therapeutic groups chapter 33 (2)
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.
group work is
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.
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?
Help members to gain confidence in problem-solving 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.
information
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.
universality is
Universality is the phenomenon of understanding that one's problems are not unique, which helps group members feel secure and understood.
question information
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.
subgroup
a small number of people that break away from the larger group and form a stronger relationship with each other
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?
"I feel you have a lot to say, but we must give others a chance as well." 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.
The nurse is conducting cognitive therapy for patients with acquired immunodeficiency syndrome (AIDS). Which response is appropriate when conducting this therapy?
"It takes a lot of courage to explore these problems. You are working hard to resolve these problems." 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.
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.
objectives
- identify basic concepts related to group therapy -describe the phaes of group therapy and role of the nurse to maintain or facilitate group process -define and discuss groups commonly led by basic level registered nurses -describe communication interventions for patients who present challenging behaviors during psychotherapy
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group member roles
-the way we behave in groups is a function of our innate personalities (quiet, loud, shy) -task, maintenance, and individual roles -task roles keep the group focused on its main purpose and get the work done maintenance keep the group together, hekp each other feel worthwhile and included individual roles nothing to do with helping the group but instead relate to specific personalities, this isn't good
self help groups
acknowledge the needs of members of a family with an individual who has a specific problem/condition -mutual aid groups for families experiencing a developmental event, life crisis, or health disorder
people who have trouble with groups
acutely psychotic acutely manic, or intoxicated
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?
bereavement 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.
advanced practice nurse
carry own family or origin factors into therapy continue work with therapist on own familty issues hold the family in therapy accountable for themselves stay clear of their family triangles meaning and value of family's social cultural context interventions
monopolizing member
compulsive speech, interrupting. -may be an attempt to deal with anxiety -other members can lose interest and withdraw
group
consists of two or more people who come together for the purpose of pursuing common goals / interests
orientation phase
group forming leader should: structure an atmosphere of respect and trust. the purpose of the group is stated at this time and members are encouraged to get to know each other -leader may need to point out similarities between members to help encourage communication to each other rather than to the leader
KEY POINTS
group has some advantages including cost savings, increased feedback, opportunity to practice skills in a safe environment, mutual learning, feeling of belonging
inpatient groups
group is rarely the same for more than one or two meetings little prior selection or prep treatment limited to hospital period, rapid turnover patients live together outside of the group
advanced practice nurse
group psychotherapy -can help a patient since it alters the brain in a way -psychodrama groups (acting out life experiences)
maintenance role of a member
help maintain the purpose and process of the group for an example, the harmonizer attempts to prevent conflict in the group
therapeutic factors in groups
installation of hope universality imparting of information altruism corrective recapitulation of the primary family group development of socializing techniques imitative behaviors interpersonal learning group cohesiveness catharsis existential resolution
therapeutic factors
instillation of hope universality (not alone) imparting information (receive information) altruism (self value by helping others) development of social techniques imitative behavior interpersonal learning catharsis (therapeutic discharge of emotions) existential resolution (aspects of life affect everyone)
termination phase
marks the end of the group -dicuss termination issues -leader summarizes the work of the group and contributions of everyone members of a group can take on any number of roles
silent member
may not speak until they feel safe or may think they are nt as competent as other members -they cannot benefit from other's feedbacks, and other members dont get their insights -silent member may be uncomfortable and create a sense of misturst -allow this person time to formulate thier thoughts, ill give you a moment to think about that
normal groups for a registered nurse
medication education health education (sex ed, diabetes, hypertension, HIV) symptom management (anxiety, anger) stress management (mindfulness a big thing now) therapeutic community meeting groups support and self help groups (AA meetings, support)
basic level registered nurse groups
medication education sex ed dual-diagnosis (alcoholic with schizo) multifamily symptom management (diabetes) stress management
outpatient groups
members are carefully selected and prepared treatment is self directed, as long as needed patients don't live together boundary is well maintained
planning a group
name and objective of the group types of patients and members group schedule physical setting configuration description of leader and member roles method of evaluationg the outcome of the group
The nurse recognizes that a closed group
no news once it begins 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.
laissez-faire leadership
progresses without any attempt by the leader to control the direction of content
milieu therapy
provides structure and support to meet individual's needs in order to influence behavior towards positive growth
individual therapy
psychoanalysis hypnotherapy cognitive behavioral therapy (cbt) play therapy supportive psychotherapy relief therapy behavior modification modeling relationship psychotherapy expressive or insight psychotherapy
registered nurse vs advanced practice nurse
registered nurses can run these groups but are not able to preform psychotherapy, or specialized treatment groups
group therapy goals
share common feelings and concern share stories and experiences diminish feeling of isolation community healing and restoration cost effective
educational groups expected outcomes
three significant side effects of their medication dangerous drug and drug food interactions identifies time and day and dose for their medication
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.
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intervention: communication guidelines
-develop and practice good listening skills -view family members in a positive manner use nonblaming manner to keep communication open give information in a clear way listen to each family member
advantages of group work
-engage in multiple patients in treatment at the same time -participates benefit from there peers who possess unique understanding of their issues -safe setting to try new ways to relate to others -promote a feeling of belonging
group and family therapy general
-intensive treatment that involves open communication with participants who are willing to take part in the therapy. -leaders guide the group with various styles.
complaining member who rejects help
-patient may appear to take pride in their problems -comes across entirely self centered, group attempt to help are rejected -high conflicitng feelings about their own dependency or connection the the group, and notice from the leader increases their self esteem -mistrust is huge for this person, emotional deprivation in their lives
definition of psychotherapy
-psychotherapy is the process whereby one human ina treatment setting, consciously attempts to influence another to grow in a direction of maturity -goal: to help individuals change unhealthy thoughts, feelings, wishes, behaviors and secondary psychosomatic symptoms
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.
