EAQ - Ch34: Therapeutic Groups

When a group member notices another member crying and suggests, "It looks as though you need the floor to tell us what is so upsetting to you," the behavior being demonstrated is which of the following? a. Altruism b. Ventilation c. Universality d. Reality testing

a. Altruism involves putting another's needs before one's own. p. 612, Table 34.1

A hospital committee is formed to determine the aftercare needed for psychiatric patients upon discharge. What type of group is this? a. Task group b. Small group c. Social group d. Psychosocial group

a. Task groups come together to perform a particular function like establishing facility aftercare standards. Social groups can occur among the workforce, but they are not task-oriented. There is no indication of the size of the group, which can vary for a task like this. Although this is referencing psychiatric patients, psychosocial is not appropriate terminology for a work committee. p. 615

Which statement demonstrates that the characteristics of successful group planning have been addressed? SATA a. "Here is a printed list of the group's objectives." b. "Were do you think we should meet each week?" c. "We usually refer to this group as Life Style Changes" d. "How does each of you plan to get to the meeting site each week?" e. "Who wants to be responsible for reminding members of the meeting?"

abce. To develop a successful group, planning should include a description of specific characteristics, including the following: name and objectives of the group, physical setting configuration , and description of leader and member responsibilities. Transportation to and from meetings is not a responsibility of the group and is not typically planned for unless on a one-to-one patient basis. p. 611

A male patient is a part of a therapeutic group comprised of both men and women. He is especially opinionated, and insists that men need to be in a separate group from women for "these conversations." The patient is also a stickler for details and is a perfectionist. Which roles might this person play in the group? a. Blocker b. Playboy c. Recorder d. Opinion giver e. Special-interest pleader

ade. Opinion givers seek to influence others. Blockers disagree with group issues and are oppositional. Special-interest pleaders not only advocate for a special group, but do so with prejudice or bias. The playboy is generally disinterested in the group, and recorders act as the group memory. p. 614

When evaluating members of a therapeutic group, what statement by a member does the nurse identify as being consistent with monopolizing behavior? a. "No, I do not have anything to say at the moment." b. "Please keep quiet and just listen to what I am saying." c. "My headache is irritating and simply refuses to go away." d. "What makes you believe that I should listen to your advice?"

b. A monopolizing member does not give anybody else a chance to be heard. Such a member is extremely talkative. In an attempt to deal with anxiety, the person may monopolize the group with one's own compulsive speech. A complaining member may continually bring somatic problems such as a nagging headache to the group and still reject any help. A silent member prefers to stay silent and observe others during any group discussions. A demoralizing member may talk angrily to the leader and show no concern for others. Such a member shows hostile behavior. pp. 617-618

A person diagnosed with anxiety is enrolled in a stress management group. What activity should the person expect in such a group? a. Being informed about antianxiety medications b. Teaching spirituality as a relaxation technique c. Sharing the understanding of life's challenges d.Enacting life's experiences for learning and insight

b. In a stress management group, the group members are taught several relaxation techniques such as spirituality, music, exercise, etc. A medication education group rather than a stress management group may provide information to its members about anti-anxiety medications, dosing schedules, and side effects. Support groups and self-help groups enhance shared understanding of life's challenges and enhance personal and social functioning. A psychodrama group encourages members to act out life's experiences leading to catharsis of emotions which can provide insight and promote reality testing. p. 616, Table 34.5

When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as which of the following? a. Altruistic b. Universality c. Subgrouping d. Contingency seeking

c. Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group. p. 612, Box 34.3

During a group therapy for depression, the leader is aware of the informal roles that the individual members assume. What types of behavior by a group member need to be confronted? a. Verbalizing the standards for the group b. Praising and seeking input from the group c. Noting the progress of the group toward the goal d. Boasting of and discussing their own achievements e. Flattering other members of the group with compliments

de. A person who boasts and discusses his own achievements is a recognition seeker. One who tries to control the other members by the use of flattery is a dominator. Members do not help the group with such behavior. Rather, they shift the group's focus to them. Such behavior from individuals needs to be confronted. A standard setter verbalizes the standards of the group. The encourager praises and seeks input from others. These are maintenance roles that increase cohesion between the group members. The orienter notes the progress of the group towards the goal. Such a task role keeps the group focused on its main purpose and gets the work done. p. 614, Table 34.3

Which patient statement demonstrates a therapeutic change brought about by group therapy? SATA a. "Helping others makes you feel good." b. "I've felt all alone for a very long time." c. "I've decided to stop smoking like you did." d. "I really believe you've made a lot of progress." e. "Waiting your turn and being respectful is important."

acde. There are aspects of the group experience that leaders and members have identified as curative and facilitative of therapeutic change. They include altruism, the instillation of hope, imitative behaviors, and the development of socializing techniques. The remaining option demonstrates a feeling of being alone and not that of group cohesiveness. p. 612, Table 34.1

The phase of group therapy in which the group deals with feelings associated with separation and loss is called what? a. Working b. Orientation c. Termination d. Post termination

c. During termination, the group members must face the fact that they are at a parting of the ways. Unresolved feelings associated with other terminations and separations may surface and need to be addressed. This is the only stage where such group work is done; orientation, working, and post termination are incorrect. p. 613

Which statement best describes the functional role of "self-confessor"? a. Seeks attention by discussing achievements b. Tries to connect various ideas and suggestions c. Provides facts or shares experience as an authority figure d. Verbalizes feelings or observations beyond the group topic

d. Self-confessors share their own feelings and thoughts beyond that which is being discussed in a group. The coordinator tries to connect various ideas and suggestions. The information giver provides facts or shares experience as an authority figure. The recognition-seeker seeks attentions by discussing achievements. p. 614

An advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic or the member's behavior and makes no comment unless asked a direct question. This is an example of what style of leadership? a. Autocratic b. Authoritarian c. Democratic d. Laissez-faire

d. A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and don't allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making. p. 615

Group members are having difficulty deciding what topic to cover in today's session. The nurse leader says, "We are talking about fear of rejection today." Which communication technique has the nurse leader used? a. Support b. Reflection c. Summarization d. Giving information

d. Giving information provides resources and information that supports treatment goals. In this instance, the nurse has helped focus the discussion. Support gives positive feedback and acknowledgement. Reflection encourages the group member to explore and expand on feelings (rather than thoughts or events). Summarization closes a discussion or group session by pointing out key issues and insights. p. 617, Box 34.6

A patient says to the nurse, "Since my spouse died, I'm having trouble concentrating. I want to stay home alone all the time but I know it would help me to be with others." Which group should the nurse suggest? a. Bereavement b. An internet support group c. Co-Dependents Anonymous d. National Alliance on Mental Illness (NAMI) family support group

a. Bereavement groups provide support for those who have experienced the loss of a loved one. An internet support group may provide support but it may not be specific to grief and would not engage the patient in face-to-face interactions as well as a bereavement group. Co-Dependents Anonymous is a twelve-step self-help group. NAMI groups provide patient and family support, education, and advocacy. p. 617, Box 34.4

At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed? a. At the first session b. As the working phase begins c. Just before the group terminates d. At the time each patient is interviewed

a. Confidentiality is part of the ground rules that are established at the beginning of the group sessions. As the working phase begins, just before the group terminates, and at the time each patient is interviewed occur in difference stages of the group's development. p. 613

The nurse is conducting group therapy for patients with antisocial personality disorder. During group therapy, a patient is found to be aggressive and bullies other members of the group. How should a nurse respond to change the behavior of the patient? a. "I feel you should stop bullying other members of the group." b. "It is not good to be aggressive and bully others during therapy." c. "Please try to control your anger and be friendly with the group members." d. "You seem to be aggressive; what is making you aggressive during therapy?"

a. During group therapy, the patients may become aggressive and bully others due to their illness. The nurse makes them acknowledge their behavior by using the response, "I feel you should stop bullying other members of the group." It helps the patient to control his or her anger. The nurse avoids a response which starts with 'you' such as "You seem to be so aggressive; what is making you aggressive during the therapy?" The patients may feel rejected and may behave more aggressively. The response, "Please try to control your anger and be friendly with the group members," is not appropriate. It may make patients feel that the nurse is not concerned about their feelings and emotions. The response, "It is not good to be aggressive and bully others during therapy," is not appropriate. The nurse avoids directly reporting the patient's behavior as good or bad, as it may cause withdrawal of the patient. p. 618

The nurse is conducting group therapy for patients with attention deficit hyperactivity disorder (ADHD). The nurse learns that the patients have conflicts among them and encourages them to resolve their conflicts. Which phase of the group development is indicated from the nurse's actions? a. Working phase b. Orientation phase c. Termination phase d. Stabilization phase

a. In group therapy, group development is categorized into three phases based on the specific roles and challenges that the nurse faces. In the working phase, the patients interact with each other and express their conflicts. The nurse should guide and support the members to resolve the conflicts and improve the patients' problem-solving abilities. In the orientation phase, the nurse encourages the patients to interact with each other and makes them feel comfortable. In the termination phase, the nurse identifies the progress of the patients and encourages them to acknowledge their progress. The nurse should encourage the patients to openly address their feelings. The stabilization phase is not a part of group development; it is part of the treatment model. In the stabilization phase, the health care professionals encourage the patients to regularly take their medications and check for signs of toxicity and adherence to medication. p. 613

The nurse is co-leading a therapeutic outpatient group. What difference does the nurse note in an outpatient group compared to an inpatient group? a. There are few external influences. b. The leader decides the group norms. c. There is little time for group cohesion. d. The level of ego function is heterogenous.

a. The boundary of an outpatient group is well maintained, so there are few external influences. Their activity is not controlled by external factors. Inpatient group is a subsystem within a larger system of the health care facility. Many other hospital activities may influence the group. The outpatient group is a more stable group. Since members do not change often, there is more time that the group members spend with each other. The group norms evolve over time rather than the leader deciding the norms. Since the patients in an outpatient group spend more time together than in an inpatient group, there is sufficient time for group cohesion to develop normally. The inpatient group may have some hesitant members who are more or less forced into the group because they are admitted to the health care facility. The outpatient group, however, is made up of motivated, self-referred individuals whose level of ego function is homogenous. p. 613, Table 34.2

A strategy the group leader may use to encourage a nonparticipating member to speak during a session is to share which of the following with the patient? a. "What you are thinking is very important to the group." b. "Your opinions about what just happened are important." c. "You are letting the group down when you fail to contribute." d. "You must be feeling safe enough to enter the discussion by now."

a. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions. Telling the patient that what he or she is thinking is very important to the group is a nonthreatening way to encourage the patient to contribute. Telling the patient that he or she is letting the group down, that his or her opinions of what just happened are important, and that he or she should be feeling safe enough to share are more threatening and may place the patient on the defensive and encourage further withdrawal. p. 618

A patient is a member of the therapeutic community meeting group at the inpatient unit. What is the most appropriate feature of this type of therapeutic community group? a. It ideally has nurses as its leaders. b. It mainly aims at providing psychotherapy. c. It teaches members about their medications. d. It is often a closed group with a stable membership.

