1. Working with Groups Merrie J. Kaas, Ph.D, RN, PMHCNS, FAAN
Professor, Univ. of Minnesota School of Nursing
Fulbright Scholar, UNAK

2. Mary Ann Boyd, Author Professor Emerita
Southern Illinois University, Edwardsville
Psychiatric Nursing: Contemporary Practice (5th ED), Lippincott: St. Louis, MO

3. What are we talking about here?
Therapeutic groups
Work groups
Teams usually task –based for a specific purpose

4. What are Groups? Teams? Groups Teams
A collection of 3 or more people who share some common experience
May not be a team
EX: family, therapy, hobby; airplane
A structured group of people who work together on defined goals/tasks that take coordinated interactions to achieve
Is a group
EX: sports, work
People come together for some purpose and/or to achieve some shared goal; have some kind of relationship and recognize the membership of the group
People come together or are brought together to engage in some task to achieve a shared goal
Group members may not share responsibility for the outcome
Team members share responsibility and accountable for the outcome
Produce an individual work product or shared world view
Produce a collective work product
Informal and formal rules, norms, and roles control interactions of the group
Team members have assigned roles; usually fewer members than groups

5. Types of Therapy Groups
Type of Group
Purpose
Members
Structure
Leader Role
Outcomes
Task
Complete designated assignments
Assigned/volunteered members
1-2 hrs./week until task completed
Attends to task and process in here and now
Completed task
Psycho-education
Develop cognitive, behavioral, affective skills to function
General functional with knowledge and skill deficits
2 hrs./week, 1-15 weeks
Provides information
Improved skills, knowledge, and emotional regulations
Counseling
Resolve usual but difficult conscious problems
Generally well-functioning
Interactive, relational
Uses structured activities, here & now, and support
Conflict/problem resolution, personal growth; improved IPR skills
Psychotherapy
Reconstruct major personality dimensions; focus is bringing unconscious to conscious thinking
Usually have acute or chronic mental distress/dx
1-2 hrs./week, 20 weeks, variety of concrete or symbolic techniques
Provides safe environment for working on psychological roadblocks to bring unconscious /habitual to conscious thinking
Alleviation of symptoms related to psychological problems and function
Support
Provide both emotional and practical support and exchange of information
Members have common interests or health concerns
1-2 hrs./week, maybe monthly
Provides information about common concerns, facilitates discussion among members; provides safe environment
Social networking, personal support, improved self-efficacy

6. Advantages of therapeutic groups
Groups provide a social atmosphere that is similar to the real world
Groups provide more opportunity for social learning
Participants can more easily learn and practice interpersonal skills
Groups are cost effective
Groups provide a sense of commonality or universality (e.g. “I’m not the only one with this problem”; “ I experienced that too.”)
Group experiences help members become aware of how others view them and what impact their behavior has on others
Group members can receive feedback/support/challenge that encourage or facilitate change in their world view
Groups offer diversity of perspectives

7. Disadvantages of therapeutic groups
Not everyone can be in a group (e.g., issues, interpersonal skills)
Confidentiality more difficult to maintain
Harder to build trust and safety for some people because it may be more interpersonal
There can be concerns with conformity and peer pressure
Scapegoating may occur
A disruptive person can cause more harm

8. Types of Work Groups or Teams
Patient care teams
Special project teams
Social activity teams
Student teams for course projects
Others?
Advantages?
Disadvantages?

9. Advantages of Teams
Shared ideas can foster creativity and learning new knowledge and skills
Increased efficiency through shared workload
Blends complementary strengths yet holds team members accountable for limitations
Improved relationships can build trust among team members
Promotes trust and ownership

10. Disadvantages of Teams
Limits creativity through “group think”
when the good of the team comes before new ideas
Can be a longer process with
everyone’s input
Inherent conflict with a diverse membership
Unequal participation of members can cause conflict and reduce team results
Not everyone is a team player

11. Group/Team Process and Content
Processes are the activities teams/groups go through to meet goals such as establishing group norms and cohesion, learning to work collaboratively and cooperatively, managing anxiety and conflict. These processes allow an individual to receive feedback from the leader and members about his/her own behavior and perceptions.
Content consists of the spoken word, the issues discussed, and the arguments and/or dialects that arise; the stories that are told
There can be no process without content
Puskar (2008), “Content is like the lyrics of a song- process is like the music of the song”

12. Levels of Group/Team Process
Intra-individual
Personal dynamics defined by history outside of the group/team
Interpersonal
The interaction group/team members have with each other and the therapist/leader shaped
Group/Team as a whole
The interactions of the group/team which characterizes it as an entity in itself with its own dynamics/culture; “us versus them”
(Tasca et al. 2014)

13. Think of a group you are in as a member or leader
Group Process
Your Group

14. Components of Therapeutic Groups
Structure: groups underlying order, includes boundaries, communication and decision-making processes, norms/rules, authority, open or closed,
Size: preferred is 5-10, but depends on group purpose
Length of sessions: minutes for more skills-based groups; minutes for process groups
Communication: member –member; member-leader, leader-leader; inside and outside group;
Power: influence over the group
Cohesion: desire of members to work together
Roles: members and leaders: maintenance, task, individual

15. Norms: Standards of Behavior
Rules or guidelines that reflect how group members should act and interact. Can be spoken(explicit) or unspoken (implicit) but they influence the behavior of the group. Can be culturally determined.
Norms do the following:
Facilitate accomplishment of group goals. Ex. Work done on time
Control interpersonal conflict because it sets the “rules”; Ex. Norm of confidentiality
Interprets social reality and acknowledges “what is”. Ex. Friday is doughnut day
Foster group interdependence especially if norms are developed together. Ex. Who takes notes at a meeting
Other examples?

