GROUP THERAPY

GROUP THERAPY

GROUP THERAPY

OVERVIEW OF GROUP THERAPHY..

GROUP

-a collection of individuals whose association is based on a shared purpose or common interests. Values and goals.

GROUP DYNAMICS-underlying forces working to produce behavior patterns in groups; these forces include group roles, stages of group development and group norms.

GROUP PROCESS- The combined verbal and non-verbal interactions occurring within the group and the meanings they convey.

It includes;Communication content(what is said verbally)Relationships among membersSeating arrangements

d.) speaking patterns or tones

e.) body languages or gestures

f.) group themes, which may be overtly or covertly expressed

GROUP DYNAMICS

1. groups can be curative.Working in a group setting allows clients to develop better insight through shared information about common problems

Several factors associated with a groups interpersonal interactions may play a role in effecting a cure

2. Group norms are the implicit or the explicit rules of conduct defining member behavior

Productive norms enhance the groups function (such as agreeing that all members opinions are valued or allowing only one member to speak at a time)

b) Nonproductive norms inhibit the groups functions(for example, not allowing disagreements or accepting absenteeism and tardiness)

3.) Leadership of a group maybe shared(by co-leaders or co-therapists), or the group may be led by one individual; common leadership includes authoritarian, democratic, and laissez-faire.

LEADERSHIP STYLES AND GROUP FUNCTIONING -can have a significant effect on group dynamics and functioning.

TYPES OF LEADERSHIP STYLES:AUTHORITARIAN

Characteristics:exerts total controlmakes all decisions discourages sharing among membersTask-oriented

EFFECTS ON GROUP MEMBERS

Can lead to frustration and anger among membersMay encourage scapegoatingMay foster passive-aggressive behavior(absenteeism)

DEMOCRATICCharacteristics Encourages member involvementFosters collaboration and cohesivenessPromotes open communicationEffects on group membersPromotes feeling that individual members are valuedFosters loyaltyEncourages productivity

LAISSEZ-FAIRECHARACTERISTICSFunctions as resource/consultantProvides minimal directionPromotes minimal interpersonal interactionsEFFECT ON GROUP MEMBERSCan cause members to feel lost or without directionPromotes disorganizationMay lead to apathy

Group therapy can occur on inpatient and outpatient community settings; brief inpatient stays and care directives provide a financial incentive for using group methods of treatments.

Stages of group developmentGroups work through three typical stages of developmentIn the orientation stage, group expectations are established and group norms are specified a. anxiety level may be high among members b. superficial sharing occurs

3. During the working stage, members work productively on the established goals and focus on the purpose of the group. a. members increase their level of self-confidence b. a cohesiveness develops within the group

In the termination stage, summarization of the group experience occurs a. Members share feelings of sadness or loss b. Some may re-experience anxiety felt during the orientation stage

GROUP ROLESEach member typically has a role within the group.These roles can overlap and change among members, depending on the situation; they may also be helpful or impede the group.

Typical roles include:Initiator: suggests innovative ideas and starts interactionsCoordinator: organizes and integrates the progress of the groupEvaluator: appraises group performanceInformation seeker: elicits factsGatekeeper: screens input and maintains open communicationEncourager: offers praise and acceptanceHarmonizer: maintains peace through compromise and alternatives

Commentator: processes the group interactionsBlocker: inhibits group advancementRecognition seeker: seeks self-praiseMonopolizer: controls by endless talkingSelf-confessor: discloses personal information inappropriately.

ROLE OF THE NURSEIn the group therapy, the nurses role depends on her educational level and experience, as outlined by the ANA standards of psychiatric-mental health clinical nursing practiceThe psychiatric-mental health generalist or registered nurse works with groups on issues that pose immediate problems with clients health or well-being

the psychiatric-mental health clinical specialist or nurse practitioner works as a group therapist, using her knowledge of behavior at the interpersonal and group levels

3 TYPES OF GROUPS:PSYCHOTHERAPY GROUPS

Psychotherapy focuses on encouraging members to analyze and improve interpersonal functioning.

Groups are designed around a specific theoretical framework.

The most common types of psychotherapy groups include; a. psychoanalytic group therapy b. interpersonal group therapy c. cognitive-behavioral group therapy

Therapeutic group

Therapeutic groups focus on group relations, interactions among members, and immediate issues of living and behaving.

Several types of groups are available to clients on both an inpatient and outpatient basis a. support groups provide acceptance and empathy for members, reinforce existing strengths and reduce anxiety

Activity groups(arts, dance and music) facilitate communication and interaction by encouraging expression of feelings in non-verbal ways; they also enhance self-esteem.

Educational groups(medication management, stress management) provide information on topics of interest; they empower clients through self-management of behaviors.

Socialization groups(clubs, hobby groups) help members to improve interaction skills and plan activities for mutual enjoyment.

Reality-orientation groups(current events groups) assist clients with cognitive impairments by using a variety of environment reminders( such as clocks, television, radio, newspapers, magazines).

Community meeting groups(inpatient groups on a particular psychiatric unit) explore common concerns and focus on problems in group-living situations. -they discuss and clarify rules, request and privileges -they also encourage clients to be self-directed

Self-help group

Members(rather than mental health professional leadership) run the group.

Members share the same problem which is the main focus of the groups work, and offer strategies for coping.

NURSING PROCESSASSESSMENT 1. Assess the individual client behaviors within the group 2. Assess the group processes, noting such factors are a. seating preferences b. communication patterns

Non verbal-patterns of communication

Response to group norms

Roles assumed by individual members

nursing diagnoses

Recognize how the groups behavior and your own behavior affect individual group members

Analyze group dynamics and group processes.

Establish individualized nursing diagnoses for clients within the group, as needed: AnxietyDecisional conflictDeficient knowledgeImpaired social interactionImpaired verbal communicationIneffective coping

ineffective health maintenance

Post trauma syndrome

Readiness for enhanced management of therapeutic regiment

Situational low self-esteem

PLANNING AND OUTCOME IDENTIFICATION

1.Work with group in setting realistic goals2.Establish desired outcome criteriaMembers will participate in group activitiesMembers will demonstrate concern for individual members of the groupMembers will focus on the identified purpose related to the specific group type and taskMembers will improve communication and socialization skillsMembers will learn effective ways to manage therapeutic regimensMembers will demonstrate improved individual coping behaviors

IMPLEMENTATION

1During the orientation phase, take the following measures

Provide directives and establish the contract for meeting schedules, purpose, and goals for the groupEncourage open communication and feedback from all membersDiscuss and establish norms of behavior

IMPLEMENTATION

2. During the working phase, take the following measuresAssume the appropriate role as leader, depending on the type of groupListen, observe and provide therapeutic feedbackComment on behavior that enhances or hinders group progressRecognize conflicts and discuss them in open mannerFoster self-esteem among membersFocus in immediate issues and problems of membersProvide appropriate information in an educational group settingEnsure the participation of all members

IMPLEMENTATION

3. During termination phase, take the following measuresAssume a supportive role in assisting members to identify and discuss termination feelingsEncourage evaluation of group and individual members progressRefers those whose needs were not met by the group for further evaluation and treatment

OUTCOME EVALUATION

The group exhibits shared allegiance and responsibilityThe group demonstrates active participation by all membersThe group accomplishes its goals or purposeThe group communicates among all members, not just between leaders and members

OUTCOME EVALUATION

Individual members demonstrate use of communication skills Individual members apply problem solving skills to their own lifeIndividual members report improved coping and behaviorIndividual members state effective ways to manage their therapeutic regimen