34. When Integration with Medical and Psychotherapeutic Care Is Needed

34. When Integration with Medical and Psychotherapeutic Care Is Needed

To be still more concrete, let me list the conditions in which parallel or prior specialized care is mandatory:

• Diagnosed psychotic disorders (schizophrenia, schizoaffective disorder) — psychiatric supervision and pharmacotherapy are mandatory, and only in a stable phase is the group format possible, with the facilitator informed of the diagnosis;

• Bipolar disorder — treatment by a psychiatrist and medication monitoring are mandatory, and only in a stable (euthymic) phase is participation possible, with caution;

• Severe depressive symptoms (PHQ-9 > 20) — treatment by a psychiatrist and/or individual psychotherapy is required, with the group format serving as a supplement during stabilization;

• Acute suicidal ideation — a crisis service and psychiatric care, first and foremost;

• Active addiction in an acute phase — addiction treatment, rehabilitation, twelve-step programs, or other specialized programs;

• An acute traumatic situation (domestic violence while still in a dangerous relationship, a fresh loss, a recent catastrophic event) — individual trauma therapy, first and foremost;

• Severe eating disorders — comprehensive multidisciplinary care (physician, psychiatrist, psychotherapist, nutritionist), with group work only alongside it;

• Acute medical conditions — stabilization under a physician’s supervision, first and foremost.

In all of these cases, the right place for FSF is as a supportive community and an environment for restoring quality of life alongside specialized care. Not the first line. And not an alternative.