Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 28 Therapeutic Groups Therapeutic Groups Many goals we set for ourselves cannot be achieved without membership in groups and families; cooperation and coordination can achieve goals that could not be reached through individual effort alone. Mental health can be preserved, maintained, and restored through interaction with others in productive groups and families. Small Group Dynamics Trust: when trust exists members will risk sharing more Self-disclosure and self-awareness Johari Awareness Model Relations within the group Cohesion: a spirit of common purpose The primary factor for keeping a group in existence and working effectively 1
Group Roles and Leadership Distributed functions approach Any member of a group may become a leader by taking actions that serve group purposes Different members may perform various roles in a group. Task roles Facilitating and coordinating solution of a group problem Group Roles and Leadership (cont'd) Maintenance roles Building group-centered attitudes Maintaining and perpetuating groupcentered behavior Group Developmental Phases Forming beginning to know one another before norms have been established Storming conflicts arise over power, authority, and competition Norming group becomes more cohesive 2
Group Developmental Phases (cont'd) Performing real work phase of the group Terminating completion of task or stop meeting Group Development Theory Basic interpersonal needs and group phases (Schulz): Inclusion: in or out Control: near or far Affection: top or bottom Group Therapy Theory Interactional group therapy (Yalom) Interaction plays a crucial role Learn about themselves and their relationships with others as a means of improving their mental health 11 Curative Factors of Group Therapy 3
Curative Factors of Group Therapy Instilling hope Universality Imparting information Altruism Corrective recapitulation of the primary group Development of socializing techniques Imitative behavior Interpersonal learning Cohesiveness Catharsis Existential factors Types of Group Leadership Single therapist Cotherapy Junior-senior cotherapy Egalitarian cotherapy Creating the Group: Selecting Members Selecting group members is one of the group leader s/therapist s most important functions Quality of interpersonal relationships among members = core of successful group treatment 4
Creating the Group: Selection Interviews Determine potential members motivation Encourage client to ask questions Correct misperceptions or misinformation Inquire about any pending life changes Inquire about what client sees as a need to work on Establish and clarify initial group contract Creating the Group: Group Contract Goals and purposes Time, length, frequency of meetings Place of meetings Start/end dates Addition of new members Attendance Confidentiality Member interaction outside the group Participation of members and therapists Fees Here-and-Now Emphasis The here-and-now work of the interactional group therapist occurs on two levels: Focusing attention on each member s feelings toward other members, therapist(s), and the group Illuminating the process 5
Here-and-Now Activation Self-reflective loop: becoming aware of here-and-now events (what happened) and then reflecting back on them (how and why) Events in the session (here-and-now) take precedence over those outside (there-and-then) Illuminating the Process Second step of interactional group therapy: moving beyond a focus on content toward a focus on process (how and why of interactions) Clearing the air: making covert interpersonal difficulties overt, a major step in interpersonal needs approach Types of Therapeutic Groups Mutual-help groups: help given to members come from members themselves Psychoeducation groups: Sharing of mental health care information Facilitating discussion of feelings and strategies to deal with feelings Medication teaching groups 6
Types of Groups (cont'd) Social skills training groups: clients are coached to develop basic, essential communication skills Groups of medically ill clients and their families: focus on stress associated with illness and how to reduce the stress Activity therapy groups: to increase social response and self-esteem Types of Groups (cont'd) Poetry, Art, Music, and Dance therapy groups Facilitate creative expression of feelings Bibliotherapy and Story-telling groups Community client groups in schools, youth centers, work places, neighborhoods, churches, prisons, etc. Groups with nurse colleagues to help reduce job-related stress Resources American Group Psychotherapy Association This site for the American Group Psychotherapy Association provides the support you are looking for to enhance your work as a mental healthcare professional or your life as a member of a therapeutic group. 7
Resources (cont'd) Group Therapy Ideas and Themes This site for Group Therapy Ideas and Themes provides descriptions of experiential activities, ideas and themes for exploring in group therapy settings. Resources (cont'd) Alcoholics Anonymous Alcoholics Anonymous subpage for professionals on how to use AA as a resource. Another link includes videos for professionals. Resources (cont'd) Narcotics Anonymous Narcotics Anonymous provides a recovery process and support network that relies on the therapeutic value of addicts working with other addicts through application of the principles in the Twelve Steps and Twelve Traditions of NA. 8
Resources (cont'd) Psychotherapy.net This site provides resources for therapists, including the DVD set Understanding Group Therapy by Irving Yalom. 9