Transcript Document

Chapter 10
Therapeutic Groups
Copyright © 2014. F.A. Davis Company
Introduction
• Health-care professionals not only share their
personal lives with groups of people but also
encounter multiple group situations in their
professional operations.
• Clients learn from each other in a group
setting.
Copyright © 2014. F.A. Davis Company
The Group
• A collection of individuals whose association
is founded on shared commonalities of
interest, values, norms, or purpose
• Membership in a group is generally by chance,
by choice, or by circumstance.
Copyright © 2014. F.A. Davis Company
Functions of a Group
• Socialization. The teaching of social norms
occurs through groups.
• Support. Fellow members are available in
time of need.
• Task Completion. Groups can assist in
endeavors that are beyond the capacity of a
single individual.
• Camaraderie. Individuals receive joy and
pleasure from interactions with significant
others.
Copyright © 2014. F.A. Davis Company
Functions of a Group (cont.)
• Informational. Learning takes place when
group members share their knowledge with
others in the group.
• Normative. Different groups enforce
established norms in various ways.
• Empowerment. Change can be made by groups
at times when individuals alone are ineffective.
• Governance. Large organizations often have
leadership that is provided by groups rather
than by a single individual.
Copyright © 2014. F.A. Davis Company
Types of Groups
• Task Groups. A group formed
to accomplish a specific
outcome.
• Teaching Groups. The focus
is to convey knowledge and
information to a number of individuals.
• Supportive/Therapeutic Groups. The primary concern is
to prevent possible future upsets by teaching the
participants effective ways of dealing with emotional
stress arising from situational or developmental crises.
Copyright © 2014. F.A. Davis Company
Types of Groups (cont.)
• Therapeutic Groups Versus Group Therapy
–Group therapy has a sound theoretical base, and
leaders generally have advanced degrees in
psychology, social work, nursing, or medicine.
–Therapeutic groups are based to a lesser extent on
theory. Focus is on group relations, interactions
between group members, and the consideration of a
selected issue.
–Leaders of both types of groups must be
knowledgeable about group process (the way in
which group members interact with each other) as
well as group content (the topic or issue being
discussed in the group).
Copyright © 2014. F.A. Davis Company
Types of Groups (cont.)
• Self-Help Groups
– Composed of individuals
with a similar problem
– Serve to reduce the possibilities of further
emotional distress leading to pathology and
necessary treatment
– May or may not have a professional leader. Run
by members, and leadership often rotates from
member to member.
Copyright © 2014. F.A. Davis Company
Types of Groups (cont.)
1. A client expresses a desire to begin attending the
self-help group Alcoholics Anonymous (AA). Which
nursing response gives the client pertinent
information about this type of group?
A. “In this type of group, membership is always within
a fixed time frame.”
B. “Group members receive comfort and advice from
others undergoing similar experiences.”
C. “The purpose of this type of group is to convey
information to a number of individuals.”
D. “The function of this type of group is to accomplish
a specific outcome.”
Copyright © 2014. F.A. Davis Company
Types of Groups (cont.)
• Correct answer: B
– AA is a type of self-help group. In this type of
group members share their experiences and
strengths and receive comfort and advice from
others undergoing similar experiences. The nurse
is giving the client pertinent information about
AA.
Copyright © 2014. F.A. Davis Company
Physical Conditions That Influence
Group Dynamics
• Seating. Best when there is no barrier between
the members; for example, a circle of chairs is
better than chairs set around a table.
• Size. Size of the group makes a difference in
the interaction among members; seven or
eight members provide a favorable climate for
optimal group interaction and relationship
development
Copyright © 2014. F.A. Davis Company
Physical Conditions That Influence
Group Dynamics (cont.)
• Membership. Two types of groups exist:
– Open-ended groups. Members leave and others
join at any time during the existence of the group.
– Closed-ended groups. All members join at the
time the group is organized and terminate
membership at the end of a designated period of
time.
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups
• Instillation of Hope. By observing the progress of
others in the group with similar problems, a group
member garners hope that his or her problems can
also be resolved.
• Universality. Individuals come to realize that they
are not alone in the problems, thoughts, and feelings
they are experiencing.
• Imparting of Information. Group members share
their knowledge with each other. Leaders of teaching
groups also provide information to group members.
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups (cont.)
• Altruism. Individuals provide assistance and support to
each other thereby helping to create a positive selfimage and promote self-growth.
• Corrective Recapitulation of the Primary Family Group.
Group members are able to reexperience early family
conflicts that remain unresolved.
• Development of Socializing Techniques. Through
interaction with and feedback from other members of
the group, individuals are able to correct maladaptive
social behaviors, and learn and develop new social skills.
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups (cont.)
• Imitative Behavior. Group members who have
mastered a particular psychosocial skill or
developmental task serve as valuable role models for
others.