16. Indicators of Power in Small Groups
Power is the ability to influence the group as a whole and individual members. Can be granted or assumed.
Assessed by:
Vocabulary: what terms are used to describe various group members? Who controls the language the group uses? How does the group define itself?
Practices: who controls how group members accomplish their tasks? To what degree do group members have autonomy as they complete tasks and make decisions?
Stories: who tells stories? Who makes decisions? Who carries out those decisions? Who gives out rewards/punishments? Who receives those rewards/punishments?

17. Indicators of Power in Small Groups
Metaphors: In what terms do group members describe themselves?
Rituals: who develops group rituals? Who implements them? Who participates in rituals? Who does not?
Objects: objects often embody the essence of the group. The slogan or logo the group chooses to represent itself can reveal the way power is distributed in the group.

18. Sources of Power (French and Raven)
Legitimate: formal right
Example= president
Reward/Punishment: ability to compensate or not
Example: parent
Expert: high level of knowledge and/or skill
Example: professor
Referent: perceived attractiveness/ worthiness
Example: movie star
Coercive: ability to punish for non-compliance
Example: judge
Informational: controls information
Example: chief informatics officer

19. Cohesion
The strength of the group members’ desire to work together toward common goals.
Factors that impact cohesion:
agreement about group goals
interpersonal attractiveness
similarities among members
satisfaction with members and leaders
Group leader can influence cohesion using a variety of activities.

20. Group Roles
Roles can be explicit and/or implicit, formal and/or informal, and task and/or maintenance
The more the group roles are explicit the higher the cohesion of the group
Task roles help to complete the group goals while maintenance roles help keep the group together
Maintenance and task roles can be done by group members and/or leader
Sometimes conflict arises when there is a difference in the role that is assumed and the role that is given.
Example: silent member given the responsibility to lead the group

21. Task Roles Leader: set direction Questioner: clarify issues
Facilitator: focus group
Summarizer: describe current position
Evaluator: assess performance
Initiator: begin group discussion

22. Maintenance Roles Encourager: set positive culture
Harmonizer: keep the peace
Compromiser: find alternatives
Gatekeeper: assess member acceptance of group
Follower: serve as interested member
Rule maker: set standards
Problem solver: solve problems

23. Individual Roles (Difficult Behaviors)
Sometimes these roles are problematic for the group and not related to task or maintenance roles.
In reality, clients are difficult because the difficulty that they manifest meets specific needs for them.
We are not the person they seek to torment. We are the targets of their coping strategies.
(Richard Nongard, 2011)

24. Common Fears (members and leaders)
Fear of self-disclosure
Fear of being exposed and vulnerable
Fear of rejection
Fear of being misunderstood or judged
Fear of being confronted or singled out
Fear of losing control

25. Problem Behaviors=Coping Behaviors
Monopolistic behavior
Storytelling
Silent member
Questioning
Giving advice
Help-rejecting
Dependency
Hostile behavior
Acting superior
Intellectualizing

26. Dealing with Difficult Behaviors of Group Members
Avoid responding with sarcasm
State your observations and hunches in a tentative way
Demonstrate sensitivity to a member’s culture
Avoid taking member’s behavior in an overly personal way
Encourage members to explore resistance – don’t demand they give up a particular “resistive” behavior

27. Stages of Group Development
Pre-Group
Advertising and recruiting
Selecting and screening
Determining the type of group
Initial Stage
Establishing and maintaining trust
Identification of goals
Dividing responsibility
Providing structure
Transition Stage
Managing anxiety and conflict
Working Stage
Developing cohesion
Providing therapy; completing task
Termination Stage
Expressing and managing separation feelings
Evaluation of group process
Ending group; Post-group follow up
Corey, 2004

28. Leadership Functions
Stage
Function
Initial
More directive; set norms; foster sense of belonging and trust; set realistic expectations
Transition
Allow expression of negative and positive feelings; help group understand conflict; examine difficult behaviors; leader becomes “human”; encourage shared responsibilities among members
Working
Encourage cohesion and problem-solving abilities; show that differing and opposite opinions don’t destroy the group; help group complete task; leader’s direction decreases as members’ increases
Termination
Encourage evaluation of group process and outcomes; reminisce about important events; don’t deny termination because it may lead to discussion of related topics such as separation, transitions, death

29. Evaluation of Group Work- Yalom’s Curative Factors
Imparting information
Instilling hope
Universality
Altruism
Development of social interaction skills
Imitation of new behaviors
Interpersonal learning
Dealing with the meaning of existence
Catharsis
Group cohesion
Corrective experiences

30. Group Development Over Time
Group becomes less leader centered and more member centered
Self-disclosure moves from being centered on impersonal events or feelings located in the past to more personal and present centered
Conflicts are handled less by avoidance and more by acknowledgment
Norms change from those that have been more imposed by the leader to those collaborated on by the group and these norms reflect the culture of the group
Boundaries between members move from being rigid to being more flexible
Individual and cultural differences become more respected and valued
Members move from reluctance in hearing feedback to seeking it