Conducting Groups March 2015
Agenda Advantages of groups Members of the group Group leader Role of the leader, maximize participation, & use effective communication skills Group participants The forceful, or passive, or impaired patient and how best to work with them in a group setting The group routine Prepare for the group Running the group Documenting the group
Advantages To The Group Process
Advantages of Groups Patients are able to explore ideas, personal feelings and needs with supportive peers. Group becomes an auxiliary social support. Establishes a sense of belonging and increases patients comfort with other people.
Advantages Of Groups Group work necessitates relating to other people: Patients learn to distinguish between inappropriate and appropriate social behavior. Patients practice both sides of the social interaction (listening and disclosing). When helping each other, patients recognize that they still have something valuable to offer. Expand patients focus beyond their own personal problems. Witnessing other members take risks and confront problems can encourage similar behavior.
Advantages Of Groups Group work can act as a reality check: Patients come to recognize that they are not alone and their problems are not unique. Problems often do not appear as overwhelming when compared to other people s experiences. Reaching a realistic perspective can open up feelings of hope. Patients learn to recognize the impact of their behavior on other s feelings, the impressions they make, and the opinions they have of themselves.
Advantages Of Groups Accountability is increased in a group setting: Members come to expect each other s attendance and call each other on lack of effort or inappropriate conduct. Participation can be viewed as a public declaration of patients intention and commitment to change. Inpatient group participants are more likely to continue in outpatient therapy.
The Group Leader Role Maximizing Participation
The Role Of The Group Leader is to: instill confidence and raise patients expectations about what they can accomplish. inform patients of the treatment process and common experiences. offer guidelines about how to participate and get the most out of group. use group (here-and-now) experiences to illustrate concepts and foster learning. express genuine concern for each patient and respect patients values. challenge patients when appropriate to stimulate progress toward goals. bring the values of the Recovery Model.
The Role Of The Group Leader is to: maintain patients attention, interest, and motivation. guide patients in recognizing and creating opportunities for positive change. creatively and flexibly adjust approach to best meet the patient s needs. help patients recognize and tap their expertise, resources, and abilities. assist patients in gaining self-knowledge from their behavior. act as a role model. strive toward personal and professional growth. maintain therapeutic conditions (providing structure and setting limits).
Maximizing Participation We work with a wide range of patients with varying skills, levels of motivation, and capacities for insight and learning. One of the group leader s many challenges is to actively guide patients towards receiving maximum benefit from each group.
Maximizing Participation General: People are more likely to participate when they understand the purpose of group, expectations for their involvement, and receive positive feedback. Verbally acknowledge patient strengths. Validate patient feelings. Express appreciation for patients productive efforts and interactions. Balance group leader feedback with feedback from peers. Periodically review confidentiality guidelines.
Maximizing Participation Ensure that treatment goals are personal and meaningful to the patient. Set the patient up to experience frequent successes. Emphasize that attending group is a significant step toward feeling better. Limit symptom and complaint focused patient dialogue. Start groups on time and minimize interruptions - reinforces the importance of the group. Have patient state something they learned / enjoyed in group - reinforce value of the group. Distribute your attention and time to speak equally with all patients in the group. Encourage patients to create personal goals.
Maximizing Participation Environment: Limit snacks to break time. Room must be a comfortable temperature. Provide different seating options to prevent discomfort. Ensure adequate and comfortable lighting. Provide group in an uncluttered room. Belongings should be in a separate room. Reduce extraneous noise (i.e. coffee makers, staff conversation, housekeeping, humming lights, paging system volume).
Utilize Effective Communication Skills Refer to communication educational module
Group Participants Every patient comes with unique strengths & weaknesses. Understanding some strengths & weaknesses is a key component of the leader Know how to handle patients who are Forceful Passive Impaired
The Forceful Patient may: have difficulty staying on task and/or controlling impulses. monopolize the conversation. have distracting behaviors (tapping pens, throat clearing). be irritable, agitated, elevated, or experiencing strong emotions. be challenging or competing with group leader. have an overbearing personality style. have a strong need for attention.
During groups assist the forceful patient by: seating the patient near you may help contain their behavior. sit near the door if you may need to summon help. ask the patient to excuse themselves from group for a few minutes until they are able to refocus. ask the patient to excuse themselves from group with expectation that they can/will participate in the next appropriate group if they are able to refocus. settle agitation or strong emotions by conveying understanding and compassion for the patient s feelings
The Passive Patient may: not understand the discussion or activity. feel they don t need treatment. have a low energy level, poor motivation, or feel hopeless. not feel they have anything of value to contribute. be reluctant to share personal issues. have competing stimuli (i.e. hallucinations, pain).
