GROUP THERAPY
Introduction
·
Group therapy or group psycho therapy is a less
time consuming procedure in which usually 8-10 people can be treated at one
time. Joseph Pratt first used this in 1905.
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Group therapy may be utilize psycho analytic,
supportive, transactional or behavioral approaches.
·
The sessions are held once or twice a week, with
each session lasting 1-2 hours, the patients usually sit in a circle.
Definition
Group therapy or group psychotherapy is a form of treatment
in which carefully selected, emotionally
ill patients are placed into group, guided by a trained therapist for the
purpose of changing the maladaptive behavior of the individual member.
Purposes
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To intervene in psychopathology
·
To reveal, examine and resolve distortions in
interpersonal relationships
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To improve the skill of relating to others
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To learn coping styles
Therapeutic functions of Group therapy (Yalom)
·
Imparting of information
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Instillation of hope
·
Universality
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Altruism
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Corrective recapitulation of the Primary Family
Group.
·
Development of socializing techniques
·
Imitative behavior
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Interpersonal learning
·
Group cohesiveness
·
Catharsis
Types of group therapy
l. According to size
A. Small
B. Large
2. According to diagnosis of clients
A. Homogeneous group
B. Heterogeneous group
3. According to nature of group
A. Primary group
B. Secondary group
4. According to purpose
A. Psychoanalytic group therapy
B. Transactional Analysis
C. Rational- emotive therapy
D. Gestalt therapy
E. Interpersonal Group therapy
F. Psycho drama group
G. Encounter Groups
H. T- groups
I. Community support groups
J. Marathon groups
Psychoanalytic group psychotherapy
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Group communication is focused on the three
levels of unconscious, semiconscious and conscious material.
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The group focuses on interpretation of dreams,
free association, and other latent content product in the group.
·
The therapist turns these experiences into
conscious, healthy learning experiences for the client.
Transactional analysis
The three ego stages of the individual- the parent, the
child, the adult-are examined in TA group.
Rational emotive therapy
It aims to maximize a person's rational thinking
Gestalt therapy
·
It emphasizes on self- expression, self-
exploration and self awareness in the patient.
·
Clients and therapist focus on every day
problems and try to solve them
Interpersonal group therapy
·
It explores the member's anxiety and stress and
their effects on the individual.
·
It is believed that anxiety from interpersonal
relationships is reduced or relieved through interpersonal support.
Psychodrama group
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During psychodrama, the client produces a topic
to be explored. The therapist directs the subject through role playing of
scenes related to the topic and incorporates the use of therapeutic ideas in
the action.
·
A catharsis occurs for the subject and also for
the audience.
Encounter groups
It aims at bringing personal change as a result of deeply
felt experiences.
T- groups
·
The goal is to verify experimentally the T-group
method. This involves the study of group norms, roles, communication
distortions, and the effect of authority on behavior patterns personality and
coping mechanisms.
·
Group members receive feedback by exposing
themselves to others in the group, and they also experiment with new and more
productive behavior.
Community support groups
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It provides identification, clarification, understanding,
role modeling, feeling of togetherness, and group cohesion.
·
They help individual member from being lonely
and depressed.
·
They help the members decrease levels of stress
and increase levels of selfacceptance. The members develop new or more effective
patterns of behavior.
Marathon groups
·
The term marathon group refers to the amount of
concentrated time the participants spend together as a group.
·
These sessions may last from 12 hrs to 2,3 or
more days, allowing short periods away from the group for sleeping and eating.
·
These groups have a clearly stated goal of
personal change or growth of the participants.
·
Size of group 8-10 members, duration of each
session is 1-2 hrs, frequently everyday or 3 days in a week.
Stages of group therapy
Initial stage
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Involvement among members is superficial
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Members are becoming acquainted with each other
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They search for similarity between themselves
and other group members
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Some amount of structuring of group norms, roles
and responsibilities take place
Working Stage
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Members get into "Work" accomplished
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Freely approach each other, discuss their
problems and attempt to solve their problems.
·
Conflict and cooperation surface during the work
group.
Termination stage
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Evaluating and summarizing the group experience
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Exploring positive and negative feelings about
group experiences.
