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April 1, 2008 (Orlando) - For elderly individuals with behavioral health
disorders who are not responding to treatments such as individual therapy
and/or psychopharmacological therapy, a structured outpatient program of
group therapy can "work magic," said Mark Agronin, MD, director of mental
health services at the Miami Jewish Home & Hospital for the Aged, Florida's
largest long-term care facility.

In a talk here at the American Association for Geriatric Psychiatry 21st
Annual Meeting, Dr. Agronin described his center's "New Beginnings" program
and presented the case of Frieda, who went from treatment failure to rapid

Frieda was an 84-year-old woman who had survived exile in Siberia and who
remained depressed and preoccupied with somatic ailments despite treatment.
She was highly intelligent and insisted that she was not depressed, although
her only joy seemed to be singing in the choir in her assisted-living

At a time when Frieda had "worn out" her latest therapist, an opportunity
presented, said Dr. Agronin. The clinic had just started the "New
Beginnings" program, a daily, structured, 6- to 8-week group therapy program
for patients with psychiatric disorders such as mood disorders who showed a
lack of improvement with other modalities but who were medically stable and
able to participate in group discussions.

The program comprises 2 daily 50-minute back-to-back group therapy sessions
separated by a 10-minute refreshment break, said Dr. Agronin.

"I tried to convince Frieda to come into the group, and it took a while," he
said. The group leader, "part cheerleader, part drill sergeant," had to go
in and help Frieda dress to get her to the program the first week, but in
the second week, things began to change. "The group members loved Frieda,
because she challenged all the labels that we gave them - being older, being
depressed, being nervous," said Dr. Agronin. The others rallied around her,
and Frieda "was a star." She was smiling, her clothes were brighter, and she
showed up early.

Dr. Agronin described a dramatic incident that happened 1 day in the
following week. Frieda interrupted a discussion about depression and anxiety
by saying: "Enough talk about this. Let's sing." She grabbed the hands of
the 2 women on either side and began belting out the song "Hava Nagila,"
which literally means "let's rejoice." Within seconds, she was surrounded by
a group of women, all with their arms raised, singing together with joy on
their faces. The song ended, and Frieda thanked everyone and strode out of
the group.

"That was the last day that she ever came to the group, but in the months
thereafter, there was a change in her. She was more engaged in activities
and seemed a lot happier, more content," he said.

"I realized that what we had accomplished in the group was something that we
were not able to accomplish in any other setting. It came down to Frieda
really feeling cared for and feeling loved in this group and getting
positive attention not for being depressed but for being a caring, strong
person," said Dr. Agronin.

"Sometimes things happen in a group in a very magical way that is very
difficult to achieve in individual therapy and with medication," he

A Chance to Be Altruistic

Doing group therapy with the elderly has challenges that make it very
different from working with younger individuals, Dr. Agronin noted. For
example, the material that is presented or discussed in the group has to
take into account the fact that most elderly individuals have some physical
and cognitive disabilities. The location needs to be able to accommodate
wheelchairs. The participants might need help with transportation. A
refreshment break during the group therapy session is important because of
hydration and nutrition issues in the elderly.

Group therapy for older adults can, however, offer several distinct
advantages over individual therapy. These include the opportunity for
structured socialization with peers, sharing age-related problems with
others, and a chance to give and receive feedback and positive
reinforcement. "It also gives individuals an opportunity to be altruistic -
to give of themselves to other people - and I think that is one of the most
transforming aspects of it," he said.

Group therapy using this type of structured, psychoeducational approach
provides a comfortable and nonthreatening environment and provides practical
information and strategies. The program is also designed to provide mentally
stimulating exercises for individuals with mild cognitive impairment and
apathy, which are common in geriatric patients, he noted.

American Association for Geriatric Psychiatry. 21st Annual Meeting:
Innovative Research in Cross-Cultural Geropsychiatry. Presented March 15,


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