Group Psychotherapy

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GROUP PSYCHOTHERAPY INTRODUCTION Foulkes (1975) referred to group therapy as “ hall of mirrors “ in which people can see themselves reflected in others. Group therapy is a powerful therapeutic tool to help the patients, correct maladaptive personal behaviors and to enhance a patient’s ability to function as a contributing member of the community. The experience of being in a group does not deny the uniqueness of each person. Rather, it allows people to directly experience their talents and possibilities through the eyes and personal experience of others. By using a variety of technical maneuvers and theoretical constructs, the leader directs group members’ interactions to bring about changes. The principles of group psychotherapy have also been applied with success in the fields of business and education in the form of training. DEFINITION Group therapy is a method of therapeutic intervention based on the exploration and analysis of both internal (emotional) and external (environmental) conflicts and the group process. 1

Transcript of Group Psychotherapy

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GROUP PSYCHOTHERAPY

INTRODUCTION

Foulkes (1975) referred to group therapy as “ hall of mirrors “ in which people can see

themselves reflected in others. Group therapy is a powerful therapeutic tool to help the

patients, correct maladaptive personal behaviors and to enhance a patient’s ability to

function as a contributing member of the community. The experience of being in a group

does not deny the uniqueness of each person. Rather, it allows people to directly

experience their talents and possibilities through the eyes and personal experience of

others. By using a variety of technical maneuvers and theoretical constructs, the leader

directs group members’ interactions to bring about changes. The principles of group

psychotherapy have also been applied with success in the fields of business and education

in the form of training.

DEFINITION

Group therapy is a method of therapeutic intervention based on the exploration and

analysis of both internal (emotional) and external (environmental) conflicts and the group

process.

[LEGO, 1996]

Group therapy is an identifiable system consisting of at least 3 people who share a

common goal.

[NUDELMAN, 1986]

Group therapy is a “hall of mirrors” in which people can see themselves reflected in

others.

[FOULKES, 1975]

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HISTORY

Group psychotherapy, as a recognized form of psychological treatment, traces its origin

to the early 1900’s. in 1907, Joseph Pratt, an internist in Boston, developed a psycho

educational method for teaching patients with TB about their disease and improving their

morale. He used a combination of lecture and informal group discussion. The success of

his group treatment approach inspired Pratt and others to use a group format to treat other

chronic diseases such as diabetes. Later, Pratt expanded its use to the treatment of

neurotic disorders. The idea of sharing a “common bond in a common disease”, which

Pratt advocated at the turn of the century, serves as the basis for many contemporary

support and mutual help groups. The notion of combining psycho education with

informal group discussion is used increasingly with patients and families because of the

benefit of combining didactic information with individuals’ experiences.

Samuel R Slavson, considered the father of group psychotherapy in America, worked

with, inner- city children and adolescence. He found that a group format using a

combination of games, tools and food to engage children in actively communicating with

each other, encouraged co- operative behaviors among children who otherwise might not

talk to each other. This work laid the ground work for group activity therapy, in which

arts and crafts help children experience and direct their energies in productive way.

CHARACTERISTICS OF AN EFFECTIVE GROUP

Goals are clearly identified and collaborately developed.

Open, goal directed communication of feelings and ideas is encouraged.

Power is equally shared and rotates among members, depending on ability and

group needs.

Decision making is flexible and adapted to the group needs.

Controversy is viewed as healthy because it builds member involvement and

creates stronger solutions.

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A healthy balance exist between task and maintenance role functioning.

Individual contributions are acknowledged and respected.

Diversity is encouraged. Interpersonal effectiveness, innovation and problem

solving adequacy are evident.

PURPOSES OF GROUP THERAPY

Psycho educational purpose of some groups is to help patients and families

better understand the disease process, treatment and modifiable risk factors

To help patients to understand and modify maladaptive patterns of relating to

others.

Strengthen healthy patterns of behavior and to help patients learn new,

better ways of relating.

