Module 4: Treatment Modalities Flashcards
Group Psychotherapy
- group therapy–very short-term
- psychoeducational groups that would occur on acute inpatient unit (15 min)
- may be more intense–occur in a partial program (30-45 min)
- could be longer-term with cognitive behavioral therapy in outpatient setting (6-8 wks)
Stages of Group Development
- Initial phase (develop trust)
- Working phase (resolve conflict)
- Mature phase (focus on goals)
- Termination (separation)
Initial phase
-group members develop trust between themselves and between group members and group leader
Working phase
- resolving conflict; may occur among group members
- transference: group member-to-member or group member-to-leader
Mature phase
-conflict between members of the group have been resolved and they’re working on goals developed during initial phase
Termination phase
- How long will a group last?
- Identifies what the outcome of a group will be
- Patients within the group may have issues with separation; abandonment
Yalom’s 11 Therapeutic Factors
- Universality
- Instillation of hope
- Imparting of information
- Altruism
- Corrective repeat of the family of origin
- Development of social skills
- Imitative behavior
- Interpersonal learning
- Group cohesiveness
- Catharsis
- Learning to accept painful aspects of life
Universality
-people within the group (perhaps w/ same diagnosis) can feel like they’re not alone–there are others, within the group, world who have same/similar difficulties
Instillation of hope
- the group is the carrier of hope, the leader is the carrier of the hope.
- members will feel the hope by interacting, by coming up with alternative coping mechanisms
Imparting of information
-occurs during psychoeducational group–symptom management, etc.
Altruism
-the action of helping others–by acting to help others the person gains some self respect and feels positive about interaction
Corrective repeat of the family of origin
-transference by a female toward a male member–group helps her recognize behavior
Development of social skills
-found in special social skill training for patients within autism spectrum, but can be found in any group therapy–teaching people about social skills and how to relate to others.
Interpersonal learning
-very similar to social skills–patient can learn about others who have similar experiences; sharing
Group cohesiveness
-very important; thinking of group as a whole (therapist needs to do this)
Catharsis
- ability to express emotion, express feeling
- may be painful feelings, anger, sadness–group is a “safe” place
Leadership styles
- Laissez-faire
- Democratic
- Authoritative
Laissez-faire
- group leader sits back and lets individual members “lead” the group
- leader doesn’t take an active role in building cohesiveness
Democratic
- leader asks for input from the group
- doesn’t make all decisions for the group
Authoritative
- very autocratic
- goal and objective for the group
- leader doesn’t take feedback from other member
- Ex: psychoeducational groups
Family
- the primary system to which a person belongs
- strength lies in the relationship among members
- the family provides tools that guide how individuals will function within intimate relationships, the workplace, and social situations
Boundaries
- Maintain a distinction between individuals within the family–each individual is their own person within an ideal situation.
- Ideal = clear intergenerational boundaries
- Pathology = diffuse or enmeshed boundaries (ex. seen as neg for children to take on independent roles)
Communication
- Ideal = clear and direct messages; clear what the discipline is for the child; what the expectations are for each member of system
- Pathology = family members have to resort to manipulation to get needs met
Emotional Support
- Ideal = affection is displayed, mutual positive regard, growth promoted in all family members (encouraged to be their own individuals)
- Pathology = hostility and conflict, growth is seen as abandonment of the family
Socialization
- socialization within family itself-between the members
- child learns to socialize through interacting with members
- Ideal = socialization skills, how to interact, negotiate, and plan; coping skills
- Pathology = change is seen as threatening, family becomes isolated
Family Therapy
- Family is seen as a system (Bowlby)
- Who is the identified patient within the family? If there’s an identified patient, there’s usually some other type of pathology
- Family triangles
Family triangles
-child has very close connection with one parent and limited or diffuse interaction with other parent–the two parents start to experience conflict
Assessment & Intervention
- Assessment of the family system and individuals
- Stage within the Family Life Cycle
- Multigenerational issues
- Sociocultural context
Assessment of the family system and individuals
-look at family system itself–how do individuals relate to one another? Is there room for growth? Is there support for the family?
Stage within the Family Life Cycle
- Is this a newly married couple?
- With children?
- Older, grown children?
Multigenerational issues
- who is the extended family?
- are they over involved? estranged?
Sociocultural context
- is the family economically stable?
- cultural context?
- how are boundaries determined?
Goals of Treatment
- help family mobilize resources and decrease tensions
- improving communication skills
- encouraging clear boundaries and independent skills of each individual
- strengthening ability to cope with life’s stressors
Types of Crises
- dispositional crises
- crises of anticipated life transitions
- traumatic stress
- maturational/developmental crises
Dispositional Crises
- an acute response to an external situational stressor
- determined by the coping skills, character, personality structure of the client
- how patient A responds to loss of job may be different from patient Bs response
Crises of Anticipated Life Transitions
- life cycle transitions over which the individual feels a lack of control
- going to college; getting job after college; having a child–transitions that result in crises for the individual
Crises resulting from traumatic stress
-rape trauma syndrome; sexual assualt
Maturational/Developmental Crises
- in response to situations that trigger unresolved conflicts in one’s life; internal origin
- something that may remind person of abandonment feelings/issues early in childhood–unable to put into words, but losing a job, breaking up w/ bf may bring about a crisis
Roberts 7 Stages of Crisis Intervention
- Plan and conduct a crisis assessment (safety, lethality assessment)
* *2. Rapidly establish rapport and therapeutic relationship–nurse needs to rapidly establish rapport; joining together of nurse and patient against the crisis. - Crisis precipitants
- Deal with feelings and emotions
- Generate and explore alternatives
- Develop and formulate an action plan
- Follow-up plan and agreement