a. Therapeutic community meeting groups are held in inpatient units. The nurses are in close daily contact with the members and make frequent individual and unit assessments. Therefore, they are ideally suited to be leaders of such groups. The main aim of the group is to provide a community meeting place for members and provide an opportunity to develop social skills modeled on actual interactions. The medication education group is designed to teach its members about their medications. Therapeutic community meeting group is an inpatient group where the group is rarely the same for more than one or two meetings. Some members leave while others join the group. It is therefore, not a closed group. p. 616, Table 34.5

Sharing similar experiences is a curative factor identified by Yalom as which of the following? a. Universality b. Ventilation c. Reenactment d. Recapitulation

a. Universality is the phenomenon of understanding that one's problems are not unique, which helps group members feel secure and understood. p. 611

An experienced psychiatric nurse has been asked about similarities between adolescent and adult groups. Which statement best describes the commonalities in these groups? a. Universality will affect both groups equally. b. Group content will be similar in both groups. c. Group processes will be similar in both groups. d. Group cohesiveness will be unlikely in both groups.

a. Universality is the term used to describe the realization that a patient is not alone in his or her thoughts or feelings. This would occur no matter the age group. The content of different age groups will not be the same. This is also true of group processes. Group cohesiveness is a natural outgrowth of group formation and is likely in both age groups. p. 612

When planning a group therapy, what does the group leader need to keep in mind about the place where the group shall meet? a. The seats should be arranged close to each other. b. A small room should be a better setting than a huge room. c. The configuration of the physical setting should be changed often. d. A classroom seating arrangement should be the preferred arrangement.

a. When seats are arranged close to each other, it promotes intimacy and facilitates active group interaction. A large room may not encourage intimacy, but a small room may be overcrowded and add to discomfort and anxiety. The size of the room should depend on the size of the group. Arranging the chairs in a circle may be better than a classroom setting. It conveys equality among all present and allows the members to see each other. The configuration of the physical setting should be consistent and should not be changed often. When the physical setting is consistent, the patients get used to it and begin to feel comfortable in the surroundings and may open up better. p. 612

In a therapy group, the nurse is using existential theory by focusing on the here and now experience to enhance the members' awareness of feelings and their meanings. What statement is an example of a here and now activation? a. "You have been sitting quietly. What are your thoughts or feelings?" b. "You were in tears last week. Can you discuss it with the group now?" c. "You looked upset when another member spoke. Why were you upset?" d. "You looked disturbed when they spoke. Did it bring up something from your past?"

a. When the nurse notices a member is sitting quietly and asks about the member's thoughts or feelings, the statement focuses on the member's current behavior which is the essence of here-and-now activation. When the nurse asks if the member wants to discuss the reason for the member's behavior during a previous meeting, the statement requires recall of an incident in the past and its explanation in retrospect. The immediacy of here-and-now experience is not there. When the nurse notices a particular behavior and asks the reason for it, the statement asks for an explanation of the "why" of a behavior. Existential theory focuses on "what" rather than the "why" of a behavior. When the nurse notices the member's behavior and asks how it relates to the past, the statement probes into the member's past experiences rather than focusing on here-and-now experiences. p. 618, Table 34.7

These comments are made by members of a group. Which comment best contributes to the group's cohesiveness? a. "We started out talking about losses, but we have strayed from that subject." b. "No one in this group wants to hear anything else about failed romantic relationships." c. "I need to talk about how my problems developed and get some ideas for solving them." d. "We aren't making progress because our group leader has as many problems as we do."

a. "We started out talking about losses, but we have strayed from that subject" represents an observation about the group's process and content. The speaker is summarizing, which contributes to the group's cohesiveness and effectiveness. The other options are nonfunctional behaviors, such as controlling, dominating, blaming, and blocking. p. 612, Table 34.1

The nurse is conducting group therapy for patients with severe mental illness. The nurse learns that a patient is nervous and says, "I noticed that you're biting your fingernails. What are you feeling right now?" Which communication technique did the nurse implement? a. Reflection b. Clarification c. Confrontation d. Summarization

a. As a group leader, the nurse must effectively communicate with the patients in the group. It helps the patient to develop trust in the nurse and encourages participation in group therapy. In reflection, the nurse states the patient's actions and explores the patient's feelings and thoughts. In clarification, the nurse restates the information given by the patients to get a clear meaning. In confrontation, the nurse resolves the conflicts between the members of the group and encourages the patients to express their thoughts. In summarization, the nurse states the key issues and solutions to the problems and outcomes of the therapy. p. 617, Table 34.6

The leader opens the discussion at the first meeting of a new group. Which comment would be appropriate for this phase? a. "Let's begin by establishing the ground rules for our group." b. "Let's start by asking each person here to define his or her problems." c. "I would like each person to explain why you are attending this group." d. "Bringing family members to our group will help us achieve our goals."

a. Establishing ground rules helps to build trust in a group and set the group's norms and expectations. This is an appropriate leader behavior in the orientation phase. Members of a new group have not established trust and would be unwilling to define their problems. Visitors would alter the group's identity and jeopardize trust. p. 613

The therapist is conducting group therapy for patients who attempted suicide a few weeks ago. What communication by the therapist does the nurse identify as use of reflection technique? a. "You are fidgeting your fingers. What are you feeling right now?" b. "You are saying, 'Nothing is wrong,' but you tried to kill yourself." c. "What do you mean when you say, 'Nobody needs me anymore?'" d. "Antidepressants will reduce your depression and make you feel better."

