Mental Health Chapter 12: Group Interventions

A nurse is preparing to lead a newly formed group at the community mental health center. When setting the tone of the group, the nurse understands that it is the responsibility of which person?

Leader

The nurse is counseling a group of clients in a closed group system. The nurse should explain to the group members that one advantage of a closed group system is that the ...

participants become more cohesive as a group.

By analyzing the content and patterns of communication, the leader can determine the existence of what?

Pathways

A group member arrives at a group session visibly upset. The member is attending a medication group that meets once a week. The group leader observes the member's appearance. Which response by the leader would be most appropriate?

"I can see you're upset right now. Let's take some time to talk after group."

Individual psychotherapy consists of three phases. Which statement by the group therapist would reflect that the group is in the working phase of therapy?

"James, when Shane speaks, it seems you become angry and tend to withdraw."

A psychiatric-mental health nurse is planning to use reminiscence with a group of older adults. The nurse chooses this intervention for which reasons? Select all that apply.

- Identify previous coping strategies that can be useful now - Help promote self-esteem - Support the natural healing process of life review

A support group member talks at length about the situations that trigger the member's anxiety. Other group members offer thoughtful suggestions from time to time, and the member consistently agrees with them but then goes on to explain why they would be ineffective. What is the nurse leader's best action?

Ask the member to suggest specific alternatives to what the other members suggest

A psychiatric-mental health nurse will soon begin a medication group for clients who have been prescribed atypical antipsychotics. What is the nurse's best initial action?

Assess each member's knowledge of his or her drug regimen.

The working stage of group therapy is marked by which characteristic?

Conflict and cooperation among group members.

A psychiatric-mental health nurse practitioner is conducting a psychotherapy group and applying Yalom's model of psychotherapy. The nurse integrates understanding of this model, emphasizing the importance of which aspect?

Development of interpersonal relationships

A nurse is planning to start a new group on the unit. To ensure a well-functioning and successful group, the nurse needs to consider individual suitability for membership and consider:

Does the purpose of the group match the treatment goals of the potential member?

A psychiatric-mental health nurse is conducting a medication group for clients at the health center on the use of herbal supplements with psychopharmacological agents. When developing and leading the group, which aspect would be most important for the nurse to employ?

Encouraging members to write down information to aid in remembering

Which action by the group leader demonstrates effective leadership?

Encouraging participation by all members - The key to being a good leader is to integrate group leadership, knowledge, and skills with nursing interventions that fit a selected group. Firmly disciplining negative behavior, using autocratic leadership strategies, and conducting meetings based on personality attributes are not keys to being a good leader.

Several members of a self-help group are making T-shirts for the group to wear in a parade. This is an example of which element of group therapy?

Group cohesiveness -Group cohesiveness is the development of a strong sense of group membership and alliance. Catharsis involves members relating to one another through the verbal expression of positive and negative feelings. Altruism is the process in which clients have the experience of learning to help others, and in the process, they begin to feel better about themselves. Universality can be defined as the sense of realizing that one is not completely alone in any situation.

Which is the interaction that moves the group toward its goals?

Group process

Which of the following is an example of a verbal communication technique?

Group theme

During a group session, a nurse leader observes a member look down at the floor and change position in the chair, each time the topic of anger and violence comes up. The nurse leader says to the member, "I've noticed that any time the discussion involves anger and violence you look away and change your position. Is something going on?" The nurse leader is using which technique?

Reflecting behavior

During which group may the client learn how to avoid relapse?

Symptom management

A psychiatric-mental health nurse is leading a recovery-oriented group for patients diagnosed with severe and persistent mental illness. The group is focusing on learning about symptoms suggesting that a relapse is about to happen and how to avoid relapse. The nurse is most likely leading which type of group?

Symptom management group

During which stage of group development may the group grieve the loss of group cohesiveness?

Termination

Which of the following is accurate when dealing with older people in groups?

The pace of the group should be slowed because of possible memory deficits

A group is trying to handle issues related to dominance, control, and power within the group. In what stage of group development is this group?

Working

A basic function of psychiatric nurses is to implement a group that focuses on helping individuals coping with their illness. This refers to ...

a supportive therapy group. - Supportive therapy groups are usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems as well as build interpersonal connections. Implementing supportive therapy groups is one of the basic functions of the psychiatric nurse.

According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others?

altruism - Altruism is learning to give to others. Universality refers to finding out that others have similar problems. Catharsis is the open expression of affect to purge or "cleanse" oneself. Group cohesiveness is the group members' relationship to the therapist and other group members.

During a group therapy session, a nurse restates the interaction with the client to check the client's meaning. The nurse is using which technique?

clarification -When the nurse uses clarification, the nurse is restating the interaction to check the meaning of the interaction and communication. Summarizing is the use of statements at the end of sessions that highlight the session's discussion, any problem resolution, and unresolved problems. Support is the giving of feedback that provides a climate of emotional support. Confrontation is challenging a participant to help the individual learn something about himself or herself.

A nurse leading group therapy identifies an individual's participation of self-disclosure with personal problems that are inconsistent with the purpose of the group. Which action by the nurse would be most appropriate?

limit repeated episodes and redirect discussion.

