Impact and implications
Introduction
The therapeutic patient education program
Program construction and implementation
Program progress
Description of the program sessions
Session and duration | Theme covered | Objectives |
---|---|---|
Session 1, 2 h | Collective educational diagnosis | Create a safe and caring environment Cocreate rules of operation Specify the modalities of a TPE program Define and share the priority themes to be explored according to the participants' needs |
Session 2, 2 h | Bipolar disorders | Define bipolar disorders Understand the risk factors |
Session 3, 2 h | Symptomatology, risk factors and protective factors | Identify risk factors and protective factors Identify symptomatology Understand how to prevent suicidal risk |
Session 4, 2 h | Treatments | Deepen knowledge of drug and nondrug treatments |
Session 5, 2 h | Taking care of oneself | Learn to take care of one’s mental health Develop coping skills Identify activities and determinants that promote mental health |
Session 6, 2 h | Preventing relapse | Identify the prodromes Increase awareness of the joint crisis plan |
Session 7, 2 h | Preparing for the session with family and friends | Define the topics to be covered according to the needs of the participants in session 8 |
Session 8, 3 h | Session with loved ones | Determine the topics to be discussed Talk about the disease with family and friends Define joint actions to prevent relapses |
Session 9, 2 h | Debriefing session | Evaluate participation in the program |
Consolidation session at 3 months, 2 h | Consolidation session | Consolidate participants' skills and knowledge |
Method
Type of research
Study population
Mode of collection
Method of analysis
Ethical considerations
Results
Simple description of sociodemographic data
Discourse analysis
Dimensions | Themes | Subthemes |
---|---|---|
Facilitators' experiences of TPE sessions | Climate of security | Feeling confident |
Allowing oneself to be | ||
Sense of freedom | ||
Caring | ||
Connecting participants | ||
Belonging to a group | Belonging to a team of facilitators of TPE sessions | |
Belonging to "something I believe in” | ||
Experience sharing | Peers: sharing their experience | |
Caregivers: contributing to experience sharing | ||
Enjoyment of facilitation | ||
Being a TPE facilitator | An expert | Expert by experience |
Medical expert | ||
Peer helpers | A bearer of hope | |
A benchmark | ||
Guarantor of the TPE framework | ||
Horizontal relationship | Natural posture | |
“Equal to equal” | ||
Participate in exchanges, self-disclosure | ||
Listening position | ||
Educational posture | ||
The role of TPE sessions | Contribution of knowledge | Learning from experience |
Learning space for caregivers | ||
Promoting empowerment | Giving freedom | |
Giving autonomy | ||
Self-normativity Destigmatisation | Self-awareness | |
Building recovery on one's own standards | ||
The changes perceived by the FG participants in patients who have used the TPE program | Appeasement | Through destigmatization |
Awareness of a common experience | ||
Openness | To one’s peers | |
To one’s loved ones | ||
To the breaking down of taboos | ||
To psychiatrists | ||
Identification | With other participants | |
With the peer helper | ||
Quality of life | ||
First stage of re-engagement | Sense of self-efficacy | |
Self-esteem | ||
Grief |
Facilitators' experiences of TPE sessions
"It is my desire to facilitate a climate of authenticity and listening in the group" (EPH, female, 33).
"It reminds me of what a patient said at one point, as if it was very surprising. He said, 'It's incredible here they listen to us,' as if in a psychiatric hospital, you can't be listened to. He couldn't believe it. It was quite spectacular to hear this come from his own mouth" (VPH, male, 66 years old).
"To have an identity that is my own, that can be different from others" (EPH, female, 45 years old). One facilitator mentioned the desire to "create this space where (…) he feeds both the feeling of freedom and the need for relationship" (PP, female, 32 years old).
"A good atmosphere and to make sure that there is a link between people, that there is exchange, and that people can have moments of listening with their peers that they don't necessarily have outside the sessions, of support in fact from others, to develop a feeling of belonging, to live better with it afterward" (N, female, 44 years old).
"which is quite present in TPE and which is good for the group and good for ourselves" (PI, male, 29 years old).
"There is something benevolent in the group in general, which makes me feel good" (N, female, 42 years old).
"It is first of all that we are in a group, that the patients I meet in another context than the crisis" (N, female, 42 years old); "to be part of this adventure, which is something I believe in, which is everything that is mutual aid groups" (VPH, female, 45 years old).
"One of my motivations for participating is already to find people from the service; being able to lead the groups is always a pleasure for me" (PI, male, 29 years old).
"The idea that they are in a group, that they share with their peers… The sharing of experiences seems to me to be very rich" (PP, female, 32 years old).
"There is this sharing between peers, which is very important. It is very interesting because it leaves room for knowledge through experience" (PP, female, 32 years old).
"these TPE groups allow for an exchange between participants and an awareness of certain symptoms or disorders" (PI, male, 29 years old) and adding that "there is also the fact that exchanging between peers allows some people to get out of the denial in which they are to varying degrees" (VPH, male, 66 years old).
"It feels good in general. After a TPE session, I feel good" (PI, male, 29 years old).
Being a facilitator of TPE sessions
"a reference point. That's what I felt when I had a peer helper as a facilitator, that he was a pillar of recovery" (VPH, female, 45 years old).
"a witnessing role (…) of a patient with bipolar disorder in recovery (…) that exists, that you can see" meant being a bearer of hope toward a recovery process.