Self help and mutual aid groups frequently do not have a professional

leader. Their purpose is to provide patients and families having similar health

concerns a place to share their experiences, derive comfort , share information and

exchange practical advice.

ELEMENTS / CURATIVE FACTORS

Certain essential elements are common to all types of group therapy. Yalom (2005)

has identified eleven essential elements of group therapy. This include

1. Instillation Of Hope: It is the first and often most important factor. People

participating in the group experience initially feel demoralized and helpless. So

providing them with hope is therefore a most worthwhile achievement. Client

should be encouraged to believe that they can find help and support in the group

and that it is realistic to expect that problem will eventually be resolved.

2. Universality: It can be defined as the sense of realizing that one is not

completely alone in any situation. Group members can identify this factor as a

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major reason for seeking group therapy. During the sessions, members are

encouraged to express complex, often very negative feelings in the hope that

they will experience understanding and support from others with similar

thoughts and feelings.

3. Imparting Of Information: This includes both didactic instructions and direct

advice, and refers to the imparting of specific educational information plus the

sharing of advice and guidance among members. The transmission of this

information also indicates to each member the other’s concern and trust.

4. Altruism: It is the personalized help that one group member extends to another.

Clients have the experience of learning to help others, and in the process they

begin to feel better about themselves. Both the group therapist and the members

can offer invaluable support, insight and reassurance while allowing themselves

to gain self knowledge and growth.

5. Corrective Recapitulation Of The Primary Family Group: This allows

members in the group to correct some of the perceptions and feelings associated

with unsatisfactory experiences they have had with their family. The

participants receive feedback as they discuss and relieve early familial conflicts

and experience corrective responses. Family roles are explored, and members

are encouraged to resolve unresolved family business.

6. Development of Socializing Techniques: It is essential in the group as

members are given the opportunity to learn and test new social skills. Members

also receive information about maladaptive social behaviors.

7. Imitative Behaviour: It refers to the process in which members observe and

model their behaviors after one another. Imitation is an acknowledged

therapeutic force; a healthy group environment provides valuable opportunities

for experimenting with desired changes and behaviors.

8. Inter Personal learning: This includes the gaining of insight, the development

of an understanding of a transference relationship, the experience of correcting

emotional thoughts and behaviors and the importance of learning about oneself

in relation to oneself.

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9. Group Cohesiveness: It is the development of strong sense of group

membership and alliance. The concept of cohesiveness refers to the degree to

which a group functions as a supportive problem solving unit. Ideally, each

member feels acceptance and approval from all others in the group. This factor

is essential in ensuring optimal individual and group growth.

10. Catharsis: It is similar to group cohesiveness and involves members relating to

one another through the verbal expression of positive and negative feelings.

11. Existential Factors: These factors are consistently operating in the group and

help to make up the final component. These intangible issues encourage each

group member to accept the motivating that he or she is ultimately responsible

for his or her life choices and actions.

TYPES OF GROUP THERAPY:

