Chapter 8: Group and Family Therapy

Chapter 8: Group and Family Therapy

Intensive treatment involving open therapeutic communication among willing participants.

Complements individual therapy; often part of treatment for mental illness in mental health settings.

Leadership Styles in Therapy

• Democratic: Encourages group interaction and decision-making to solve problems.

• Laissez-faire: Leader takes a hands-off approach; group directs itself.

• Autocratic: Leader fully controls direction and structure; limits group interaction and decision-making.

Examples of Group Therapy Topics

• Stress management

• Substance use disorders

• Medication education

• Understanding mental illness

• Dual diagnosis groups

Benefits of Group Settings

Multiple clients can participate.

Encourages personal growth and a sense of belonging.

Provides opportunities to share and learn from others’ experiences.

Group Therapy

Group process: Verbal and nonverbal communication during sessions; includes progress of work and member interaction.

Group norm: Behavioral expectations that provide structure (e.g., raising hands before speaking, sitting in same place each session).

Hidden agenda: Goals by members or leaders different from stated group objectives, potentially disrupting the process (e.g., targeting another member).

Group dynamics: Influenced by whether the group is open (new members can join) or closed (membership fixed).

A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when demonstrating which of the following actions?

a

Observes group techniques without interfering with the group process

b

Discusses a technique and then directs members to practice the technique

c

Asks for group suggestions of techniques and then supports discussion

d

Suggests techniques and asks group members to reflect on their use

b Discusses a technique and then directs members to practice the technique

When taking action to resolve conflict resolution techniques, the nurse should use democratic leadership supports group interaction and decision making to solve problems.

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Laissez-faire leadership allows the group process to progress without any attempt by the leader to control the direction of the group.

Autocratic leadership controls the direction of the group

Group Membership

Homogeneous group: All members share a specific characteristic (e.g., diagnosis, gender).

Heterogeneous group: Members do not share a specific personal characteristic (e.g., mixed diagnoses).

Subgroup: Small group within a larger group that functions separately.

Open group: New members can join as others leave.

Closed group: No new members after the group is formed.

Components of Therapy Sessions

Open and clear communication.

Cohesiveness and established guidelines.

Clear direction toward goals.

Development of interpersonal skills and resolution of personal/family issues.

Encouragement of positive interactions, empowerment in decision-making, and self-worth building.

Mutual respect among members.

Support and education (including community resources).

Focus:

• Address client needs and problems.

• Build therapeutic relationship.

Goals:

• Make positive personal decisions.

• Make productive life choices.

• Develop strong sense of self.

Individual Therapy

Focus:

• Address family needs and problems within family dynamics.

• Improve family functioning.

Goals:

• Learn effective ways to manage mental illness in the family.

• Improve understanding among family members.

• Maximize positive interactions.

Family Therapy

Focus:

• Help individuals build functional and satisfying relationships in a group.

Goals:

• Vary by group type, but generally include:

  • Discover shared feelings, experiences, and thoughts.

  • Experience positive behavior changes through group interaction and feedback.

Group Therapy

Focus and Goals for Individual, Family, and Group Therapies (Table

Individual Therapy

• Focus:

  • Address client needs and problems.

  • Build therapeutic relationship.

• Goals:

  • Make positive personal decisions.

  • Make productive life choices.

  • Develop strong sense of self.

Family Therapy

• Focus:

  • Address family needs and problems within family dynamics.

  • Improve family functioning.

• Goals:

  • Learn effective ways to manage mental illness in the family.

  • Improve understanding among family members.

  • Maximize positive interactions.

Group Therapy

• Focus:

  • Help individuals build functional and satisfying relationships in a group.

• Goals:

  • Vary by group type, but generally include:

    • Discover shared feelings, experiences, and thoughts.

    • Experience positive behavior changes through group interaction and feedback.

Group Therapy Goals

Share common feelings and concerns.

Share stories and experiences.

Reduce feelings of isolation.

Create a community of healing and restoration.

Provide a cost-effective alternative to individual therapy.

Concerns in Group Therapy

Privacy of members.

Unequal attention among members.

Group norms may discourage personal opinions.

Disruptive members can reduce group effectiveness.

Use play to discuss shared experiences.

Children

Highly beneficial due to strong peer relationships.

Adolescents

Supports socialization and memory sharing.

Older adults

Phases of Group Development

1. Planning Phase

• Primary focus: Identify group characteristics (inclusion, name, seating, schedule).

• Responsibilities:

  • Consider group composition (e.g., pairing withdrawn clients carefully).

  • Avoid overcrowding; ensure room size fits group size.

  • Use circular seating to promote equality (especially with democratic leadership).

2. Orientation Phase

• Primary focus: Define group purpose and goals.

• Responsibilities:

  • Leader sets tone of respect, trust, and confidentiality.

  • Members get to know each other and the leader.

  • Discuss group termination process.

3. Working Phase

• Primary focus: Promote problem-solving skills and facilitate behavioral change.

• Responsibilities:

  • Leader uses therapeutic communication to guide progress.

  • Members take informal roles that may help or hinder progress.

  • Cohesiveness develops; leader’s role becomes less dominant.

4. Termination Phase

• Primary focus: Conclude group sessions.

• Responsibilities:

  • Discuss termination issues.

  • Leader summarizes group work and contributions.

  • Members may take on varied roles.

  • Solicit feedback about group experience.

A nurse is planning group therapy for clients dealing with bereavement. Which of the following activities should the nurse include in the initial phase?

Select all that apply.

a

Encourage the group to work toward goals.

b

Define the purpose of the group.

c

Discuss termination of the group.

d

Identify informal roles of members within the group.

e

Establish an expectation of confidentiality within the group.

b Define the purpose of the group.

c Discuss termination of the group.

e Establish an expectation of confidentiality within the group.