Group themes reflect the underlying concerns or feelings of the members. Identification of group themes is important for ...

understanding the group dynamics.

A group has formed and is going through the phases of group development. The nurse leading the group determines that the group is in which phase when the group realizes its purpose?

working

During which type of leadership does the group leader offer little guidance to the group?

Indirect -When using indirect leadership, the leader primarily reflects the group members' discussion and offers little guidance or information to the group. Direct leadership behavior enable the leader to control the interaction by giving direction and information and allowing little discussion. Co-leadership occurs when two people share responsibility for leading the group. Autocratic leadership occurs when one people make all the decisions for the group.

Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group's process?

Keeping the group on task by restating goals

During a group session, the nurse leader uses clarification to check the meaning of a member's statement. Which statement would be most appropriate?

"What I'm hearing you say is that you feel quite overwhelmed today."

A group member is describing some of the painful events experienced during childhood. The member does not elaborate on the feelings surrounding the events apart from saying that they made the member feel "upset." How should the group leader best apply the leadership technique of probing?

"When you say that these things made you 'upset,' how exactly did you feel?"

A psychiatric-mental health nurse has been leading a symptom management group for several weeks. The nurse and the participants express satisfaction with the group's activities and the nurse has identified that an indirect leadership style will be appropriate. How should the nurse apply this leadership style?

Avoid intervening during a meeting unless absolutely necessary

A nurse is leading a group. During the session, the nurse observes the members testing each other to see if they can trust each other. The nurse leader also notes that the members are testing the nurse, too. The nurse interprets this behavior as characteristic of which phase?

Beginning

A client diagnosed with antisocial personality disorder is exhibiting aggressive behavior. Which intervention would be most appropriate for this client?

Anger management -The purposes of an anger management group are to discuss the concept of anger, identify antecedents to aggressive behavior, and develop new strategies to deal with anger other than verbal and physical aggression.

The nurse has been asked to sit in and observe a support group for individuals who were once addicted to drugs. The nurse notices that one group member disagrees with statements made by all other group members. What role is this individual playing in the group?

Blocker - The blocker resists progress by arguing or disagreeing beyond reason. The dominator asserts authority and superiority by manipulating the group or certain members. The follower goes along with the ideas of others, assuming an audience role. The gatekeeper facilitates and encourages the contributions of others, thereby keeping communication open.

The nurse is beginning a group counseling session with an open group system. The nurse should explain to the group members that one advantage of an open group system is that ...

new members can join the group at any time.

A psychiatric-mental health nurse has just reviewed the group rules at the first session. During this time, the nurse observed the verbal and nonverbal interactions among the group. The nurse is assessing for which group concept?

Group dynamics - Group dynamics are the all the verbal and nonverbal interactions that occur in the group. Groupthink is the tendency of group members to avoid conflict and adopt a normative pattern of thinking that is often consistent with the ideas of the group leader. Group themes are the collective conceptual underpinnings of a group and express the members' underlying concerns or feelings regardless of the group's purpose. Group process is the development and culmination of the session-to-session interactions of the members that move the group toward its goals.

A group is in the working stage and developing the rules and standards for acceptable behavior in the group. The group is developing group:

norms

A psychiatric-mental health nurse is leading a symptom management group for clients diagnosed with anxiety disorders. One of the members consistently asks for information to be clarified and explained further. This member is acting in which role?

Information seeker -The information seeker asks for clarification of the values pertinent to the group activity. The coordinator shows or clarifies the relationships among various ideas and suggestions. The recorder writes suggestions, keeps minutes, and serves as group memory. The opinion giver states belief or opinions with emphasis on what should be the group's values.

During a group session, a member says, "I believe the group should try to focus on the feelings that we are all experiencing, not the end result of the behavior." Based on this statement, the nurse leader determines that this member is assuming which role?

Opinion giver -The member is acting in the role of opinion-giver, where the person states beliefs or opinions with emphasis on what should be the group's values. The initiatior-contributor suggest or proposes new ideas or a new view of the problem or goal. The information giver offers authoative facts or generalizations or gives his or her own experiences. The energizer attempts to stimulate the group to action or decision.

Over the past several weeks, members of the group have been demonstrating clear dislike of one of the members. As a result, there is conflict and tension within the group. When dealing with this situation, which action would be the priority for the nurse leader?

Maintaining a neutral position about the situation

Which is an example of group cohesiveness?

Members wearing T-shirts that they made to a group session

A therapy group is in session, and one member shares feelings of hopelessness about the member's future. A second member responds by saying, "I felt hopeless once, but then I went back to school and worked and raised kids to put myself in a better position. It was hard; sometimes I don't know how I did it. But I got great grades, the kids turned out well, and I have a well-paying job." The nurse interrupts and acknolwedges the second member's contribution of information and then redirects the discussion to the first member and others in the group. The nurse identifies the second member as having assumed which role?

Monopolizer

An ongoing support group for new mothers of high-risk babies has been meeting for 3 months. A new member comments that she doesn't have time to come to a group "just to talk." Other members meet the woman's comments with silence. Which statement best explains this situation?

