Victoria Selby, MS, PMHNP-BC Therapeutic groups Victoria Selby, MS, PMHNP-BC

Objectives Define a group Describe components of a small group Compare the stages of group development Analyze small-group factors Examine responsibilities and qualities of nurses as group leaders and the types of groups they lead Identify special considerations for groups in the acute care setting

What is a group? Sounds easy…. A collection of people who have a relationship with one another, are interdependent, and have common norms Each group has its own structure Group power = content + process by the leader & the members

Group tasks Primary – main purpose of the group (intrinsic to the survival of the group) Secondary – other gains

Components of small groups Structure - underlying order; includes boundaries, communication, decision-making processes, authority relationships; offers stability and helps regulate behavior and interactional patterns Group size - 7-10 ideal Length - duration 20-40 min. lower functioning 60-120 min. high functioning Communication - feedback, group dynamics, patterns Roles are determined by behavior and responsibilities of group members Power - Ability to influence group Norms - group behavior (standards, expectations) Quality of communication and interaction Conforming to the group Toward group goals and tasks Cohesion - strength of members' desire to work together toward common goals

Group roles and functions: Maintenance roles – involve the group process and function Encourager Harmonizer Compromiser Gatekeeper Follower Rule maker Problem solver

Group roles and functions: Task roles – deal with completing the group’s tasks Leader Questioner Facilitator Summarizer Evaluator Initiator

Role of the group leader Plans the group Establishes a therapeutic relationship Studies the group and participates Creates a safe space for challenge of authority, ideas, facilitate the group process toward the goals Identifies themes Takes opportunities to practice conflict mgmt, assertive communication Uses humor

Co-leading Shared responsibilities of the leadership role Will influence the group in various ways Sharing group observations Divides the work and increases diversity of ideas/creativity Role modeling May divide the group May result in competition

Group roles and functions: Individual roles – those that are not related to the tasks and maintenance of the group. Monopolizer Seducer Mute/silent Complainer Truant or latecomer Moralist

Planning a group Essentially : Where? When? Why? How? Who? Establish goals Criteria for membership selection Expectations Open and closed groups

Phases Orientation Conflict Cohesive Working Forming Storming Norming Yalom Tuckman Orientation Conflict Cohesive Working Forming Storming Norming Performing

Phases: Orientation (Forming) Leader is directive Establish rules Use of "we", "our" Evaluation of self, others, and fit into the group

Phases: Conflict (Storming) Who is making decisions? Hierarchy Accept the shared responsibility Assess resources and limitations Hostilities toward the leader and members

Phases: Cohesive (Norming) Desire to work together Sharing, self-disclosure Different views occur without destroying the group (leader facilitates this) Value of differences and similarities

Phases: Working (Performing) Yalom’s curative factors Imparting information Instillation of hope Universality Altruism Corrective reenactment Dev. Of social interaction techniques Imitative behaviors Interpersonal learning Existential factors Catharsis Group cohesion

The end of the Group Termination phase Evaluation Group as a whole or individuals Evaluation Rating scales Progress notes Outcomes

Groups in the acute care setting Rapid patient/client turnover Variety of disorders Lack of time to establish relationship pre-group Group boundaries Group leader is involved with the group throughout the day Multiple staff lead the “same” group ( Yalom, 2005)

Types of groups Task groups Self-help groups Educational groups Supportive therapy groups Psychotherapy groups Peer support groups Types of groups led depend on the needs and goals of the patients/clients, as well as the education of the nurse.

References Stuart, G. W. & Laraia, M.T. (2013). Principles and practice of psychiatric nursing (10thed.) St. Louis, Missouri: Mosby Elsevier. Yalom, I.D. (2005). The theory and practice of group psychotherapy (5th ed.). New York, N.Y.: Basic Books.