a. When the therapist notes a behavior and asks about current feeling, the therapist is encouraging the group member to explore and expand on the current feeling rather than thoughts or events. This is the use of the reflection technique of communication. When the therapist tells the group member that antidepressants will reduce their depression, the therapist is giving information that supports treatment goals. This is the information technique of communication. When the therapist asks the group member to expand or explain what he or she says, the therapist uses the clarification technique of communication. When the therapist encourages group members to explore the inconsistencies in their communication or their behavior, the therapist uses the confrontation communication technique. p. 617, Table 34.6

Which statement made by the nurse leader is associated with issues addressed during the working phase of group development? SATA a. "Today we will be focusing on improving communication skills." b. "I get the sense that you all don't agree with what was just said." c. "Everyone will get an opportunity to express their feelings about what I said." d. "It appears that several of you agree about how to respond to a rude co-worker." e. "We need to identify people you can talk with when the group work is completed."

abcd. All groups go through developmental phases. In the working phase, the group leader's role is to encourage focus on problem solving consistent with the purpose of the group. As group members begin to feel safe within the group, conflicts may be expressed, which should be viewed by the group leader as a positive opportunity for group growth. It is important for the leader to guide and support conflict resolution. Through successful resolution of conflicts, group members are empowered to develop confidence in their problem-solving abilities and better support one another in their individual efforts to grow and change. Determining post termination goals is not addressed during the working phase. p. 613

What is an advantage of group therapy sessions? SATA a. Feedback is provided by a variety of sources. b. Patients are provided with a sense of belonging. c. Private issues are often the topic of group discussion. d. Several patients can be involved in treatment simultaneously. e. Inclusion into a group is not dependent on stability of one's condition.

abd. There are advantages and disadvantages of group approaches in the care of psychiatric patients. Advantages include the following: engaging multiple patients in treatment at the same time, thereby saving resources; participants benefit not only from the feedback of the nurse leader but also that of peers who may possess a unique understanding of the issues; and promoting a feeling of belonging. Until symptoms are stabilized, persons who are acutely psychotic, acutely manic, or intoxicated have difficulty interacting effectively in groups and may interfere with other members' ability to remain safely focused on group goals and progress. Disadvantages of group therapy sessions include concerns that private issues may be shared outside the group. p. 611, Box 34.1

Which functions represent informal individual roles by members of a group? SATA a. Dominator b. Help seeker c. Standard setter d. Information seeker e. Recognition seeker

abe. Informal roles group members often assume may or may not be helpful to group development. Individual roles do not help the group but instead relate to specific personalities, personal agendas, and desires for having needs met by shifting the group's focus to them. Dominator, help seeker, and recognition seeker are examples of individual roles. Maintenance roles, such as the standard setter, keep the group together, help each person feel worthwhile and included, and create a sense of group cohesion. Task roles, such as the information seeker, keep the group focused on its main purpose and get the work done. p. 614, Table 34.3

A nurse is conducting group therapy for Alzheimer patients in a nursing home. Which appropriate action does the nurse follow during the orientation phase of therapy? SATA a. The nurse states the purpose of the group to the patients. b. The nurse frequently reminds the patients about the group rules. c. The nurse avoids pointing out the similarities among the patients. d. The nurse requests that the patients avoid talking with one another. e. The nurse introduces him or herself and the patients to one another.

abe. The first phase of group development after a group is formed is called the orientation phase. The nurse states the purpose of the group and makes introductions. It helps the patients to feel comfortable and establish trust within the group. The nurse frequently reminds the group about the rules, as people with psychiatric illness and Alzheimer disease may have difficulty paying attention. Frequent reminders help the patients to effectively participate in the group activity. The nurse should encourage the patients to talk and discuss among themselves rather than approaching the nurse. The nurse should point out the similarities between group members to help facilitate connections. It helps the patients to relate with each other and effectively communicate with the other members of the group. p. 613

Inpatients with serious mental illness are given group therapy. A nurse has been instructed to regularly check the members of the team and play a maintenance role. Which appropriate functions does the nurse perform? SATA a. Tries to mediate conflicts between members of the group b. Gives new ideas to effectively treat the patient in group therapy c. Encourages the members of the group to communicate with each other d. Shares opinions with the group members that can influence group values e. Seeks attention of the members by boasting and discussing achievements

ac. The responsibility of the nurse when playing the maintenance role is to encourage the members of the group to communicate with each other. It helps to have effective interaction with the patients and to know their feelings and perceptions. The nurse should try to reduce the conflicts between the members of the group and increase their problem-solving abilities. Seeking attention from the members by boasting and discussing achievements is an individual role where the nurse tries to be recognized for their achievements and hard work. It is not a part of the maintenance role. Sharing opinions with the group members is the function of task role and not included in the maintenance role. Giving new ideas or a fresh outlook is a task role and not a part of the maintenance role. It helps to identify the patients' perceptions and feelings and to plan the task according to the patients' needs in order to get an effective outcome. p. 614, Table 34.3

Which situation is supportive of the laissez-faire leadership style? SATA a. Group objectives allow for a variety of strategies. b. Group effectiveness depends on group interaction. c. Group dynamics present with a self-directed group. d. Group focus is that of supporting individual creativity. e. Group members are of varying cognitive functioning levels.

acd. There are three main styles of group leadership, and a leader selects the style that is best suited to the therapeutic needs of a particular group. A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. In a creative group, such as an art or horticulture group, the leader may choose a flexible laissez-faire style, directing minimally to allow for a variety of responses. The autocratic leader exerts control over the group and does not encourage much interaction among members. Staff leading a meeting with a fixed, time-limited agenda may tend to be more autocratic. In contrast, the democratic leader supports extensive group interaction in the process of problem solving. p. 615