PARAMETERS

SUPPORTIVE

GROUP

THERAPY

ANALYTICALLY

ORIENTED

GROUP THERAPY

PSYCHOANLYSIS

OF GROUPS

TRASACTIONAL

GROUP THERAPY

BEHAVIOURAL

GROUP

THERAPY

FERGUENCY Once a week1-3 times a

week

1-5 times a

week

1-3 times a

week

1-3 times a

week

DURATIONUpto 6

months 1-3+years 1-3+years 1-3 yearsUp to 6

months

PRIMARY

INDICATIOSPsychotic &

anxiety

disorders

Anxiety &

personality

disorders

Anxiety &

personality

disorders

Psychotic &

anxiety

disorders

Phobias,

passivity,

sexual

problems

INDIVIDUAL

SCREENING

INTERVIEWUsually Always Always Usually Usually

COMMUNICATION

CONTENT

Primarily

environmental

factors

Present & past

life situations,

Intra group &

extra group

relations

Primarily past

life

experiences&

intra group

relations

Primarily intra

group relations

Specific

symptoms

without focus

on causality

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TRANSFERANCE Positive

transference

encouraged

to promote

improved

functioning

Positive &

negative

transference

evoked and

analyzed

Transference

neurosis

evoked and

analyzed

Positive

relationships

fostered,

negative

feelings

analyzed

Positive

relationships

fostered, no

examination

of

transference

DREAMS Not analyzed Analyzed

frequently

Always

analyzed &

encouraged

Analyzed

rarelyNot used

DEPENDACE

Intra group

dependence

encouraged,

members

relay on

leader to

great extend

Intra group

dependence

encouraged,

dependence on

leader variable

Intra group

dependence not

encouraged,

dependence on

leader variable

Intra group

dependence

encouraged,

dependence on

leader not

encouraged

Intra group

dependence

not

encouraged,

reliance on

leader is high

THRAPIST’S

ACTIVITY

Strengthen

existing

defenses,

active, give

advice

Challenge

defenses,

active, give

advice or

personal

response

Challenge

defenses,

passive, give

no advice or

personal

response

Challenge

defenses,

active, give

personal

response, rather

than advice

Create new

defenses,

active and

directive

MAJOR GROUP

PROCESSESS Univeralization,

reality testing

Cohesion,

transference,

reality testing

Transference,

ventilation,

catharses,

reality testing

Abreaction,

reality testing

Cohesion,

reinforcement,

conditioning

SOCIALIZATION

OUT OF GROUP Encouraged Generally

discouraged Discouraged Variable Discouraged

GOALSImproved

adaptation to

environment

Moderate

reconstruction

of personality

dynamics

Extensive

reconstruction

of personality

dynamics

Alteration of

behaviour through

mechanism of

conscious control

Relief of

specific

psychiatric

symptoms

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TYPES OF THERAPY GROUPS

The functions of a group vary depending on the reason the group was formed. Clark

identifies three types of groups in which nurses most often participate: task, teaching &

supporting or therapeutic groups, self help groups

1. TASK GROUPS

The function of a task group is to accomplish a specific outcome or task. The

focus is in solving problems and making decisions to achieve this outcome. Often

a deadline is placed on completion of task, and such importance is placed on a

satisfactory outcome, that conflict within the group maybe smoothed over or

ignored to focus on the priority at hand.

2. TEACHING GROUPS

Teaching, or educational groups exist to convey knowledge and information to a

number of individuals. Nurse can be involved in teaching groups of many

varieties such as medication education, child birth education, breast self education

and effective parenting classes. These groups usually have a set time frame or set

number of meetings. Members learn from each other as well as from the

designated instructor. The objective of teaching group is verbalization or

demonstration by the learner of the material presented by the end of the

designated period.

3. SUPPORTIVE OR THERAPEUTIC GROUPS

The primary concern of support group is to prevent future upsets by teaching

participants effective ways dealing with emotional stress arising from situational

or developmental crises

4. SELF HELP GROUPS

An additional type group in which, nurses may or may not be involved is the self

help group. It allows clients to talk about their fears and relieve feelings of

isolation while receiving comfort and advice from others undergoing similar

experiences. Eg. Alcoholic anonymous, narcotic anonymous, over eaters

anonymous, women’s groups and men’s group.

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CONCEPTS IN GROUP DYNAMICS:

Patient Selection:

Member selection is based on a patient’s treatment need capacity to contribute to

group goals. Group members do not know each other before entering the group,

and it is best not to include people in the same group who socialize with each

other. It is not possible to have full control over patient selection, particularly in

inpatient or partial hospitalization settings, but the therapist should carefully

consider the rationale for including patients who are actively psychotic,

uncontrolled manic, paranoid or hostile even in inpatient setting. These

individuals cannot benefit from the group when their symptoms are intense and

they will disrupt the group even with the most skilled leadership.

