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

2. 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

3. 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

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

5. 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 ideal
Length - duration
20-40 min. lower functioning
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

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

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

8. 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

9. 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

10. 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

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

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

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

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

15. 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

16. 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

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

18. 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)

19. 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.

20. 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.