During the initial phase the nurse should, identify the purpose of the group, set the tone of the group, including an expectation of confidentiality and discuss termination of the group.

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During the working phase, the group works toward goals, and identify informal roles that other members in the group often assume.

Maintenance vs Task vs Individual Roles

Support group purpose and process (e.g., harmonizer prevents conflict).

Morale

---

Handle specific duties (e.g., recorder takes notes during sessions).

Foundation

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Promote personal agendas, often harming teamwork (e.g., dominator, recognition seeker).

Ego

Acute vs Outpatient vs Virtual Settings

Membership changes daily; focus is on relief.

Leader provides high structure due to unit activity impact.

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Membership is stable; focus on growth.

Leader allows members more input in direction.

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Challenges include limited non-verbal cues, reduced control of group process, and less full presence.

A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role?

a

A member who praises input from other members

b

A member who follows the direction of other members

c

A member who brags about accomplishments

d

A member who evaluates the group’s performance toward a standard

c A member who brags about accomplishments

When evaluating functional roles of a group, the nurse should identify an individual who brags about accomplishments is acting in an individual role that does not promote the progression of the group toward meeting goals.

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An individual who praises the input of others is acting in a maintenance role.

An individual who is a follower is acting in a maintenance role.

An individual who evaluates the group’s performance is acting in a task role.

Family Types

Nuclear: Children living with married parents.

Single-parent: Children living with one single adult (related or unrelated).

Adoptive: Children living with adoptive parents.

Blended: Children living with one biological/adoptive parent and a nonrelated stepparent (married).

Cohabitating: Children living with one biological parent and a nonrelated adult who is cohabiting.

Extended: Children living with one biological/adoptive parent and a related adult who is not their parent (e.g., grandparent, aunt, uncle).

Other: Children living with related or nonrelated adults who are not biological/adoptive parents (e.g., grandparents, adult siblings, foster parents).

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Key Points

• Family is the first and most influential system in a person’s life.

• Families pass through developmental stages with changing roles.

• Families can have healthy or dysfunctional traits in one or more areas.

• Healthy relationships support the well-being of all members.

Areas of Functioning in Families

Communication

• Healthy families: Clear, understandable messages; members encouraged to express thoughts/feelings.

• Dysfunctional patterns:

  • Blaming: Shift focus from own faults.

  • Manipulating: Use dishonesty to meet personal agendas.

  • Placating: Take blame to maintain peace.

  • Distracting: Insert irrelevant info during problem-solving.

  • Generalizing: Use sweeping terms like “always” and “never.”

Management

• Healthy: Adults agree on important matters (rules, finances, plans).

• Dysfunctional: Chaotic; children may make major decisions.

Boundaries

• Healthy: Clear role boundaries understood by all.

• Dysfunctional:

  • Enmeshed: Roles and feelings overlap; unclear boundaries.

  • Rigid: Rules inflexible; members isolate and avoid communication.

Socialization

• Healthy: Members interact, plan, and model coping skills; children adapt to both family and societal roles.

• Dysfunctional: Children fail to develop healthy social skills; struggle adapting to societal roles.

Emotional/Supportive Functioning

• Healthy: Emotional needs met; mutual concern present; conflict/anger managed.

• Dysfunctional: Negative emotions dominate; members are isolated, fearful, and show little concern for others.

Other Concepts Related to Family Dysfunction

Scapegoating: Less powerful member blamed for family problems.

Triangulation: Third party drawn into unstable relationship between two members.

Multigenerational issues: Emotional/behavioral patterns persisting across ≥3 generations (e.g., substance abuse, dysfunctional grief, divorce).

Discipline

Can be healthy or dysfunctional.

• Healthy: Consistent, timely, age-appropriate; protects safety and provides security.

  • Should be given in private when calm; caregivers should be united in approach.

Family

Reciprocal relationships with commitment; may include nontraditional arrangements. Dysfunction can occur in management, boundaries, communication, emotional support, or socialization.

Family Therapy

Family as a system, not individuals.

Assessments: Use interviews and family assessment tools.

Nursing role:

• Teach skills (e.g., medication management, coping strategies).

• Mobilize resources, improve communication, strengthen ability to cope with illness.

Multi-family therapy

Brings together families with shared challenges to learn skills and share experiences (e.g., families with a member diagnosed with schizophrenia).

A nurse on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members conspire together to exclude the rest of the group. This is an example of which of the following concepts?

a

Triangulation

b

Group process

c

Subgroup

d

Hidden agenda

c Subgroup

A subgroup is a small number of people within a larger group who function separately from that group.

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Group process is the verbal and nonverbal communication that occurs within the group during group sessions.

Triangulation is when a third party is drawn into a relationship with two members whose relationship is unstable.

A hidden agenda is when some group members have a different goal than the stated group goals. The hidden agenda is often disruptive to the effective functioning of the group.

A nurse is conducting a family therapy session. The younger child tells the nurse about plans to make the older sibling look bad, believing this will earn more freedom and privileges. The nurse should identify this dysfunctional behavior as which of the following?

a

Placation

b

Manipulation

c

Blaming

d

Distraction

b Manipulation

The nurse should identify, manipulation is the dysfunctional behavior of using dishonesty to support an individual agenda.

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Placation is the dysfunctional behavior of taking responsibility for problems to keep peace among family members.

Blaming is the dysfunctional behavior of blaming others to shift focus away from the individual’s own inadequacies.

Distraction is the dysfunctional behavior of inserting irrelevant information during attempts at problem solving.