At a psychiatric mental health center, the case manager is assigning leadership roles to a group of nurses. What kinds of groups can be led by basic-level registered nurses? SATA a. Mindfulness group b. Psychodrama group c. Dual-diagnosis group d. Medication education group e. Bereavement support group f. Dialectical behavior treatment group

acde. Registered nurses with basic-level training (diploma, associate degree, or baccalaureate degree) may lead activity, educational, task, and support groups. They can lead psychoeducational groups. Examples of such groups are dual-diagnosis group, stress management groups like mindfulness group, and medication education group. They may also lead support and self-help groups such as bereavement support groups. Advanced practice nurses lead psychodrama and dialectical behavior treatment groups. p. 616, Table 34.5

What are the advantages of group therapy? SATA a. Feedback from peers b. Promotion of confidentiality c. Promotion of a feeling of belonging d. Treatment of multiple people at one time e. Promotion of independence in problem solving f. Provision of an opportunity to practice communication

acdf Feedback from peers, treatment of multiple people at one time, provision of an opportunity to practice communication, and promotion of a feeling of belonging are advantages of group therapy. Promotion of independence in problem solving and confidentiality are not advantages of group therapy. p. 611, Box 34.1

Which statement is true regarding the impact of a silent member of a therapy group? SATA a. The person's opinions and feelings are not expressed. b. The group's objectives are not important to the person. c. The group does not benefit from the person's feedback. d. The person is uninvolved or disinterested in the discussion. e. The silence contributes to a sense of mistrust among members.

ace. Patients who are silent in the group may be observing intently until they decide the group is safe for them, or they may believe they are not as competent as other, more assertive group members. Silence does not mean that the member is not engaged or involved, but it should be addressed for several reasons. The person who does not speak cannot benefit from others' feedback, and other group members are deprived of this group member's valuable insights. Furthermore, a silent group member may make others uncomfortable and create or contribute to a sense of mistrust among the group members. p. 618

Which statement is reflective of a group member assuming an unhelpful informal individual role? SATA a. "You all can do whatever you think is best." b. "Alright, what is the focus of today's meeting?" c. "I have a lot of experience with solving this type of problem." d. "Has everyone had the opportunity to express their opinions?" e. "I don't think that has anything to do with the issues we are discussing."

ace. Studies of group dynamics have identified informal roles that group members often assume, which may or may not be helpful in the group's development. The classic descriptive categories for these roles are task, maintenance, and individual roles. There are individual roles that have nothing to do with helping the group, such as blocking group discussions, boasting about experience and skills, and displaying disinterest in the progress of the group's work. Positive task roles keep the group focused on its main purpose and get the work done. Maintenance roles keep the group together, help each person feel worthwhile and included, and create a sense of group cohesion. p. 614, Table 34.3

The nurse is planning a dual-diagnosis group. Which patient is appropriate to include in this group? a. A patient diagnosed with Alzheimer disease and depression b. A patient diagnosed with bipolar disorder and methamphetamine abuse c. A patient diagnosed with anorexia nervosa and dependent personality disorder d. A patient diagnosed with avoidant personality disorder and generalized anxiety disorder

b. Dual-diagnosis groups incorporate learning about co-existing mental illnesses and substance use disorders. The goals are to engage patients in treatment to decrease their use of substances in a systematic, meaningful process and improve psychiatric symptoms. Alzheimer disease, depression, anorexia nervosa, dependent personality disorder, avoidant personality disorder, and generalized anxiety disorder present psychiatric illnesses but not substance abuse problems. p. 616, Table 34.5

At what phase of group development would the nurse hear the following interchange? Patient 1: "I do not feel comfortable here." Patient 2: "I wonder what we are supposed to talk about." Patient 3: "Let's ask the leader to explain things again." a. Working b. Orientation c. Termination d. Preorientation

b. During orientation, the members get to know one another. Initially, they experience anxiety and are unsure of the expectations. p. 613

A nurse manager instructs the nurse to conduct group therapy for outpatients with obsessive compulsive disorder (OCD). Which appropriate action does the nurse follow while conducting group therapy? a. The nurse encourages the patients to be in contact after therapy. b. The nurse conducts the therapy for the patients for a period of 2 years. c. The nurse frequently rotates the members of the group for each therapy. d. The nurse selects the patients with different levels of ego to form a group.

b. The group composition, needs, and treatment differ for outpatient and inpatient groups. Group therapy is given for an extended period of 2 years, or as long as required, for outpatients. It helps to achieve effective treatment outcomes. For outpatients, group therapy members having similar ego functioning and a homogenous level of thinking are selected to form a group. It helps to avoid conflicts among the group members and to encourage the members to support each other. The members of the group should be advised not to be in contact with the other group members after therapy as it can lead to personal involvement. The members of outpatient group therapy are stable and don't change therapies as they are self-referred and motivated. The members of inpatient group therapy change for every meeting due to their uncertain and contradictory behavior. p. 613, Table 34.2

A nurse has been instructed to give group therapy to patients with intellectual disabilities. The nurse follows a laissez-faire style of leadership and asks the patients to paint scenery during group therapy. Which appropriate action does the nurse follow while conducting the group therapy? a. The nurse gives clear directions to the patients while painting. b. The nurse allows the patients to paint anything during group therapy. c. The nurse advises the patients to interact with others to share their ideas. d. The nurse checks that the patients do not interact during the group therapy.

b. The three leadership styles a nurse can choose while conducting group therapy are autocratic leader, democratic leader, or laissez-faire leader. The laissez-faire leadership style is followed during group therapy which involves art. The nurse allows the patients to paint as they wish. It helps to explore their thoughts, perceptions, and feelings and effectively design the treatment. The nurse avoids giving directions to the patients during the therapy, as the patient may feel rejected and resist portraying feelings and perceptions. In democratic leadership, the nurse encourages the patients to interact with one another and share their feelings. In autocratic leadership, the nurse controls the patients and does not allow them to interact with one another. During group therapy like painting, the patients must not be advised and restricted from interacting with others. The nurse allows the patients to behave as they wish and the nurse must observe and document the patients' feelings and interpersonal skills. p. 615