"When I am in the TPEs, it is to validate certain questions (asked by the participants in the TPE program) with my experience, my experimentation. It gives legitimacy to a whole bunch of sometimes quite delirious things that we may have experienced but that exist" (VPH, female, 45 years old).
"delivering medical information. I feel like I'm taking on a bit of a posture (…); like the doctor who is a guest on a TV show, ‘So doctor, tell us’ (laughter). At the same time, I feel that sometimes, there are questions that need to be answered and that we have some answers, and I want to pass on knowledge and information, and it can be nice to have this medical hat on" (PP, female, 32 years old).
"When I am a facilitator, I feel that I am leaving my medical and caregiving posture to be more an educator. I have that feeling. I am trying to create a climate conducive to learning by transmitting information" (PP, female, 32 years old).
"During the TPE groups, I spend a lot of time in a listening position. Everyone around the table, I feel like I am listening to them" (PP, female, 32 years old).
"What we aim for in TPE is horizontality" (PP, female, 32 years old);"It's about being on the same level in fact" (VPH, female, 45 years old).
"the notion of a framework, the organization of the session, paying attention to time, sharing the word (…) The framework and the flexibility in the framework" (PP, female, 32 years old).
The role of TPE sessions
"I am almost in the position of the one who is also learning, who is learning, who is growing at the same time as the group" (N, female, 42 years old). Another added "… it taught me a lot of things in fact. I think it improves my daily practice and the support I can offer my patients" (PP, female, 32 years old).
"being able to accompany, encourage, transmit knowledge" (VPH, woman, 45 years old) and "to bring clarity to people concerned by psychological disorders, on the disorders themselves" (PP, woman, 32 years old).
"To create this space where we tell them that there is another possible way than the one of dependence on care, to find their own resources, to better understand themselves" (PP, female, 32 years old).
"We can explain things, but it won't have the same impact as someone who has experienced the same disorders or who has gone through certain things or who has taken certain treatments, who has realized that with certain treatments, it was effective or not" (PI, male, 29 years old).
"I like this image of the toolbox, that they can leave at the end with a toolbox of the TPE session, that they can choose the tools they prefer to work with" (N, female, 44 years old).
"to really find their own standards within themselves by trying to get away from the injunctions of the outside world, of society, to really build their recovery on who they are, on their needs" (EPH, female, 33 years old).
"the illness, in general, which is quite stigmatized. For personal reasons, I really want to be able to put words to it, to have things said, to be able to put words to it" (PP, female, 32 years old).
Changes perceived by the TPE facilitators in patients who had used the TPE program
"It's about appeasement. The fact of being able to verbalize in the group. The fact that it can be heard by others, that it is not judged, accepted, validated because we have gone through the same things" (N, female, 42 years old).
"the awareness that there is a common experience of the disorder" (N, female, 44 years old).
"of one's real limitations, that's something that can seem negative in TPE; patients are all at different stages of their disease, not necessarily all the same" (VPH, female, 45).
"the different phases of grief; in any process there is grief. What's funny is that when you're in this TPE, they're all addressed together. There are some who are in acceptance, recovery (…). A patient was quite in denial at the beginning and all that. It progresses; it progresses, and finally, all the phases of mourning are approached. Depending on where each person is at, they have the possibility of moving on to the next phase; there is a process that takes place" (VPH, woman, 45 years old).
"People identify with the person who has a pathology and who has recovered. They say to themselves "why not me?" False shame disappears; for example, when you start talking about your delusions, "he too", this necessarily breaks down barriers. The peer identifies with the participants who are also there. Double movement. It is because there is a double identification that complex exchanges take place and everyone identifies" (VPH, male, 66 years old).
"As the sessions progress, participants will allow themselves to say things that they have experienced or gone through because they know that it will be heard and validated, because it will be experienced or in any case welcomed without being stigmatized" (N, female, 42); "at the end of the TPE, there is often a group created on WhatsApp® to keep in touch; they have become aware that it is a key to recovery to be supported by peers" (VPH, female, 45).
"(…) Taboos that disintegrate. There are people who say 'if he or she talks about it, I can talk about it too'. Under certain conditions of prudence, it can be an opportunity to talk about it with those close to them. It frees up speech" (VPH, male, 66 years old).
"In the session with the loved ones, accepting that what you do as work is shared with the most intimate people and that it succeeds like the ones we have been able to live that pffff, (sic.)… it mobilizes a lot of things" (VPH, female, 45).
"a kind of destigmatization of psychiatrists (…) they are also there to help people" (PI, male, 29 years old).
“individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. [22]:"With (…) the toolbox, we can manage daily life a little bit, improve in the end to have a more fulfilled life with what we have seen in TPE" (PI, male, 29 years old).
"Participating in the TPE group is a first step to get back into action, to take care of oneself again" (PP, female, 32 years old).
"A participant was able to build her own information booklet based on her skills and transmit them to the whole group, and that was very important for her and useful for the other participants" (PP, female, 32 years old).
Discussion
General discussion
Main results
TPE and the personal recovery process
“a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles… a way of living a satisfying, hopeful and contributing life even with the limitations caused by illness” [23].
Posture of the facilitators
"renouncing the omnipotence linked to one's knowledge in front of the patient, who was previously considered incompetent to manage his or her illness".
"must be based on exchanges, trust and the absence of hierarchy" to move toward a partnership [28].