During groups assist the passive patient by: peep questions within the patient s comfort zone. Ask questions that they are able to answer. use the patient s language to discuss problems (i.e. not feeling like myself rather than depressed). solicit patient s help (i.e. assist another patient, pass out handouts, read aloud). acknowledge what the patient s nonverbal behavior appears to convey (i.e. tension, boredom). inquire if there is anything making the patient uncomfortable. ask the patient direct questions. Praise any efforts.
During groups assist the passive patient by: assume a less directive approach to reduce potential defensiveness or further withdrawal. ask patients if they understand why they are in group. Review purpose and expectations. maintain a neutral expression and posture with I don t know answers. It could be patient is trying to buy time to think and have a more well thought out answer. ask the patients how a significant person in their lives might answer the question. reassure patients you are not in a rush. Encourage them to take their time.
The Impaired Patient may: have impaired hearing, vision, mobility, speech, and/or memory. need to be able to move around freely. not have the endurance to participate in a full session. feel self-conscious or be sensitive to receiving assistance. deny or not be aware of their limitations. have a sense of powerlessness and/or be over-looking their capabilities. not have replaced everyday tasks and pastimes that can no longer be managed.
During groups assist the impaired patient by: seat hard of hearing patients near you. Face them when speaking to the group or the patient directly. Utilize handouts or a chalkboard. sit confused, cognitively impaired patients near you. May redirect or focus with touch. pair the patient with another member who can provide assistance. sit near the door if you might need to summon assistance. for those with poor memory or concentration, use yes/no questions; use the same words when repeating a statement; engage patients in simple hands-on activities during discussion. ask one question or provide one instruction at a time.
During groups assist the impaired patient by: use nonverbal demonstration or cues with verbal instructions. use concrete language. Limit abstractions. Clarify ambiguities that arise. encourage patient to move around the group room as needed for personal comfort. encourage patient to take their time and reassure them that you are not in a rush. encourage as much independence and dignity as possible while assuring patient safety. prepare discussions and activities that limit frustration and draws upon patient s capabilities.
The Group Routine Prepare Run Document
The group routine needs to be Consistency decreases possible patients anxiety levels, develops group cohesion, and supports structure and quality care.
Prepare for the group by: verifying topic/activity schedule. identifying the short-term goals to be addressed during group. have handouts, materials, chalkboard, etc. ready. gathering patients five minutes ahead of start time.
Running the group includes: the group leader and patients introduce themselves. May have new members briefly tell their story if applicable to group. providing a brief orientation of the group process. reviewing confidentiality and group rules periodically. introduce group topic or activity. Explain what the group will be doing AND the purpose. presenting the group topic or activity. concluding the group. Summarize session content and relate this to individuals in the group.
Documentation of the Group should include: patient s behavioral or mental status patient s participation and/or contribution to the group. any specific interventions used with the patient. patient s progress toward a short-term goal.
Documentation examples of behavioral or mental status Give specific example(s) of the patient s behavior: Patient was restless during session, often getting up and moving around the room. Patient spoke rapidly in a loud voice but would temporarily slow down when prompted. Give a specific example of the patient s mental status: Patient appeared depressed avoiding eye contact & wearing same clothes for 2 days. Patient appeared angry as evidenced by throwing down her paper and abrupt body movements.
Documentation examples Body Behavior / Appearance: posture, body movements, gestures, dress, hygiene/grooming. Facial Expressions: grimacing, smiling, glaring, rigid, rolling eyes, chewing on lip. Voice: tone, pitch, volume, intensity, inflection, spacing of words, pauses, silences. Physiological Responses: quickened breathing, blushing, sweating.
Documentation examples participation in groups Patient provided an example of an irrational thought needing help means she will be a burden. Patient responded to other s comments and expressed concern about an absent patient. Patient responded to direct questions with 1-2 word answers.
Documentation examples interventions used Requested that patient assist another peer on a task took task seriously and mood improved. Challenged negative thinking by having patient identify positive aspects of self.
Documentation examples of patient progress toward goal State specifically what progress was made, or why progress was not made. Patient identified daughter s recent move and retirement as triggers of depression. Patient said she forgot to use relaxation techniques during last anxiety attack. Patient was pre-occupied by argument with family and did not stay on topic (the STG).
Post Test Close this tutorial and open the corresponding post test.