A nurse leads a community meeting on an inpatient unit. What is the nurse's goal for this meeting? a. Teaching patients about ways to express anger b. Promoting and maintaining a therapeutic milieu c. Helping patients to express and resolve intrapersonal conflicts d. Teaching patients about the purpose and side effects of medication

b. With the promotion of patient rights and advocacy, a common group consistently held on inpatient units is the therapeutic community meeting. As every interaction occurring on an inpatient milieu has the potential to be therapeutic, the community meeting is the essential venue at which unit happenings are processed and integrated into treatment. Helping a patient express and resolve intrapersonal conflicts is the goal of individual psychotherapy. Teaching patients about medication or ways to express anger are goals of a psychoeducational group. p. 616, Table 34.5

In the context of group therapy, what term is used for recurring ideas or feelings expressed by the members that share a common thread? a. Group norm b. Group theme c. Group content d. Group process

b. During group discussions, members may express ideas or feelings that recur and share a common thread. This is referred to as the , which provides a direction to the group. Group content refers to all that is said in the group. Group norm is the term for the group-specific rules that develop over time. These are the expectations of behaviors from the group members. Group process refers to how the group's members work together towards a common aim. It describes the dynamics of interaction among the members. p. 612, Box 34.2

The nurse plans to give dialectical behavior treatment to patients with borderline personality disorder. What appropriate action does the nurse perform? SATA a. The nurse encourages the patients to act out any memorable experience. b. The nurse teaches the techniques of mindfulness to the patients in the group. c. The nurse advises the patients to not observe the other members of the group. d. The nurse gives repeated instructions to the patients while doing the group activity. e. The nurse avoids giving choices to the patients while doing a task in the group activity.

bc. Dialectical behavior treatment is a type of group psychotherapy that is used for patients with borderline personality disorder. In this group therapy, the patients are advised not to observe other members of the group. The therapy is focused on making the patients accept themselves rather than comparing themselves to others. The patients are taught mindfulness techniques. That helps the patients to focus on the present and effectively participate in the given group task. In psychodrama group, the nurse teaches the patients how to act in real life situations through role play. The patients are given situations in which they act and learn how to respond to circumstances. The nurse gives options and asks the patients to select any one of them while doing a task. It helps to develop decision-making ability in the patients. The nurse avoids giving repeated instructions to the patients, as it can make the patients irritated and aggressive. p. 616, Table 34.5

The nurse is conducting group therapy for the patients who were victims of sexual abuse. The nurse finds a patient is silent and does not interact much with the members of the group. What appropriate action does the nurse take for effective interaction with the patient? SATA a. The nurse asks open-ended questions. b. The nurse gives the patient time to think. c. The nurse divides the group members into pairs. d. The nurse addresses the silent patient separately from the group. e. The nurse ignores the silent member and focuses on other group members.

bcd. During a group therapy, patients remain silent until they develop trust in the group members and the nurse. The nurse should encourage the patients to interact and effectively participate in the tasks by giving ample time for the patients to think and respond. The patients must be given time to organize their thoughts and feelings. The nurse should interact with the patients individually and should try to find the reason for this patient's silence. The nurse should encourage the silent members to participate in the task by dividing the group members into pairs. The patients may be motivated by observing their partners' active participation in the task. The nurse should not simply ignore the silent patients because silent group members do not benefit fully from group therapy and may make other members uncomfortable. The nurse can ask closed-ended questions to the patients who are not responsive as some patients are reluctant to respond to open-ended questions and will give vague answers like, "I don't know." pp. 617-618

The nurse recognizes that which of the following describes a closed group? a. Will demonstrate cohesiveness b. Will discuss topics that will be restricted c. Will not add new members once it is formed d. Has a membership that is limited to one gender

c. A closed group is one to which no members are added once the group has begun. Discussing topics that will be restricted, having a membership that is limited to one gender, and demonstrating cohesiveness may or may not be characteristics of the group. p. 612, Box 34.3

A veteran nurse has been asked to lead an art therapy group in the therapist's absence. After determining no tools in the room are harmful, the nurse tells the group to create whatever they like using whatever tools they choose. What type of leadership is this? a. Autocratic b. Democratic c. Laissez-faire d. No leadership style

c. A laissez-faire leadership style involves very little control by the leader. This style would not be optimal for all therapeutic sessions, but works well with creative endeavors. Autocratic style is the least likely style to use in psychotherapy, as the leader controls the situation and discourages interaction among members. Democratic leadership includes extensive group interaction and is the most common form of leadership in psychotherapy. The nurse is the leader even if he or she is not exerting a large amount of influence. p. 615

A patient is describing a traumatic and painful experience to members of a therapeutic group. Which communication technique should the nurse discourage? a. Support b. Empathizing c. Confrontation d. Active listening

c. Confrontation should be avoided after a difficult disclosure. The nurse should guide the group in empathy, active listening, and support. p. 617

In group therapy for patients with bipolar disorders, when one member leaves the group, another is added to maintain the number of members at 15. How does the nurse describe the membership of the group? a. Subgroup b. Closed group c. Homogeneous group d. Heterogeneous group

c. Sometimes group therapy is planned for outpatients by careful selection based on particular characteristics among the group members, such as a similar diagnosis. Such a group is homogeneous. A subgroup is a smaller group that is isolated within a larger group. For example, within a creative group focusing on music, there may be different subgroups which focus on instrumental and vocal music. Membership in a closed group is restricted. New members are not added if others leave. Such groups are helpful where there is fixed schedule to follow and addition of a new member may disrupt the group's functioning. Heterogeneous groups generally consist of members with many differences. An exercise group with members from different age groups who may be obese or thin, hypertensive or arthritic or diabetic, is an example of a heterogenous group. p. 612, Box 34.3

