Group Therapy

Nurses Role

• Determine personal biases and belief systems

• Recognize various phases of group development

• Assess pt experiences related to Yalom

• Determine the most effective leadership style for leading a particular group (Autocratic, Democratic)

• Determine pt that are appropriate for group therapy

  • Suicidal pt may benefit from group

• Assess pt perception of reality—best if pt is oriented x4

What is a group and the 8 functions

• A collection of individuals whose association is founded on shared commonalities, interests, values, norms, and purposes—pt’s learn from each other

• Functions

  • Support: available in time of need, group members sense security

  • Governance: established rules and criteria

  • Camaraderie: members may experience joy and connection

  • Socialization: experience social norms

  • Empowerment: provide support and facilitate positive change

  • Task Completion: assist to complete tasks that need more than one person

  • Information Sharing: share information, resolve similar situations

  • Normative Influence: reinforce established norms of communication and behavior

Goals of Group Therapy

• Share feelings and concerns

• Share stories and experiences

• Diminish feelings of isolation

• Create a community of healing and restoration

• Provide a more cost-effective environment than that of individual therapy

Type of Groups

• Task Group – goal is to accomplish a specific task, led by professional or lay person

• Teaching Group – goal is to convey knowledge, led by professional or lay person

• Therapeutic Group

  • Need an advanced degree to lead a psychotherapy group

  • A setting where a number of clients meet to share, gain  insight, improve coping skills

  • Focus is on dynamics within the group

• Self Help Group 

  • Usually  doe not have a professional leader, group is led by its members

  • A valuable resource for specific problems (Ex. Alcoholics Anonymous)

  • Allows member to talk about feelings & fears, relieves isolation, supportive

Conditions that Influence Group Dynamics

• Seating – it is best when there are not barriers between members, circle of chairs is best

• Size – 7 – 8 members provides environment for optimal interaction

• Membership - 

  • Open Ended = members can join at any time

  • Closed Ended = members join at the time the group is formed, non members cannot attend

• Hidden Agenda – when group members have different goals that may disrupt group process

• Subgroup – small # of people within a larger group who function separately from the group

Yalom’s Factors

• Imitative Behavior – role modeling, imitation

• Interpersonal Learning – opportunities to gain insight

• Altruism – mutual sharing and concern for others in the group

• Catharsis – non-threatening atmosphere to share positive and hard feelings

• Existential Factors – Group supports individual accountability, and responsibility

• Universality – individuals realize they are not alone in their thoughts and feelings

• Installation of Hope – the progress of others bring hope to individuals in the group

• Imparting Information – formal instruction and sharing passes knowledge to others

• Corrective Recapitulation of the Primary Family – the re-experience unresolved issues

• Development of Socializing Techniques – opportunity to correct maladaptive behaviors

• Group Cohesiveness – members develop a sense of belonging, bring value to each other-

3 Phases of Group Development

• Phase 1: Orientation

  • Build rapport within the group, Confidentiality is emphasized

  • Leaders encourage member participation without disclosing too much

  • Discussion related to termination (How long is the group? 4 week? 6 weeks? Etc.)

  • Leader / members work together to establish purpose, rules, and goals, and set the one of respect

• Phase 2: Middle/Working

  • Sometimes leaders assign formal roles

  • Members take informal roles in the group

  • Leader role transitions more to that of a facilitator

  • Trust has been established, Work towards completing a task or goal

  • Conflict is managed more by group participants, Client’s problem solve

• Phase 3: Final/Termination

  •  The end of the group sessions

  • Group members may experience a sense of grief and loss

  • Leader’s role is to encourage participants to share feelings

  • Important for participants to have opportunities to reminisce

  • Some members may feel abandoned linked to previous losses / triggered

Leadership Styles

• Autocratic

  • Members depend on the leader to problem solve

  • Group Productivity is High 

  • Group Morale is low

  • Focus is on the leader

• Democratic

  • Production is a bit lower

  • Focus is on the members

  • Enthusiasm and morale are high

  • Members are encouraged to problem solve

• Laissez-Faire Leadership

  • Members do as they please

  • Goals and topic are undefined

  • Both productivity and morale are low

  • This type of leadership offers no focus for the group

  • Members may stray from the identified topic – Nurse does not intervene

Group Member Roles

• Task Roles: members who take on various task

  • Coordinator – someone who clarifies ideas and suggestions, 

  • Evaluator – examines the groups plan and performance

  • Elaborator – explains and expands upon group plans

  • Orienter – maintains the direction of the group 

  • Initiator – Outlines tasks, proposes solutions

• Maintenance Roles: Members who maintain or enhance group process

  • Follower – a passive participant, listens attentively

  • Encourager – offers recognition and acceptance of others

  • Gatekeeper – encourage acceptance and participation of all group

  • Harmonizer – minimizes tension by intervening during arguments

  • Compromiser – relieves conflict / assists members with compromise

• Individual Roles: Roles that fulfill personal or individual agendas

  • Mute or silent member – non-participatory, uncomfortable with sharing

  • Aggressor – expresses negativity and hostility, uses sarcasm, degrading

  • Blocker – resists group efforts, rigid, behaviors impede group process

  • Help-Seeker – lacks concern for others, uses group to gain sympathy

  • Recognition seeker – seeks attention by sharing accomplishments

  • Monopolizer – maintains control by dominating conversation

  • Dominator – authoritative, dominates conversation

  • Seducer – excessive premature self-discloser

    
    

Family Therapy

• Focus is on the family system as a whole

• Nurse Role: educate, mobilize family resources

• Functional Family Dynamics

  • Boundaries are distinguishable between roles

  • Socialization within the cultural norms is apparent

  • Emotional support and compassion is offered freely 

  • Communication is gentle, kind, respectful, and honest

  • Management of family affairs is streamlined and free of anxiety

• Dysfunctional Family Dynamics

  • Manipulating – the use of dishonesty to support one’s agenda\

  • Scapegoating – one member is blamed for the problems in a family

  • Triangulation – a third party is drawn into an unhealthy relationship

  • Generalizing – the use of “always” & “never” when describing events

  • Blaming – strategy to shift the focus away from one’s own inadequacies

  • Distracting – sharing irrelevant information to distract from the issue at hand

  • Multigenerational Issues – a pattern of dysfunction for 3 or more generations

  • Placating – one person takes responsibility for problems to keep the peace at all cost

  • Rigid boundaries – rules & roles are completely inflexible, minimal communication, isolative

  • Enmeshed boundaries – thoughts, roles, and feelings are blended , individual roles are unclear

  • Manipulation – a deceitful, skillful action to meet a goal

Developmental Stages of Groups

• Form – intentionally polite, conversation is exploratory, orientation, touch on adjournment 

• Storm – politeness fades, members vie for roles, power struggles

• Norm –  tension decreases, cooperation, integrating individuals strengths and weaknesses

• Perform – synergistic energy, optimal level of functioning within the group

• Adjourn– closure, reminisce, celebrate accomplishments, process learnings