Referral barriers--near failure to thrive of a group.

This paper describes the purpose, goals and painful beginnings of a free group service to chronic, low functioning, psychiatric outpatients in a hospital system. The 'Thursday Group' was first made available in 1985 for patients who are depressed, psychotic or otherwise severely emotionally disturbed. It has few restrictive criteria, yet it nearly 'failed to thrive' and almost perished due to lack of referrals. This paper focuses on some possible reasons for the referral barriers. They include the degree of visibility of the therapist in the system, habit and the status of group treatment in the minds of staff, the dynamics of these patients and patient-staff relationships, the staff's own dynamic and their position within the system, and finally the understanding of the limits and capacities of a group. The therapeutic value of the group and its more hopeful current place in the system is described.