A patient diagnosed with borderline personality disorder who is attending a court-ordered therapy group projects an angry affect. The patient doesn't speak much, but when he or she does it is usually to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this? a. Remove the patient from the group because he or she is disrupting the group process for other participants. b. Spend one entire group session focused on the patient and try to get him or her to open up to other members in depth. c. Respond neutrally to the patient's comments, ask for group feedback, and talk to him or her privately to form a connection. d. Confront the patient firmly each time he or she makes a rude comment and let the patient know he or she will be taken out of group if this behavior continues.

c. The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger to form a connection with the patient, which may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile patient. p. 618

Group therapy is a mainstay of inpatient psychiatric treatment. Which statement best describes how this approach came to be used? a. Group therapy was initiated to contain costs. b. Group therapy assures patient confidentiality. c. Group therapy was initially used to treat veterans. d. Group therapy was initially used for patients in drug treatment programs.

c. Group therapy was initially used to maximize the number of patients who could be treated at one time as the result of veterans returning from the First and Second World Wars. Group therapy may affect cost as it requires fewer healthcare professionals to manage, but this was not the main reason it began. Group therapy is a staple in drug treatment programs, but this was not the first population treated with it. One of the potential drawbacks to group therapy is the lack of confidentiality among members of the group. p. 611

A primary healthcare provider instructs the nurse on how to conduct group therapy for psychiatric patients. Which appropriate action does the nurse follow for effective group therapy? a. The nurse arranges the seats in rows of different height. b. The nurse plans similar group activities for the outpatients and inpatients. c. The nurse includes the patients having common psychiatric illness in a group. d. The nurse makes small groups and conducts activities in a large, spacious room.

c. Patients with similar mental illnesses should be in the same group to help the nurse plan the most appropriate group activity for them. The patients can share their life experiences, feelings and concerns. The nurse should conduct group activities in appropriate surroundings. The nurse should not conduct therapy for a small group in a spacious room, as the nurse cannot concentrate on the patients, and the patients may become distracted. The seating arrangements for the group must be done in a circle, as it conveys equality among the members of the group and the leader. Arranging the seats at different heights can make the patient feel different from other members of the group. The nurse should not follow similar group activities for outpatients and inpatients, as the needs of inpatients are significantly different from the outpatients. p. 611, Box 34.1

The nurse is conducting cognitive therapy for patients with acquired immune deficiency syndrome (AIDS). Which response is appropriate when conducting this therapy? "I know it is difficult to discuss your illness, but it is part of the treatment." "Please share your feelings with me instead of discussing among yourselves. I can help you." "You will be a healthy person very soon and can get back to your work after the treatment." "It takes a lot of courage to explore these problems. You are working hard to resolve these problems."

d. A nurse acting as group leader should effectively communicate with the patients in the group and support them. The nurse's response that it takes a lot of courage to explore the problems indicates that the nurse is giving support to the patients. The nurse's response of offering help and encouraging them to share their problems with the nurse is not appropriate. The nurse is following autocratic leadership style when instructing the patients to avoid interacting with each other. In cognitive therapy, the nurse follows a democratic leadership style and encourages the patients to share their feelings. The statement that the patient will be a healthy person very soon indicates that the nurse is giving false assurance and hope to the patient. The statement that it is difficult to discuss about your illness indicates that the nurse is more concerned with completing the treatment rather than the patient's feelings. p. 617, Table 34.6

When conducting group therapy for narcissistic personality disorder patients, the nurse takes up the task role of an energizer. What specific task role does the energizer perform? a. Measure the group's work against objectives b. Try to preserve group harmony during conflicts c. Attempt to mediate conflicts between the members d. Encourage the group to make decisions or take action

d. As an energizer, the nurse encourages the group to make decisions or take action. Generally, the evaluator measures the group's work against the objectives set. Mediating conflicts between the members is not a task role. It is a maintenance role where the nurse acts as a harmonizer. In the maintenance role of a compromiser, the nurse tries to preserve harmony within the group whenever there is a conflict. p. 614, Table 34.3

The group goals are to learn to express feelings comfortably rather than keep them covert. When a group member shares with the group how expressing these feelings make him or her feel, the patient is engaging in which of the following? a. Subgrouping b. Confrontation c. Group content d. Providing feedback

d. Feedback includes letting the group know how they and the comments made in group make the individual feel. This is the only option that accurately describes the sharing of expressed feelings; group content, confrontation, and subgrouping are incorrect. p. 612, Box 34.2

A primary healthcare provider is planning group therapy for a group of aggressive people who show anger and anxiety. What treatment group would be most appropriate? a. Dual-diagnosis b. Health education c. Stress management d. Symptom management

d. If the members of the group are of similar symptoms, they can be well managed under in a group. The members can share their experiences and learn from one another. Symptom management groups are ideal for such members. Health education groups deals with educating the group members about comorbid chronic medical illnesses. Dual-diagnosis groups are groups which take care of the members with coexisting mental illness and drug or substance abuse. Stress management groups are not limited to any single symptom. They teach members about relaxation techniques to manage stress. p. 616, Table 34.5

