Psych Exam 2 - Ch. 34 (Therapeutic Groups)

A nurse is the leader for a medication group for patients diagnosed with bipolar disorder. No new patients will be added as the group progresses, and so the group is considered which of the following?

Closed A closed group admits no new members. p. 612, Box 34.3

A patient is describing a traumatic and painful experience to members of a therapeutic group. Which communication technique should the nurse discourage?

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

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?

Consider giving a writing assignment for everyone in the group to share. 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?

Demoralizing 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

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?

Encourage the group to make decisions or take action 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

What is the group leader's responsibility in the termination phase?

Encouraging group members to reflect on progress made. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify post termination goals. Contact with other members in the group outside of the group is not therapeutic and usually is discouraged. The group leader does not remove him- or herself from the group process. Group members do not fill out evaluation forms in group therapy. p. 613

The nurse is a group leader for an inpatient therapeutic group. When compared to an outpatient group, what does the nurse identify as the benefits of an inpatient group?

Extra group contact is endorsed. An inpatient therapeutic group endorses extra group contact. The patients eat, sleep, and live together in the inpatient unit. In outpatient groups, the patients are carefully selected. In an inpatient group, the patients are admitted with little prior selection, as they are taken from those who are admitted to that inpatient unit. In outpatient groups, the patients are highly motivated as they are self-referred. In inpatient groups, the members may be hesitant as therapy is often compulsory for them. Inpatient groups do not have a stable composition, as the group is rarely the same for more than one or two meetings. p. 613, Table 34.2

When the group leader suggests that a patient, "Choose the problem that is troubling you most at this time and tell us about it," the leader is promoting which of the following?

Focusing Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time. p. 616, Table 34.5

Group therapy is a mainstay of inpatient psychiatric treatment. Which statement best describes how this approach came to be used?

Group therapy was initially used to treat veterans. 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

The nurse follows existential theory while conducting group therapy for patients with obsessive compulsive disorder. Which appropriate action does the nurse take according to the theory?

Helps patients to focus on their feelings to promote self-learning According to existential or gestalt theory, the nurse helps the members to acknowledge their problems and promotes self-learning. It helps to improve the patients' decision-making ability. According to interpersonal theory, the nurse should act as a role model. It helps the patient to reduce anxiety by showing an appropriate response to stressors. According to the theory of group process, the nurse encourages the patient to interact with other members of the group. It helps patients learn how to effectively share their feelings. According to psychodynamic theory, the nurse encourages the patient in resolving conflicts. It enhances the problem-solving ability of the patient. p. 615, Table 34.4

Which statement is not true regarding self-help and support groups?

Professional leadership is inappropriately expensive for treatment of minor problems. Self-help and support groups do not exist to address minor problems. Problems successfully treated by self-help and support groups include addictions, eating disorders, and adjustment to life changes caused by major illnesses. Being able to help others with the same problem, promoting of dialogue, self-disclosure, and encouragement, and self-help and support groups designed to serve people with a common problem are true statements regarding self-help groups. p. 616, Table 34.5

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?

Reflection 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

A person diagnosed with anxiety is enrolled in a stress management group. What activity should the person expect in such a group?

Teaching spirituality as a relaxation technique 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

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?

The nurse allows the patients to paint anything during group therapy. 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 patient has been enrolled in group psychotherapy. What feature about the group is appropriate?

The purpose of group psychotherapy is to treat those with psychiatric disorders. 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

When planning a group therapy, what does the group leader need to keep in mind about the place where the group shall meet?

The seats should be arranged close to each other. 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

The nurse is co-leading a therapeutic outpatient group. What difference does the nurse note in an outpatient group compared to an inpatient group?

There are few external influences. 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

While conducting group therapy for patients in the working phase, the nurse observes some progress in the group interaction. What observation by the nurse indicates that the group can now share what they have learned?

They show some confidence and start supporting each other. In the working phase, the group leader encourages the group members to share their differences and growth is based on conflict resolution and how the group members learn to support each other. That helps to improve the members' individual confidence. When members complain about others in the group, by pointing out their errors, it is not a sign of growth. It is not the members who decide if they are ready for the next phase of the group therapy. It is the leader who decides that. The group members' opinion about their own progress is not as important as the leader's observation of a change and ability to resolve conflicts and support others. p. 613

The nurse recognizes that which of the following describes a closed group?