Functional Similarity:

Group members should have enough in common with each other to feel

interpersonally comfortable in the group and it is referred as the functional

capacity. This means that group members should have sufficient levels of

functional ability and social recognizability to allow them in meaningful

conversation. Significant differences in educational level, life experiences or

developmental levels can be barriers to full participation. When group members

feel uncomfortable, they are not as likely to talk with each other. The leader

should avoid including members who are the only ones with permanent

characteristics such as different race, gender, education or age than the other

members.

MacKenzie referred to this as the “ Noah’s Arch” phenomenon. That is, a therapy

group ideally should have at least two members with similar characteristics.

Pairing members in this way precludes the creation of a group social isolate. For

eg: it would not be appropriate to place a single adolescent girl in a group of

adolescent boys.

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Capacity to contribute:

Group members must be able to both contribute to group goals and derive benefit

from this treatment modality. Usually, patients with more than mild cognitive

disorders, anti social behaviors, strong hostility or paranoid symptoms do not

profit from group intervention. First, their symptoms disrupt the group

functioning. Second, their pathologies interfere with their own ability to derive

benefit because their symptoms preclude the necessary co – operation with other

members. They should be included only after their symptoms are under sufficient

control that they gain some benefit from group membership. All group members

need to be able to contribute in a meaningful way to the functioning of the group

as a whole.

Matching individual need with membership:

Another factor to consider with group composition is the issue of homogenous

compared with heterogeneous group membership. Homogenous group include

patients with same diagnosis, similar age group and same gender. They are

particularly useful in treating disorders in which denial plays a role, for example,

addiction or eating disorders. Heterogeneous groups draw their membership from

a variety of diagnoses. These groups are composed of men and women, rather

than being single gender and prospective members can run the age gamut of

adulthood. The advantage of a heterogeneous group is that the rich complexity of

its membership can provide several different ways of approaching interpersonal

relationships. The format works well with patients experiencing relationship

difficulties.

Choosing open or closed groups:

Another decision is whether to have open or closed membership. Open groups are

those in which group membership changes frequently. This type of group is found

in inpatient settings that depend on member residency and in many mutual help

and support groups. Closed groups are those in which group membership does not

change for the life of the group or only for a clearly understood reason. Members

often must meet certain criteria for acceptance, such as a diagnosis or a particular

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therapeutic issue. Foe example, alcoholic anonymous is open only to people with

a drug problem .psychotherapy group can share characteristics of both open and

closed membership. They are open in that as one member leaves the group,

another fills the empty slot, but they have a closed membership in that members

cannot arbitrarily enter the group simply because they have similar interests or

problems.

Group size:

Psycho educational groups can consist of 10-15 members. In psycho educational

groups, the members discuss a particular topic such as medication, prevention or

symptom management of a mental disorder, but the process does not allow

individual to address personal psychological issues unrelated to the discussion

topic. Most insight oriented therapy groups limit membership to six to eight. This

size not only allows for a variety of interpretations but also permits sufficient

interpersonal space for intimate sharing. Therapy group needs to have at least five

members. With fewer than five members, the group is likely to produce an

emotional intensity or to form sub groups, both of which are difficult to regulate.

Time boundaries:

Time boundaries in group therapy are extremely important. Most group therapy

sessions last 75 – 90 minutes. Therapy sessions should begin and end on time.

Attention to time boundaries respects the need of individuals to have lives outside

the group and firmly integrates the group as a set pattern in the patient’s life.

Inpatient versus outpatient groups:

Inpatient groups differ from outpatient groups in several ways. Group

membership in the inpatient groups depends on the particular patient population.

Because of short stays, the focus of group may be on spotting mal adaptive

behaviors that can be worked on in outpatient therapy and stabilizing symptoms

enough to permit discharge. The content and process of inpatient therapy is more

superficial than in outpatient settings. With inpatient therapy, the therapist takes a

much more active role, clarifies more often and directs the process of establishing

appropriate norms.

