it is important to keep a few tips and pieces of advice in mind in order to stay balanced.

Nearly half of young people who have a first psychotic episode are able to return to work or school after three months. Even if it takes time, it is realistic to expect to eventually return to the same life plan, or a similar one, and to live a rewarding, independent life despite psychosis.

To make the return to work and/or school easier, a great deal of flexibility and ongoing support is offered, including:

• Job-search support (help with a CV, search strategies, one-to-one support, interview practice, and so on),
• Meetings outside of regular working hours,
• Adjusting how often appointments take place to take the job and the young person's progress into account—for example more often in a crisis, then less often later to avoid schedule conflicts,
• Telephone follow-up, either by appointment or according to the young person's needs,
• Partnership with Arrimage, an organization that helps with job placement and job retention,
• Partnership with integration resources or the employer if the young person wishes,
• Discussions with the case manager and the employer,
• Adaptation of tasks or pace to facilitate integration, if necessary, and
• Better matching between employer/integration program and employee.