Therapeutic Groups
· Introduction
o In psychiatry, working with clients and families often takes the form of groups.
o Clients learn from each other in a group setting.
o So, what is a group?
· Functions of a Group
o There are 8 different functions of a group:
§ 1. Socialization
§ 2. Support
§ 3. Task Completion
§ 4. Camaraderie
§ 5. Information Sharing
§ 6. Normative Influence
§ 7. Empowerment
§ 8. Governance
· Types of Groups:
Task Groups
Teaching Groups
Supportive/Therapeutic Groups
Self-Help Groups
· A patient expresses a desire to begin attending the self-help group Alcoholics Anonymous (AA). Which nursing response gives the patient pertinent information about this type of group?
o “In this type of group, membership is always within a fixed time frame.”
o “Group members receive comfort and advice from others undergoing similar experiences.”
o “The purpose of this type of group is to convey information to a number of individuals.”
o “The function of this type of group is to accomplish a specific outcome.”
· Physical Conditions that Influence Group Dynamics
o Seating:
There should be no barrier between the members
o Size:
Group size does make a difference in the interaction among members.
Seven or eight members provide a favorable climate for optimal group interaction and relationship development.
o Membership:
Some groups may be open or closed
· 11 Curative Factors of Groups
o Instillation of Hope
o Universality
o Imparting of Information
o Altruism
o Corrective Recapitulation of Primary Family Group
o Development of Socializing Techniques
o Imitative Behavior
o Interpersonal Learning
Group Cohesiveness
Catharsis
Existential Factors
· After a supportive-therapeutic group, a nurse hears one patient say to another, “I never thought that other people had the same problems that I have.” The nurse ascertains that this statement represents which curative factor described by Yalom?
o Catharsis
o Group cohesiveness
o Universality
o Imitative behavior
· Phases of Group Development
o Phase I: Initial or Orientation Phase
§ Group activities:
· Leader and members work together to establish rules and goals for the group.
§ Leader expectations:
· Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals.
§ Member behaviors:
· Members are superficial and overly polite. Trust has not yet been established.
o Phase II: Middle or Working Phase
§ Group activities:
· Productive work toward completion of the task is undertaken.
§ Leader expectations:
· Leader becomes more of a facilitator.
§ Member behaviors:
· Trust has been established between members, and cohesiveness exists.
· Conflict is managed by the group with minimal assistance from the leader.
o Phase III: Final or Termination Phase
§ Group activities:
· A sense of loss that precipitates the grief process may be evident.
§ Leader expectations:
· The leader encourages members to discuss feelings of loss and to reminisce.
§ Member behaviors:
· Feelings of abandonment and grief from previous losses may be triggered.
· Leadership Styles
o Autocratic
o Democratic
o Laissez-faire
· During a group meeting, a patient raises the concern that noise at the nurses’ station keeps him awake at night. The nurse, present in the meeting, interrupts, stating, “I’ll handle this matter. We need to move on.” The nurse is demonstrating which type of leadership style?
o Democratic
o Autocratic
o Laissez-faire
o Surrogate
· Member Roles:
o Complete the task of the group.
o Maintain or enhance group processes.
o Fulfill personal or individual needs.
· Psychodrama
o Psychodrama is a specialized form of group therapy in which patients become “actors” in life-situation scenarios.
o Other members of the group play the roles of people with whom the protagonist has unresolved issues.
o Purpose is to provide the patient with a safe place to confront unresolved conflicts to progress toward resolution.
· The Role of the Nurse in Group Therapy
o In psychiatry, nurses may lead various types of therapeutic groups, such as client education, assertiveness training, support, parent, and transition to discharge groups, among others.
o American Nurses Association guidelines specify nurses who serve as group psychotherapists should have a master’s degree in psychiatric nursing.
o Additional specialist training is required beyond the master’s level to prepare nurses to become family therapists or psychodramatists.
· Group Therapy Goals
o Experience positive behavior changes as a result of group
o Interaction and feedback.
o With individual groups, we want the individual to make more positive individual decisions, develop a strong sense of self, and make productive life decisions.