The nurse closes a group therapy session by talking about every important issue, individual achievements, and learning. What communication technique does the nurse use? Reflection Clarification Confrontation Summarization

d. In group therapy, nurses use various communication tools and techniques. Here, the nurse is talking about the key things that happened during that therapy session, and about what the members have learned during the session. This is summarization. Confrontation is about encouraging the group members to explore the difference in thoughts and behaviors. Reflection deals with communication by sharing of feelings. Clarification is a technique where the nurse asks the members to properly expand and explain what they said during a conversation. p. 617, Table 34.6

During a group therapy session, a therapist helps the members to understand conflicts they were unaware of earlier and encourages peer feedback. What theoretical foundation does the nurse identify as the basis of this group therapy? a. Existential b. Interpersonal c. Communication d. Psychodynamic

d. Psychodynamic theory is based on Freud's concepts of psychoanalysis. The focus of this theory is unconscious conflicts and transference. The goal is to help the members develop insight to the conflicts they were unaware of earlier. By using the interpersonal theory, the therapist helps to reduce anxiety and encourages members to validate their feelings and thoughts with each other and rebuild their personality. By using the communication theory, the therapist helps the members to identify confusing or contradictory messages and learn clear communication skills. The existential theory puts more emphasis on the "what" of behaviors than on the "why" of behaviors and helps the members to reach their own full potential. p. 615, Table 34.4

A therapeutic group leader notices that while one member in the group talks at length about his own personal life, the others get bored and drift off. What statement by the leader is most appropriate in such a situation? a. "Why do you talk so much? Are you nervous about something?" b. "You are talking for a long time. Now please give others a chance." c. "You have been talking for 20 minutes now. Others are getting bored." d. "I feel you have a lot to say, but we must give others a chance as well."

d. The excessively talkative member is monopolizing the group by talking at length. The member will feel less defensive when the leader uses "I feel . . ." sentences rather than "You are . . ." sentences. Telling the member right away that others are getting bored by such lengthy talks may seem like the leader is putting the blame on the member. The member may become defensive if the nurse confronts him directly in a group setting and asks about his nervousness. When the nurse tells the member to give others a chance, the member may stop talking at length. But starting the sentence with "You are talking . . ." may make the member feel defensive as the member might think the nurse is accusing him of wrongdoing. p. 617

A patient has been enrolled in group psychotherapy. What feature about the group is appropriate? a. Therapeutic groups manage patient governance and advocacy matters. b. Basic-level registered nurses can be leaders of such therapeutic groups. c. Group psychotherapy is helpful when individual psychotherapy is unsuccessful. d. The purpose of group psychotherapy is to treat those with psychiatric disorders.

d. The main aim of group psychotherapy is to treat those with psychiatric disorders. Patient governance and advocacy matters are managed in therapeutic community meetings. Basic-level registered nurses cannot become leaders of such groups. Since this group is used to bring about personality changes, only a trained leader (often an advanced practice nurse) can lead such a group. Group psychotherapy is conducted concurrently with individual psychotherapy. p. 616, Table 34.5

A new member has joined the group after being part of another therapeutic group. The patient is very quiet for the first few meetings. How should the nurse manage this silence? a. Ignore the patient until he or she decides to speak. b. Keep questioning the patient about his or her reluctance to share. c. Ask the patient bluntly how he or she expects to improve with no input. d. Consider giving a writing assignment for everyone in the group to share.

d. The patient's silence may mean that the patient is determining the safety of this new group. Asking everyone to answer the same question or write on the same topic can encourage participation from a new member. Ignoring a patient is not only unhelpful, it's unethical. Some people do advocate confrontation as a communication technique, but that is generally helpful only if a level of trust has been established. Repeated questioning will likewise yield no better results. p. 618

During a group therapy, a member does not show concern for others and talks back to the nurse. The member refuses to take any personal responsibility for his actions. What type of behavior does the member exhibit? a. Silent b. Complaining c. Monopolizing d. Demoralizing

d. There are patients who are self-absorbed and angry, with no consideration for others. These people are demoralizing members who do not take any responsibility for their wrongdoings. Silent members generally do not express their feelings, and may or may not mingle with the group. Complaining members are the ones who keep complaining about their problems but avoid or reject the help. Monopolizing members are extremely talkative and do not give others a chance to be heard. p. 618

A patient with tenacious suicidal behavior has been advised dialectical behavioral treatment (DBT). What does the nurse need to know about DBT? a. The patient is encouraged to observe others in the group. b. The patient is seen by the therapist for DBT once every day. c. Treatment can be provided by a basic-level registered nurse. d. Emotional skills can be improved, leading to reduced risk of self-destructive behavior.

d. DBT improves interpersonal, behavioral, cognitive, and emotional skills, and reduces self-destructive behaviors. The patient is seen for DBT every week rather than once every day. The patients are discouraged from making observations about others in the group. Instead, they are encouraged to consider everything that is presented in the group in terms of their own use of skills, emotional challenges, and areas of growth. The treatment is provided by those with specialized training and advanced education such as advanced practice registered nurses. Basic-level nurses do not lead such psychotherapy groups. p. 616, Table 34.5

A therapeutic group is in its working phase. What does the nurse identify as the most appropriate role of the group leader during this phase of the group development? a. Point out similarities between the members b. Encourage members to get to know each other c. Help members to identify post termination goals d. Help members to gain confidence in problem-solving

d. During the working phase, the group leader encourages the members to focus on problem solving, and guides and supports them in conflict resolution. Through successful conflict resolution, the members gain confidence in problem-solving activities. In the orientation phase, the members may be excessively silent or overbearing because they are yet to establish trust with one another. The leader encourages them to get to know each other by pointing out the similarities between the members. In the termination phase, the leader encourages members to reflect upon the progress of the group and helps the members to identify the post termination goals. p. 613