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PHASES OF GROUP DEVELOPMENT:

The phases of group development are sequential and overlapping, beginning with

planning, which takes place before the group starts and ending with termination and

referrals if needed. Tuckman 1965 describe the phases of group development as forming,

storming, norming, performing and adjourning.

Pre Interactive Phase :

The leader’s first task is to establish suitable foundation for the group selecting an

appropriate time and place for the group sessions and clearing these arrangements

with other staff members. Psychotherapy groups must take place in a quite, well

ventilated room where the group is not disturbed and the chairs should be arranged so

that all group members face each other. The initial assessment interview takes place

as an individual session before the first group session. Assessment interviews provide

the therapist with an important opportunity to evaluate motivation and personal

commitment. Another important goal of the pre group assessment interview is to

make entry into the group easier. People may have preconceptions about the therapy

that the therapist can dispel. During this initial discussion, the patient begins to

experience the “person” of the leader. Experiencing the group leader as a human

being and a consistent member of the group beforehand often reduces the patient’s

anxiety about joining the group. During the pre group assessment interview, the

therapist can provide necessary information about the group purpose, format and

expectations and the patient can ask questions that may make the difference between

whether he or she rejects or accepts group membership.

Forming Phase:

The forming phase of group therapy is the orientation phase in which group members

begin to know each other. The therapist can begin the group with a self introduction

and ask the members to say their names and tell the group something about

themselves. The manner in which the individuals express themselves and the type of

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information they choose to share provide important data that can be used later, in the

working phase. However, the therapist needs to make sure that members do not

prematurely disclose lengthy intimate details about themselves because premature

sharing can lead to intense discomfort when the shares reflects on it, resulting in

unanticipated termination.

Acceptance, inclusion and trust are primary values held by members in beginning

group meetings. Initially, group communication tends to be tentative, polite and

guarded, as members explore their values and ideas with each other. They need to

know that other group members, including the leader, will respect their contribution

and will not make them look foolish to their peers. Finding that other members have

had similar experiences and related feelings help strengthen initial emotional bonding

among group members. The group leader encourages the development of universality

by linking member contributions together, pointing out similarities, and stressing the

importance of group members as therapists for each other.

When the group begins to meet, the leader plays an important role in establishing the

group structure. A standard first meeting format is to (1) identify the group‘s purpose

and goals; (2) name fundamental structural norms such as expected attendance,

confidentiality, and what to do incase of absence; and (3) explain how the group will

function. A general statement about the nature of work (i.e., that the group provides a

place where members can discuss serious personal issues and receive personal

feedback from each other) establishes the task of the group as serious. If members

have never been in group therapy before, the therapist briefly educates them as to

their roles as members.

Storming Phase:

The storming phase of group development signals movement beyond the initial

hesitancy and fear about being in the group. It can appear as a subtle questioning of

appropriateness of time or group objectives. This opens the door to exploration of

stronger feelings, hidden agendas and open conflicts as members struggle with issues

of power and control. Although uncomfortable, this phase of group development is

absolutely essential because it sets the foundation for the development of the group

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specific norm that will guide the group in the working phase. This phase usually does

not last long. Establishing trust remains a central task for this phase of group

development. During this phase, the therapist acts as a gatekeeper by helping

individual group members identify but move beyond their personal agendas and

engage in their group dialogues. During this phase group members begin to engage

with each other at deeper level and to reveal more of their issues while asking for a

similar commitment from others.

Norming Phase:

During this phase, the group develops norms- behavioral standards and basic

operating procedures- that provide structural boundaries and guidelines for behaviors

that will or will not be tolerated. Some behaviors as classified as universal norms

because they are standards found in all psychotherapy groups. These are

predetermined norms, voiced during the opening session, that include regular

attendance, confidentiality and the expectation of verbal contributions. Other

standards are group specific norms, which emerge from the need of group members to

facilitate goal achievement. For eg, group specific norms for a chronic schizophrenic

therapy group might include specific basic group behaviors such as talking one at a

time, not leaving the room during the session, refraining from violent behaviors

towards other group members and refraining from obscene language. Specific norm

in a drug abuse group would be to remain drug free during the group session.

