Halter Ch 34 - Therapeutic groups

3. What advantages does group therapy have over individual therapy? Select all that apply. a. Groups are less expensive than one-on-one therapy. b. Groups provide an opportunity to learn from others. c. Groups are homogeneous in composition. d. Feedback is available from the group leader and group members. e. Interpersonal skills can be practiced in a safe environment.

a. Groups are less expensive than one-on-one therapy. b. Groups provide an opportunity to learn from others. d. Feedback is available from the group leader and group members. e. Interpersonal skills can be practiced in a safe environment. Advantages of therapy groups: (1) multiple members can be in treatment at the same time, thereby reaching more patients and reducing personnel costs. (2) members of therapeutic group benefit from knowledge, insights, and life experience of both the leader and the participants. (3) a therapeutic group can be a safe setting to learn new way of relating to other people and to practice new communication skills. (4) groups can promote feelings of cohesiveness.

7. The advanced practice nurse is assigned a group of patients. Which patient would not be appropriate to consider for inpatient group therapy? (Select all that apply.) The patient who a. Has limited financial and social resources b. Is experiencing acute mania c. Has few friends on the unit d. Is preparing for discharge tomorrow e. Does not speak up often yet listens to others

b. Is experiencing acute mania This patient may need immediate one-on-one treatment and may be disruptive in a group therapy setting.

5. The nurse describes the purpose of psycho-educational groups as providing group members with the knowledge and skills necessary to manage psychiatric symptoms. Which phase of group development is represented? a. Planning (formation) phase b. Orientation phase c. Working phase d. Termination phase

b. Orientation phase During the first session in the orientation phase, the group leader begins by providing a personal introduction. The members are encouraged to get to know one another through their own introductions. The leader then describes the purpose of the group.

9. A patient continues to dominate the group conversation despite having been asked to allow others to speak. What is the group leader's most appropriate response? a. "You are monopolizing the conversation." b. "When you talk constantly, it makes everyone feel angry." c. "You are supposed to allow others to speak also." d. "When you speak out of turn, I am concerned that others will not be able to participate equally."

d. "When you speak out of turn, I am concerned that others will not be able to participate equally." The leader can encourage the use of statements that do not focus on "what" the other one did but on the "how," such as "When you speak this way, I feel sometimes..." The leader helps by noting that feelings are not right or wrong; they simply exist. People tend to feel less defensive when I feel statements rather than you are statements are used.

2. When a group member supports and encourages another group member and feels "good" about doing so, which group phenomenon is being demonstrated? A. Altruism B. Catharsis C. Cohesiveness D. Instillation of hope

A - Altruism Altruism involves putting another's needs before one's own. This is the only option that correctly identifies with the example provide in the question.

8. 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 client is interviewed

A - At the first session Confidentiality is part of the ground rules that are established at the beginning of the group sessions.

7. Which group phase is most influenced and managed by the group leader? A. Orientation B. Working C. Termination D. Post-termination

A - Orientation The group leader often is most directive in the orientation phase, in which roles and ground rules are set. No other phase is so managed by the leader.

5. What are the advantages of therapy groups? (Select all that apply.) A. Feedback from peers B. Treatment of multiple people at one time C. Promotion of independence in problem solving D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging F. Promotion of confidentiality

A. Feedback from peers B. Treatment of multiple people at one time D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging All these options are advantages of groups. Since the members openly discuss and provide feedback, confidentiality is not possible.

5. Sharing similar experiences in a group setting is referred to using which term? A. Universality B. Imparting information C. Socializing D. Catharsis

A. Universality The phenomenon of understanding that one's problems are not unique helps group members feel secure and understood and is an example of universality. No other option is used to describe this group behavior.

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

B - Orientation During orientation the members get to know one another. Initially, they experience anxiety and are unsure of the expectations.

1. A client on the psychiatric unit asks the nurse, "What does group work mean? I was told I would be going to group and doing group work." How should the nurse respond to provide the best answer to the client's question? A. "You will attend group therapy and find solutions for each other's problems." B. "You will give and receive feedback from a group of your peers who may also have similar problems to work through." C. "You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide." D. "Group work is the work that you do beforehand so you can present it to the group when you meet."