Will not add new members once it is formed 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

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?

Working phase 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 leader opens the discussion at the first meeting of a new group. Which comment would be appropriate for this phase?

"Let's begin by establishing the ground rules for our group." 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

When evaluating members of a therapeutic group, what statement by a member does the nurse identify as being consistent with monopolizing behavior?

"Please keep quiet and just listen to what I am saying." 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 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?

"What you are thinking is very important to the group." 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

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?

"You have been sitting quietly. What are your thoughts or feelings?" 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

A patient is scheduled to start group therapy today. The patient asks, "What does group work mean? My healthcare provider said I would be going to group and doing group work." How does the nurse best respond?

"You will give and receive feedback from a group of your peers who also may 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. Finding solutions for each other's problems, splitting up to work separately on solutions, and doing work beforehand do not describe group work. p. 612, Box 34.2

Which statement made by the nurse leader is associated with issues addressed during the orientation phase of group development? (SATA)

-"We will all be respectful of each other's opinions." -"We are expected to talk to each other, not at the group's leader." -"Trusting each other is extremely important to the success of this group." -"What is expressed here in the group will not be discussed outside the group." All groups go through developmental phases. In the orientation phase, the group is forming. The group leader's role is to structure an atmosphere of respect, confidentiality, and trust. The purpose of the group is stated, and members are encouraged to get to know one another and to establish trust with one another. Therapeutic interaction is supported when the group leader encourages the group to talk directly to each other rather than to the leader, and reminds members about ground rules for respectful, meaningful interaction. Actual problem solving does not occur in this phase. p. 613

Which statement is reflective of a group member assuming an unhelpful informal individual role? (SATA)

-"You all can do whatever you think is best." -"I have a lot of experience with solving this type of problem." -"I don't think that has anything to do with the issues we are discussing." 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

A nurse working on an inpatient unit considers patients for a new therapy group. Which patient should the nurse include? (SATA)

-A patient who self-isolates. -A patient who seldom speaks but usually listens to others. Patients who self-isolate or have difficulty with self-expression benefit from a group by providing a safe setting to try new ways of relating to other people, practicing communication skills, and promoting a feeling of belonging. Not all patients benefit from group treatment, including a patient with impending discharge. Until symptoms stabilize, persons who are acutely psychotic, acutely manic, or intoxicated are unable to interact effectively in group and may interfere with other members' ability to remain focused on group goals and progress. In this question, a patient with delusions and flight of ideas, usually resulting from mania, should not be included in the group. pp. 611-612

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? (SATA)

-Boasting of and discussing their own achievements -Flattering other members of the group with compliments 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

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)

-The nurse gives the patient time to think. -The nurse divides the group members into pairs. -The nurse addresses the silent patient separately from the group. 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

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)

-The nurse states the purpose of the group to the patients. -The nurse frequently reminds the patients about the group rules. -The nurse introduces him or herself and the patients to one another. 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

The nurse plans to give dialectical behavior treatment to patients with borderline personality disorder. What appropriate action does the nurse perform? (SATA)

-The nurse teaches the techniques of mindfulness to the patients in the group. -The nurse advises the patients to not observe the other members of the group. 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

Which statement is true regarding the impact of a silent member of a therapy group? (SATA)

-The person's opinions and feelings are not expressed. -The group does not benefit from the person's feedback. -The silence contributes to a sense of mistrust among members. 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 scenario would most likely have ethical consequences?

A patient is overheard on the phone discussing another group member. Although each scenario has challenges and can lead to ethical quandaries, the most likely to have ethical consequences is the discussion of one patient's behavior and care with someone not authorized to receive such information. Two group members discussing a third may not be ideal, but it is less likely to be deemed unethical since they are all part of the same group. Therapists can and often do discuss behaviors with a patient's family, but only if approved by the patient. A patient has the right to decline any form of therapy assuming he or she is fully competent. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 616

At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed?

At the first session 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