The group pressure on members who do not confirm to expected norms helps

reinforce bonding. Because norm violation by one member affects the entire group,

the leader must always address norm violations as being significant.

Performing/Working Phase:

Once the ground rules for operating the group are in place, members actively engage

in working on group determined agendas. The performing phase is characterized by

cohesion and productivity and the most in depth work of the group takes place during

this phase. Self disclosure is more spontaneous and honest in the performing phase.

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Members know what to expect from each other. In the process of working through

differences, a genuine respect for other members has developed, members trust the

comments of others and the sense of belonging is at its highest peak. Here, group

members experience the altruism of helping others, interpersonal learning, self

understanding, and recapitulation of the family.

Throughout the performing phase, the therapist’s primary function is to facilitate

movement towards the group goals by providing an accepting interpersonal

environment in which group members feel supported in exploring difficult issues.

Group members take responsibility for leadership activities and, in essence, become

therapist for each other.

Adjourning (termination) phase:

Good endings are as important as good beginnings in group life. The adjourning

phase of group relationships occur in a variety of ways: members leave, the group

disbands, or a member is asked not to return for violating the group contract. Most

often, individual group members leave a psychotherapy group because their work is

finished or because they are discharged from the hospital or treatment program.

Preparation for voluntary endings in an outpatient group can begin with a non

established in the first meeting or during the initial interview when the therapist asks

each group member to tell the group of impending departure one weak and to return

the next to say goodbye. Terminations are important both for the group as a whole

and for the patient. Sufficient time for effective goodbye should be provided during

each patient’s last session. Ask the patient to tell the group what has been helpful and

to say something to each group member.

If the group as a whole is ending the therapist can help the group summarize the goal

achievement and gain closure on any unresolved issues. Providing feedback about

positive goal achievement individually and collectively is important to individual

members and the group as a whole.

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INDIVIDUAL FUNCTIONS WITH IN A GROUP:

Roles involving task functions:

Initiator: proposes new ideas, directions, tasks, methods.

Elaborator: expand son existing suggestions and develops the group’s plans further.

Evaluator: critically evaluates ideas, proposals, and plans, examining the practicality

of proposals and the effectiveness of procedures.

Co–ordinator: helps to pull together ideas and themes to clarify suggestions that

have been made and to help various subgroups work more effectively together

towards their common goals.

Roles involving group maintenance functions:

Encourager: Offers praise to and agrees with other members; communicates

acceptance of others and their ideas and an openness to differences within the group .

Harmonizer: mediates conflicts and disagreements that crop up, trying to relieve or

reduce tension within the group.

Compromiser: seeks a position between contending sides; seeks a compromise that

all parties can accept.

Roles involving primarily personal, individualistic functions:

Aggressor: Acts negatively, with hostility toward other members; criticizes others’

contributions; attacks the group and its members.

Recognition-seeker: calls attention to own activities; boasts; redirects things

towards self.

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Help-seeker or confessor: uses the group as a vehicle either to gain sympathy or to

achieve personal insight and self-satisfaction without consideration for others or the

group as a whole.

Dominator: asserts authority and seeks to manipulate others so as to be in control of

everything that happens.

HOW GROUP THERAPY WORKS?

Display of inter personal pathology

Feed back and self observation

Sharing reactions

Examining the results of sharing reactions

Understanding ones’ opinion of self

Developing a sense of responsibility

Realizing ones’ power to effect change

High affect potentiate change

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COMMON PROBLEMS AFFECTING GROUP THERAPY AND PROCESS AND

ASSOCIATED NURSING INTERVENTIONS:

SL.

NO

GROUP PROBLEM NURSING INTERVENTION

1.

2.

3.