• Interpersonal Learning. Group offers varied
opportunities for interacting with other people.
• Group Cohesiveness. Members develop a sense of
belonging that separates the individual (“I am”) from
the group (“we are”).
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups (cont.)
• Catharsis. Within the group, members are able to
express both positive and negative feelings.
• Existential Factors. The group is able to assist
individual members to undertake direction of their
own lives and to accept responsibility for the quality
of their existence.
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups (cont.)
2. After a supportive-therapeutic group, a
nurse hears one client say to another, “I
never thought that other people had the
same problems that I have.” The nurse
ascertains that this statement represents
which curative factors described by Yalom?
A. Catharsis
B. Group cohesiveness
C. Universality
D. Imitative behavior
Copyright © 2014. F.A. Davis Company
Curative Factors of Groups (cont.)
• Correct answer: C
– According to Yalom, the curative factor of
universality occurs when group members realize
that they are not alone in their feelings and
experiences.
Copyright © 2014. F.A. Davis Company
Phases of Group Development
Phase I: Initial or Orientation Phase
• Leader and members work together to
establish rules and goals for the group.
• Leader promotes trust and ensures that rules
do not interfere with fulfillment of the goals.
• Members are superficial and overly polite.
Trust has not yet been established.
Copyright © 2014. F.A. Davis Company
Phases of Group Development (cont.)
Phase II: Middle or Working Phase
• Productive work toward completion of the
task is undertaken.
• Leader role diminishes and becomes more
one of facilitator.
• Trust has been established between the
members, and cohesiveness exists.
• Conflict is managed by the group members
themselves.
Copyright © 2014. F.A. Davis Company
Phases of Group Development (cont.)
Phase III: Final or Termination Phase
• A sense of loss, precipitating the grief process, may
be experienced by group members.
• The leader encourages the group members to
discuss these feelings of loss and to reminisce about
the accomplishments of the group.
• Feelings of abandonment may be experienced by
some members. Grief for previous losses may be
triggered.
Copyright © 2014. F.A. Davis Company
Leadership Styles
• Autocratic
– Focus is on the leader, on whom the members
are dependent for problem-solving, decision
making, and permission to perform.
– Production is high, but morale is low.
Copyright © 2014. F.A. Davis Company
Leadership Styles (cont.)
• Democratic
– Focus is on members who are encouraged to
participate fully in problem-solving of group
issues, including taking action to effect change.
– Production is somewhat lower than with
autocratic leadership but morale is much
higher.
Copyright © 2014. F.A. Davis Company
Leadership Styles (cont.)
• Laissez-faire
– There is no focus in this type of leadership.
– Goals are undefined, and members do as they
please.
– Productivity and morale are low.
Copyright © 2014. F.A. Davis Company
Leadership Styles (cont.)
2. During a group meeting, a client raises the
concern that noise at the nurses’ station
keeps him awake at night. The nurse,
present in the meeting, interrupts, stating,
“I'll handle this matter. We need to move
on.” The nurse is demonstrating which type
of leadership style?
A. Democratic
B. Autocratic
C. Laissez-faire
D. Surrogate
Copyright © 2014. F.A. Davis Company
Leadership Styles (cont.)
• Correct answer: B
– This is an example of an autocratic leadership
style that restricts client participation in planning
care. The nurse is in control and client autonomy
is limited.
Copyright © 2014. F.A. Davis Company
Member Roles
• Members play one of three types of roles
within a group:
– Task roles serve to complete the task of the
group.
– Maintenance roles maintain or enhance group
processes.
– Individual (personal) roles fulfill personal or
individual needs.
Copyright © 2014. F.A. Davis Company
Psychodrama
• Psychodrama is defined as a type of group therapy
that employs a dramatic approach in which clients
become “actors” in life-situation scenarios.
• An identified client (called the protagonist) is
selected to portray a life situation.
• Other members of the group play the roles of people
with whom the protagonist has unresolved issues.
• Group members who do not participate in the drama
act as the audience, and the group leader is called
the director.
Copyright © 2014. F.A. Davis Company
Psychodrama (cont.)
• The purpose is to provide the client with a safe place
in which to confront unresolved conflicts in an effort
to progress toward resolution.
• Nurses who work as psychodramatists require
specialized training beyond the master’s degree.
Copyright © 2014. F.A. Davis Company
The Role of the Nurse in Group
Therapy
• Nurses who work in psychiatry may lead various
types of therapeutic groups such as client education
groups, assertiveness training groups, support
groups for clients with similar problems, parent
groups, transition to discharge groups, and others.
• Guidelines set forth by the American Nurses
Association specify that nurses who serve as
group psychotherapists should have
a minimum of a master’s degree in
psychiatric nursing.
Copyright © 2014. F.A. Davis Company