·
Evaluation of the goals been achieved
Criteria of patients to be included in group therapy
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Ability to communicate
·
Willingness to share his problems with others
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Motivation to change
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Patients with authority anxiety
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Patients using defense mechanism of projections,
repression, denial, suppression, transference reactions.
Factors contributing to group
therapy
·
Faith in the treatment procedure
·
Universality of problems
·
Direct guidance for the problem
·
Altruism
·
Development of socializing skills
·
Imitative behavior
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Catharsis
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Conflict resolution
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Acceptance of reality
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Group cohesiveness
·
Interpersonal learning
CONTRANDICATION
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Antisocial patients
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Actively suicidal or severely depressed patients
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Patients who are delusional & who may
incorporate the group into their delusional system.
Group size...
Optimal size for group therapy is 8 to 10 members.
Frequency and length of sessions:
Most group psychotherapist conduct group
sessions once a week; each session may last for 45 minutes to 1 hour.
Therapeutic interventions/techniques in the group therapy
·
Approval
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Acceptance
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Clarification
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Exploration
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Identification
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Interpretation
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Information giving
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Encouraging expression of feelings or ideas
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Reassurance
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Support
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Understanding
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Reflection
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Listening
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Teaching
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silence
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Structuring
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Limit setting
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Transference and counter transference
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Themes
Advantages of group therapy
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Cost effective
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Decreases the feeling of isolation, uniqueness
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Enhances problem sharing
·
Opportunity to explore specific styles of communication
in a safe atmosphere
·
Clear multiple ways of solving problems from
other group members
·
Learn socialization skills
·
Group provides for its members understanding,
confrontation and identification with more than one individual.
Disadvantages
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Individual privacy is destroyed
·
Resistance and reluctant to change
·
Therapist at times dominates in the therapy
session
Nurses roles in group therapy
Group task role
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Aim is to identify group problems and select methods
to solve those problems.
·
Seeks clarification
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Suggests or proposes new ideas
·
Asks for opinions or values pertinent to what
the group is undertaking
·
Gives information, offers facts or
generalization
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Gives his/her opinion by stating his/her ideas
and values about group suggestions
·
Elaborates the meaning of suggestions offered to
the group
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Coordinates shows or clarifies how ideas can
work
·
Orients the group on target by defining where
the group is in relationship to its goal.
·
Evaluates the accomplishment of the group in
relation to its task
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Motivates the group to greater productivity
·
Records the productive discussions
Group building and maintenance
roles
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Aim- to strength, regulate and perpetuate the
group members to function as whole group
·
Encourages and accepts the contribution of
others
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Reconciles differences between group members
·
Admits his/others error to maintain group
harmony
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Keeps communication open and provides
encouraging remarks Sets group goals and evaluate the group functioning
·
Observe group discussion, gives feed back and
interprets
Individual role
Aim: meet the needs of the group member and not the group.
This hampers group functioning, we need to be aware of-
·
Expresses aggression, which deflates the status
of individual and group accomplishment
·
Resists progress by arguing or disagreeing
beyond reason
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Calls attention to himself/ herself through
boasting and pointing out his achievements.
Gives self confession by expressing his/her feelings and ideology not
related to the group, but uses the group audience
·
Demonstrates his/her lack of involvement
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Asserts his or her authority and superiority in
manipulating the group or certain members of the group.
·
Seeks help or tries to elicit sympathy from the
group Tries to have his/her own biases
and prejudices.
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Individually oriented behavior
Some basic roles of nurses
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Determine setting and size of the group
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Choose frequency and length of group sessions
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Select a therapist/ co therapist for group
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Formulate policy on group therapy with other
therapeutic modalities Formulating
appropriate goals
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Selecting patients who can perform the group
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Preparing patients for group therapy
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Build the culture of the group explicitly and
implicitly
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Explaining the group members to maintain the
confidentiality of the group activities.
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Identify and resolve the petty problems of the
group
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Fix up time for the subsequent sessions
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Maintain attendance group members
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Obtain written informed consent from the group
members
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Maintain strict discipline and confidentiality
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Document all the sessions
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Monitor the group members behavioral changes
COMMENTS