The nurse is conducting group therapy for patients with schizophrenia. During group therapy, the nurse finds and connects various ideas and suggestions for conducting an effective therapy. Which nursing function does this indicate?
Coordinator The nurse has to play different roles and perform different functions while being a part of the group therapy. The role of coordinator is to find and connect various ideas and suggestions for conducting effective group therapy for the patients. The function of the orienter is to document the progress of the patients in the group therapy and to check whether the goals of the treatment are achieved. The evaluator evaluates the work done by the members of the team and directs them to reach the objectives. The recorder acts as a memory of the group and keeps notes of the patients' behavior and progress.
A patient with tenacious suicidal behavior has been advised dialectical behavioral treatment (DBT). What does the nurse need to know about DBT?
Emotional skills can be improved, leading to reduced risk of self-destructive behavior. 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.
info
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. This is the only group with the focus on a shared problem; cognitive-behavioral, time-limited, and milieu are incorrect groups.
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? Select all that apply.
The nurse gives the patient time to think. The nurse addresses the silent patient separately from the group. The nurse divides the group members into pairs. 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."
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.
homogeneous group
all members share a certain chosen characteristic such as a diagnosis or gener
laissez-faire leader
allows the group to behave in any way they choose and does not attempt to control the direction of the group
group therapy
analytic group psychotherapy psycho educational groups psychodrama music therapy self directed therapy family therapy remotivational group therapy exercise, movement group
KEY POINTS
clinical supervision is important for leaders can be objective to group interactions and learn new techniques
orientation phase
define the purpose and goals of the group -group leader sets a tone of respect, trust, confidentiality, people get to know each other, discussion about termination
alternative or complementary therapies
energy therapies therapeutic touch aromatherapy
autocratic leader
exerts control over the group and does not encourage much interaction among each other.
basic level nurse self assessment
experiencing strong or negative reaction to a family seek a supervisor to discuss what is happeneing
communication techniques
give information clarification confrontation reflection summarization
group leader communication techniques
giving information clarification confrontation reflection summarization support
basic concepts r/t group work
group psychotherapy: specialized treatment intervention led by trained leaders or co leaders purpose is to treat clients with psychiatric disorders many advantages to this group yalom's curative factors
clinical supervision
important for group leaders, provides feedback about their performance and enhances their professional growth
advanced practice nurses
in addition can offer psychotherapy
types of psychotherapy
individual group milieu family
therapy groups expected outcomes
insights, behavior changes, reduction in symptoms
autocratic leadership
leader completely controls the direction and structure of the group without allowing group interaction or decisions to solve problems
working phase
leader role: encourage a focus on problem solving that is consistent with the purpose of the group -conflicts may be expressed and emotions can run high -this is a positive opportunity for growth -successful resolution of conflict and the feeling of empowerment should be noted
termination phase
leaders role: encourage members to reflect on the progress they have made and identify post termination goals. members may experience loss or anger about the ending of the group -it is important to address such feeling as part of the work toward successful group work
healthy vs unhealthy family patterns
management boundary communication emotional-supportive socialization
group work
method whereby individuals with a common purpose come together and benefit by giving and receiving feedback
problematic behaviors in group members
monopolizes group (all about me) complains but continues to reject help (got a headache but dont give me pills) demoralizes others (thats a stupid idea, you make bad choices) silent person (doesn't speak, can make others feel uncomfortable and hurt trust)
heterogeneous group
not based on a shared chosen personal characteristic. such as clients from a unit, mixture of men and women with a wide range of diagnosis
components of therapy sessions
open and clear communication direction toward a particular goal opportunities for development of skills encourage clients to mix positive feedback, feel empowered of their lives support is huge
working phase
promote problem solving skills to faciliate behavioral cghanges. power and control issues may domiante this phase -group leader uses communication to encourage group work toward meeting the set goals -members may take informal roles in the group, which may interfere or favor the goals set
psychopharmacological issues
role of nurse to explain to the family: purpose of a prescribed medication desired effects possible side effects adverse reactions -more info family members have about meds, less anxiety that will be present
demoralizing member
self center, angry, depressed or lack of empathy -refuse to take personal responsibility and can challenge the leader and be negative to the group process -leader may speak to them in private -this can help decrease hostile behavior
excercise applying CBT skills
situation or stimulus leads to a thought or reaction leads to action/response
group includes
size defined purpose degree of similarity among members rules boundaries content process
role of group leader
starting maintaining terminating
When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as
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.
democratic leader
supports extensive group interaction in the process of problem solving. psychotherapy groups most often use this style
democratic group
supports group interaction and decision making to solve problems
individual roles
tend to prevent teamwork, own agenda may be shown with this role. dominator, who tries to control other members or the recognition seeker, who boasts about personal ahcievements
group leadership
the group leader has multiple responsibilities in intiating, maintaining, and terminating a group -orientation phase: structure, size, composition, purpose and timing of the group is made out -working phase: communication, flow progresses, group is conducted termination phase: leader ensures that each person summarizes their accomplishments and insights and give positive and negative feedback regarding the group -sensitivity to culture and diversity is huge for a group leader
disadvantages of group work
time constraints in which a person may feel cheated of time, particularly in a large group -concerns of privacy -dealing with disruptive member behavior
task role of a member
various tasks are available during the group, such as the recorder who can take notes and records everything that happens
KEY POINTS
when a new group is formed, similarities and differences in many dimensions and culture must be considered