Fear of authority resulting in

timid,agreesive, hostile or

withdrawn behavior

Initial anxiety in a group,

displayed by silence, fidgeting,

nervous movement and selective

hearing.

Hidden Agenda

Use non verbal and verbal

communication techniques, listen to

and encourage client to share and

explore feelings

Respond in an understanding manner

when the client expresses feelings

(even when they are hostile).

Reassure client that nurse-therapist

will not respond punitively to the

expression of feelings.

Give “strokes” for positive interactions

Help client establish a role in the

group, one related to the client’s skills

Share with client that discomfort in the

initial state of group development is

common.

Meet client’s dependency needs.

Identify the source of individual and

group anxiety causing the hidden

agenda.

Explore the hidden agenda with the

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4.

5.

Sub grouping

Deviant behavior- behavior that

needs personal need and

undermines the group

group and its meaning and effect on

the group’s functioning.

Establish clarifying goals and purpose

of the group (thereby lessoning the

group’s anxiety an aiding in

elimination of subgroups.

Direct subgroup interest towards the

goals of the group, thereby lessoning

subgroup pre occupation with outside

themes

Identify deviant behavior and discuss it

with the client.

Identify sources of discomfort in the

environment that affects the client.

Explore with the client whether he or

she identifies the behavior as deviant.

Help members of the group identify

deviant behavior.

Help the client explore how this

behavior affects his or her relationship

in the group.

Use group pressure to help the deviant

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6. Resistance to therapy(eg.

Grunting, moaning, staring into

space, over responding to

situations, changing the subject,

absence from group).

member change or conform to group

norms.

Explore resistant behavior with the

client.

Confront the client with his or her

behavior, using an understanding

approach.

Help the client identify what he or she

has accomplished while a member of

the group.

Help the client work through feeling of

loss during termination. (ie feelings of

anger, euphoria, depression, rejection).

Help the client express both positive

and negative feelings about the group

and evaluate the group experience

realistically. Plan a termination activity

that allows expression of group

members’ feelings.

Lesson intensity of group interaction

as group nears termination.

NURSES’ RESPONSIBILITY IN GROUP THERAPY

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The primary role of the nurse – therapist in group therapy is to guide individuals through

a problem solving process by anticipating and responding to the needs and concerns of

the group members. The nurse therapist has both task and maintenance role functions.

Group task functions are concerned with the practical issues of leading a group, where as

group maintenance functions focus on less tangible group process.

ADVANTAGES:

1. More clients can be treated in a group, making the method cost effective.

2. Members benefit by hearing others discuss similar problems; feelings of isolation,

alienation, and uniqueness.

3. It provides the client opportunity to explore their specific styles of communication

in a safe atmosphere where they can receive feedback and undergo changes.

4. Members learn multiple ways of solving a problem from others and group

exploration may help them to discover new ways of solving problems.

5. Members learn about the functional roles of individuals in the group. Sometimes a

member shares the responsibility as a co-therapist.

6. The group provides for its members’ understanding, confrontation and

identification with more than one person. The member gains a reference group.

DISADVANTAGES:

1. A member’s privacy may be violated, such as when a conversation is shared

outside the group. This behaviour obstructs confidentiality and hampers complete

and honest participation.

2. Clients may experience difficulty exposing themselves to a group or believe that

they lack the skill to communicate effectively. Some clients may use these factors

as resistance; others may be reluctant to expose themselves because they do not

want to change.

3. Group therapy is not helpful if the therapist conducts the group as if it is an

individual therapy. Such a therapist may see dynamics and group process as

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incidental or antagonistic to the therapeutic process. The effective group leader

must be skilled in techniques and interventions that foster group interaction and

shape group behaviour and growth.

CONCLUSION

Purpose of group therapy is to intervene in mentally disorder behaviour, thinking

and feeling. Group therapy offers multiple stimuli to reveal examine and resolve

distortion in interpersonal relationship. The purpose of the group is related to goals and

expected outcomes. The group therapist focuses on the process of interpersonal learning

and change.

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