The new member has violated group norms.

A psychiatric-mental health nurse is working to ensure that the decision-making group the nurse is leading is effective. The nurse implements an open leadership style and ensures that time pressures are avoided. The nurse is working to prevent which situation?

groupthink

Which concept should the nurse consider prior to a formal client referral to a therapeutic group?

the client's social skills

Which maintenance role is responsible for mediating differences among group members and relieves tension in conflict situations?

harmonizer - In a group, the harmonizer mediates differences among members and relieves tension in conflict situations. The encourager praises, agrees with, and accepts the contributions of others. The compromiser operates from within a conflict and may yield status or admit error to maintain group harmony. The gatekeeper attempts to keep communication channels open by encouraging or facilitating the participation of others or proposes regulation of the flow of communication through limiting time.

The nurse leads a small group that is discussing the impact of eating disorders on everyday life. Which action does the nurse implement as the group recorder?

documenting group suggestions -There are three categories of group member roles, including task roles, maintenance roles, and individual roles. The group recorder is a task role, and documenting the group suggestions is an action the nurse implements in this specific group role. Stimulating the group to action is an example of the nurse implementing the task role of energizer. Offering the group facts or generalizations is an example of nurse implementing the task role of information giver. Defining the group's position in relation to goals is an example of the nurse implementing the task role of orienter.

A nurse is trying to manage the situation of a disliked member in the group and is encountering difficulties in managing the situation. The best action of the nurse is to ...

get supervision from an experienced group leader.

Which therapeutic factor refers to the group members' relationships to the therapist and other group members?

group cohesion - Group cohesiveness refers to the group members' relationships to the therapist and other group members. Catharsis is the open expression of affect to purge or "cleanse" oneself. Altruism is learning to give to others. Universality refers to finding out that others have similar problems.

A psychiatric-mental health nurse is responsible for leading a newly formed group. Which individual would be responsible for determining an individual's suitability for the group?

group leader

Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the ...

group leader.

A client with post-traumatic stress disorder is referred to a group to help the client deal with the issues associated with the trauma and its aftereffects. Which group would be most appropriate for this person?

psychotherapy group -The most appropriate group would be a psychotherapy group. Psychotherapy groups treat individuals' emotional problems. These groups focus on examining emotions and helping individuals face their life situations. Psychotherapy groups provide an opportunity for patients to examine and resolve psychological and interpersonal issues within a safe environment. The purposes of psychoeducation groups are to enhance knowledge, improve skills, and solve problems. The intervention strategies used in psychoeducation groups focus on transmission of information necessary for making some type of change and providing a process for making the change. Self-help groups are led by people who are concerned about coping with a specific problem or life crisis. These groups do not explore psychodynamic issues in depth. Task groups focus on completion of specific activities, such as planning a week's menu. LO: 4

Which type of group is usually associated with clients who have dementia and have difficulty with recent memory?

reminiscence groups -Reminiscence groups are usually associated with clients who have dementia who are having difficulty with recent memory. Recalling distant memories is comforting to clients and improves their well-being. In self-care groups, the leader not only reinforces basic self-care skills but also, more importantly, helps identify strategies that can motivate the clients and provide structure to their daily lives. The purposes of anger management groups are to discuss the concept of anger, identify antecedents to aggressive behavior, and develop new strategies to deal with anger other than verbal and physical aggression. A medication group can be used primarily to transmit information related to medications, such as compliance, management of side effects, and lifestyle adjustments.

A psychiatric-mental health nurse is assessing a client who has come to the community mental health center for an evaluation. The client has a history of alcohol abuse. During the assessment, the client says, "I've been clean and sober for the last 10 years, but I continue to go to my meetings at least once a week." The nurse interprets the client's statement as indicating participation in which type of group?

self-help group -The client is most likely describing participation in a self-help group, such as Alcoholics Anonymous. Self-help groups are led by people who are concerned about coping with a specific problem or life crisis. The purposes of psychoeducation groups are to enhance knowledge, improve skills, and solve problems. The intervention strategies used in psychoeducation groups focus on transmission of information necessary for making some type of change and providing a process for making the change. Supportive therapy groups are usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems. In conducting this type of group, the nurse focuses on helping members cope with situations that are common for other group members. Task groups focus on completion of specific activities, such as planning a week's menu.

A client diagnosed with schizophrenia is having hallucinations. Which type of group would be beneficial for this client?

symptom management -In symptom management groups, members learn when a symptom indicates that relapse is imminent and what to do about it. Handling hallucinations, being socially appropriate, and staying motivated to complete activities of daily living are a few common topics. In self-care groups, the leader reinforces basic self-care skills and helps identify strategies that can motivate the clients and provide structure to their daily lives. The purposes of anger management groups are to discuss the concept of anger, identify antecedents to aggressive behavior, and develop new strategies to deal with anger other than verbal and physical aggression. A medication group can be used primarily to transmit information related to medications, such as compliance, management of side effects, and lifestyle adjustments.

A group has been given the assignment of completing the arrangements for a day trip to the aquarium. This is an example of which type of group?

task