Therapeutic Approaches

1. Therapeutic Approaches Review chapter outlines in notes

2. Therapeutic Groups • Intervention with Families • Mileu Therapy • Relaxation Therapy • Assertiveness Therapy • Promoting Self-Esteem • Behavioral Therapy • Cognitive Therapy • Electroconvulsive Therapy • Complementary Therapy • Client Education

3. Functions of a Group • Socialization. The teaching of social norms occurs through groups. • Support. Fellow members are available in time of need. • Task completion. Groups can assist in endeavors that are beyond the capacity of one individual alone. • Camaraderie. Individuals receive joy and pleasure from interactions with significant others. • Informational. Learning takes place when group members share their knowledge with the others in the group. • Normative. Different groups enforce established norms in various ways. • Empowerment. Change can be made by groups at times when individuals alone are ineffective. • Governance. Large organizations often have leadership that is provided by groups rather than by a single individual.

4. Types of Groups • Task groups. This is a group formed to accomplish a specific outcome. • Teaching groups. The focus is to convey knowledge and information to a number of individuals. • Supportive/therapeutic groups. The primary concern is to prevent possible future upsets by teaching the participants effective ways of dealing with emotional stress arising from situational or developmental crises. • Therapeutic groups vs. group therapy • Group therapy has a sound theoretical base, and leaders generally have advanced degrees in psychology, social work, nursing, or medicine. • Therapeutic groups are based to a lesser extent on theory. Focus is on group relations, interactions between group members, and the consideration of a selected issue. • Leaders of both types of groups must be knowledgeable about group process (the way in which group members interact with each other) as well as group content (the topic or issue being discussed in the group).

5. Self-help groups • Composed of individuals with a similar problem • Serve to reduce the possibilities of further emotional distress leading to pathology and necessary treatment • May or may not have a professional leader. Run by members, and leadership often rotates from member to member

6. The Role of the Nurse in Group Therapy • Nurses who work in psychiatry may lead various types of therapeutic groups, such as client education groups, assertiveness training, support groups for clients with similar problems, parent groups, transition to discharge groups, and others. • Guidelines set forth by the American Nurses Association specify that nurses who serve as group psychotherapists should have a minimum of a master’s degree in psychiatric nursing.

7. Curative Factors of Groups • Instillation of hope. By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. • Universality. Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. • Imparting of information. Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members.

8. Altruism.Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. • Corrective recapitulation of the primary family group. Group members are able to re-experience early family conflicts that remain unresolved. • Development of socializing techniques. Through interaction with and feedback from other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills.

9. Imitative behavior. Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. • Interpersonal learning. Group offers varied opportunities for interacting with other people. • Group cohesiveness. Members develop a sense of belonging rather than separating the individual (“I am”) from the group (“we are”). • Catharsis. Within the group, members are able to express both positive and negative feelings. • Existential factors. The group is able to assist individual members to undertake direction of their own lives and to accept responsibility for the quality of their existence.

10. Phases of Group Development Initial or Orientation Phase • Leader and members work together to establish rules and goals for the group. • Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals. • Members are superficial and overly polite. Trust has not yet been established. Middle or Working Phase • Productive work toward completion of the task is undertaken. • Leader role diminishes and becomes more one of facilitator. • Trust has been established between the members, and cohesiveness exists. • Conflict is managed by the group members themselves. Final or Termination Phase • A sense of loss, precipitating the grief process, may be experienced by group members. • The leader encourages the group members to discuss these feelings of loss and to reminisce about the accomplishments of the group. • Feelings of abandonment may be experienced by some members. Grief for previous losses may be triggered.

11. Leadership Styles • Autocratic. Focus is on the leader, on whom the members are dependent for problem-solving, decision-making, and permission to perform. Production is high, but morale is low. • Democratic. Focus is on members, who are encouraged to participate fully in problem-solving of group issues, including taking action to effect change. Production is somewhat lower than with autocratic leadership but morale is much higher. • Laissez-faire. There is no focus in this type of leadership. Goals are undefined, and members do as they please. Productivity and morale are very low.

12. Member Roles • Members play one of three types of roles within a group: • Task roles –serving to complete the task of the group • Maintenance roles – maintaining or enhancing group processes • Individual (personal) roles – fulfilling personal or individual needs