B. "You will give and receive feedback from a group of your peers who may also have similar problems to work through." Group work is a method whereby individuals with a common purpose come together and benefit by mutually giving and receiving feedback within the dynamic and unique group context. None of the other options accurately and adequately describe group work.

3. When the group leader suggests that a client "choose the problem that is troubling you most at this time and tell us about it." The leader is promoting what action? A. Insight B. Focusing C. Reframing D. Feedback

B. Focusing Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time. None of the other options are associated with selecting a particular focus.

4. 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 makes her feel, she is engaging in what activity? A. Group content B. Confrontation C. Subgrouping D. Providing feedback

D - Providing feedback Feedback includes letting the group know how they and the comments made in group make the individual feel. This form of sharing is not associated with any of the other options.

4. A patient diagnosed with borderline personality disorder is attending a court-ordered therapy group. The patient projects an angry affect, does not speak much, except 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 patient's behavior? A. Remove the patient from the group because this behavior is disrupting the group process for other participants. B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. C. Spend an entire group session focused on that patient and try to get him/her to open up to other members in depth. D. Confront the patient firmly each time he/she makes a rude comment and let him/her know they will be taken out of group if the behavior continues.

B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. 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 that 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 client.

5. A democratic group leadership style is most appropriate for which purpose? A. 30-minute meetings to discuss unit rules B. Creating meaningful trauma-related artwork C. A group directed toward anger management D. The organization the unit's holiday celebration

C - A group directed toward anger management Democratic leadership is best implemented when extensive group interaction is devoted to problem solving. None of the other options is problem solving in its focus.

6. The nurse reading in a group's protocol notes that it is a closed group understands that the group demonstrates which characteristic? A. Discussion topics will be restricted. B. Membership is limited to one gender. C. No new members will be allowed. D. The group is focused on demonstrating cohesiveness.

C - No new members will be allowed A closed group is one to which no members are added once the group has begun. The term closed does not refer to any of the other options.

3. When a client is encouraged to talk with others who have had similar problems, the nurse is suggesting a which type of group? A. Cognitive-behavioral B. Time-limited C. Support group D. Milieu group

C - Support Group Support groups are composed of members who have had or are currently sharing similar experiences, such as a bereavement group or a group of women with breast cancer. None of the other options have this specific purpose as its focus.

1. Which phase of group therapy does the group deal with feelings associated with separation and loss? A. Orientation B. Working C. Termination D. Post-termination

C - Termination 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. None of the other options are focused on the emotions associated with the ending of the group experience.

3. What is the group leader's responsibility in the termination phase? A. Allowing members to exchange contact information so they may remain as a support for each other. B. Removing himself or herself from the group so they can function independently. C. Encouraging group members to reflect on progress made while providing group feedback. D. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

C. Encouraging group members to reflect on progress made while providing group feedback. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify posttermination goals. Contact with other members in the group outside of the group is not therapeutic and is usually discouraged. The group leader does not remove himself or herself from the group process. Group members do not fill out evaluation forms in group therapy.

4. When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior using which term? A. Confronting B. Blocking C. Subgrouping D. Imitating

C. Subgrouping 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. None of the other options are associated with behavior.

7. What response demonstrates an effective strategy to encourage a nonparticipating member to speak during a group session? A. "You are letting the group down when you fail to contribute." B. "Your opinions about what just happened are important." C. "You must be feeling safe enough to enter the discussion by now." D. "What you are thinking is very important to the group."

D - "What you are thinking is very important to the group." The incorrect options place the client on the defensive and encourage further withdrawal. The correct option is less threatening. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions.

2. When a member tells the group, "I think the committee saw how unsure of myself I am. I felt all shaky inside during the promotion interview, just like I am feeling and acting right now." To present reality the leader should provide which response? A. Remain silent and nod slightly to signal that the client should continue. B. Say, "Tell us more about how you are feeling." C. Ask, "Does this shaky feeling occur often?" D. Ask the group to give feedback about how the client appears to them.

D - Ask the group to give feedback about how the client appears to them. This option is the only one that will result in present reality. The client will learn more about the reality of how he appears to others. The remaining options either give encouragement to continue or seek additional information.

6. A key quality indicator that might be identified for successful outcome in a medication education group could be that clients will engage in which activity? A. Stating they respected the leader B. Demonstrating a bond among members of the group C. Describe modes of transmission of sexually transmitted diseases D. Confer with health care provider before changing medication regimen

D - Confer with health care provider before changing medication regimen The key quality indicator that relates to successful outcomes in a medication education group is the client's recognition of the need to discuss medication changes with his or her physician rather than adjusting the dose or stopping the medication without consultation. None of the other options are associated with the focus of medication education.

2. The advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic and makes no comment unless asked a direct question. What leadership style is the nurse implementing? A. Autocratic B. Authoritarian C. Democratic D. Laissez-faire

D. Laissez-faire 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 do not allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making.

8. Group members are having difficulty deciding what topic to cover in today's session. Which nurse leader response reflects autocratic leadership? a. "We are talking about fear of rejection today." b. "Let's go around the room and make suggestions for today's topic." c. "I will let you come to a conclusion together about what to talk about." d. "I'll work with you to find a suitable topic for today."

a. "We are talking about fear of rejection today." Autocratic leaders exert control over the group and do not directly encourage much interaction among members.

6. Group dynamics can vary widely, and sometimes members disrupt the group process. Which of the following participant traits may indicate a need for additional support for a new nurse facilitator? Select all that apply. a. A member with paranoid delusions b. A quietly tearful participant expressing suicidal thoughts c. An angry woman who raises her voice d. A calm but ineffective communicator

a. A member with paranoid delusions b. A quietly tearful participant expressing suicidal thoughts

4. What group would benefit most from a laissez-faire leader? a. Art group b. Grief group c. Social skills group d. Anger management group

a. Art group Laissez-faire leaders allow the group members to behave in any way they choose and do not attempt to control the direction of the group. In a creative group, such as an art group, the leader may choose a flexible laissez-faire style.

1. Which outcome would be appropriate for a group session on medication education? Select all that apply. a. Patient will identify three side effects of prescribed medication. b. Patient will verbalize the purpose of taking the medication. c. Patient will acknowledge and accept the financial cost of prescribed medications. d. Patient will correctly identify time of day and dose for each prescribed medication. e. Patient will list two potential drug-drug and drug-food interactions for prescribed medications.

a. Patient will identify three side effects of prescribed medication. b. Patient will verbalize the purpose of taking the medication. d. Patient will correctly identify time of day and dose for each prescribed medication. e. Patient will list two potential drug-drug and drug-food interactions for prescribed medications. For medication education groups, the expected outcome would be the demonstration of precise knowledge.

2. What question by the nurse leader is helpful in managing a monopolizing member of a group? a. "You seem angry. Is there something you want to discuss with the group?" b. "Would it be helpful if you had time to think about the question?" c. "Would you tell us about experiences that have frightened you?" d. "Who else would like to share feelings about this issue?"

d. "Who else would like to share feelings about this issue?" One subtle method in dealing with a monopolizing group member is to address the entire group. Disruptive member - Leaders empathize with the patient in a matter-of-fact manner, "You seem angry." Silent member - allow the person to have extra time to formulate thoughts "Would it be helpful if you had time to think about the question?"

10. The nurse is planning the care of patients on her unit, which includes a dual-diagnosis group. Which patient would be appropriate for this group? The patient with a. Major depression disorder and a history of recurrent suicidal ideation b. Generalized anxiety disorder and frequent migraine headaches c. Bipolar disorder and anorexia nervosa d. Schizophrenia and alcohol use disorder

d. Schizophrenia and alcohol use disorder Dual-diagnosis groups discuss comorbid mental illness and substance use disorders.