Unit 4 Therapeutic Groups Chapter 34

Question 1

What is the Goal of therapeutic groups?

Answer 1

A therapeutic group is any group of people who meet for personal development and psychological growth.

examples are narcotic anonymous, alcohol anonymous.

Question 2

What is Universality , and the benefit of it during group therapy?

Answer 2

Universality – feeling of belonging, others have experienced what I have

Question 3

You are having a group therapy with recovering alcoholics. There is a member of the group who is completely sober from alchohol. Which statement would best describe the benefits of this group?

a.Universality
b.Repression
C. Altruism
D. Conversion

Answer 3

a.Universality

feeling of belonging, others have experienced what I have

Question 4

What is the benefit of Altruism

Answer 4

Altruism – Personal growth through helping others, leading to improved self- worth

Question 5

What are the 4 Phases of Group Development

Answer 5

Planning
Orientation
Working
Termination

Question 6

What occurs during the Planning Phase of Group Development

Answer 6

Name of the group
Objective of the group)
 Participants (age, dx, gender)](are you excluding certain members?)
Description of leader and members responsibilities

Question 7

What occurs during the Orientation Phase of Group Development

Answer 7

Introduction - Group rules , or Hello, My name is…

 Leader structures an environment of respect, trust and confidentiality. (ground rules)

 Leader provides introduction and purpose of the group.

 Members are encouraged to provide introduction

Question 8

What occurs during the Working phase of Group Development

Answer 8

Working Phase- working through issues

 Leader facilitates communication, the flow of the group and group conduct.
Conflicts may be expressed – can be positive opportunity for group growth through resolution.
Storming – disagreements, personality clashes
Norming – resolution – cooperation emerges
 Performing – norms and roles are established and focus on achieving goals

Question 9

You as a nurse is conducting a study with a group of fellow nurses. You notice that group members are having disagreements and personality clashes, What stage is the group experiencing?

A. Forming
B. Storming
C. Norming
D.Performing

Answer 9

B. Storming

Storming refers to the disagreements, attempts at dominance,
and personality clashes that are addressed in order for the work of the group to be done. The authority and legitimacy of the leader may be questioned in this phase.

Question 10

You as a nurse is conducting a study with a group of fellow nurses. You notice that group members are resolving personality clashes and disagreements, What stage is the group experiencing?

A. Forming
B. Storming
C. Norming
D.Performing

Answer 10

C. Norming

Norming occurs when personality clashes and disagreements are resolved and a spirit of cooperation emerges. Team mem- bers begin to settle into their respective roles.

Question 11

You as a nurse is conducting a study with a group of fellow nurses. You notice that group members are establishing goals and norms in the group, What stage is the group experiencing?

A. Forming
B. Storming
C. Norming
D.Performing

Answer 11

D.Performing

Question 12

What occurs during the Termination Phase of Group Development

Answer 12

No more group -“whatever happens in the group stays in the group”

FEEDBACK YOUR OVER ALL EXPERIENCE IN GROUP

 Members share their new insights and identify future goals

 Feedback – information members get from other members about how they affect one another

the leader ensures that each member summarizes personal accomplishments, shares new insights, and identifies future goals. The leader encourages group mem- bers to provide both positive and negative feedback regarding the group experience. Feedback refers to information that group members get from other members about how they affect one another. Members may experience feelings of loss or anger about the group’s ending.

Question 13

What are the different type of Participating Roles

Answer 13

Task Roles – keep the group focused on its main purpose– keep the group focused on its main purpose
“keep focused on task”

Maintenance roles – Keep the group together, inclusion, group cohesion– cohesion
“making sure everyone has a voice”

Individual roles – Relate to personal agendas and personal desires. Nothing to do with
“each person has their own roles”

Question 14

Styles of Leadership

Answer 14

-Autocratic
-Democratic
-Laissez-faire

Question 15

Autocratic leadership

Answer 15

Only one person has control everyone else just follows

Autocratic leaders exert control over the group and do not directly encourage much interaction among members.
* For example, staff leading a daily community meeting for patients in a psychiatric hospital with a fixed, time-limited agenda may tend to be more autocratic.

Question 16

Democratic leadership

Answer 16

Control or power is changed from members to leaders

Democratic leaders support extensive group interaction in the process of problem solving. Psychotherapy groups most often employ this empowering leadership style.

Question 17

Laissez-faire leadership

Answer 17

No leader , you can do what you want

Laissez-faire leaders allow the group members to behave in any way they choose and do not attempt to control the direction of the group. In a creative group, such as an art or gardening group, the leader may choose a flexible laissez-faire style, directing the members only minimally to allow for a variety of responses and little productivity.
ART GROUP

Question 18

Group Leader Communication Techniques

Answer 18

Active listening
Eye contact; head nod, “Go on…”…

Ask questions
“Could you tell us the last time you did that?”

Giving information
“Antidepressants may take as long as four weeks or more to show full therapeutic effects.”

Clarification
“What do you mean when you say ’I can’t go back to work’?”

Confrontation
“Jane, you’re saying ’nothing is wrong,’ but you are crying.”

Empathizing
“I can see how that experience was very painful.”

Reflection
“I notice you’re clenching your fists. What are you feeling right now?” “It sounds like that really upset you.”

Summarizing
“We’ve talked about different types of cognitive distortions, and everyone identified at least one irrational thought that has influenced their behavior in a negative way. In the next session, we’ll explore some strategies for correcting negative thinking.”

Support
“It took a lot of courage to explore those painful feelings. You’re really working hard on resolving this problem.”

Question 19

Advantages of Therapeutic Groups

Answer 19

• Multiple members can be in treatment at the same time, thereby reaching more patients and reducing personnel costs.
• Members of a therapeutic group benefit from the knowledge, insights, and life experiences of both the leader and the participants.
• A therapeutic group can be a safe setting to learn new ways of relating to other people and to practice new communication skills.
• Groups can promote feelings of cohesiveness.

Question 20

Disadvantages of Therapeutic Groups

Answer 20

Disadvantages
* Individual members may feel cheated of participation time, particularly in large groups.
* Concerns over privacy.
* Disruptive group members reduce a group’s effectiveness.
* Group norms may discourage personal opinions.
* Not all patients benefit from group treatment.

Question 21

Which of the following is a NOT illustrating a challenging member behavior in group therapy?

A. The member who allows others to speak while actively listening
B. The member who overtakes the speaker while talking.
C. The member who answers the question the speaker asks them in a descriptive way.
D. The member who doesn’t speak at all during a group meeting.

Answer 21

A. The member who allows others to speak while actively listening

Question 22

What are the 3 different types of Challenging member behaviors

Answer 22

*Monopolizing Group Member

*Disruptive/Demoralizing Group Member

*Silent Group Member

Question 23

Monopolizing Group Member behavior and Interventions

Answer 23

*Talkativeness
*Overtalks
*Doesnt allow others to participate
*Displays Manic behavior

Interventions:
Address them directly
“I know you are excited about this topic , can you please give everyone else a chance”
One subtle method in dealing with a monopolizing group mem- ber is to address the entire group. Provide them with a reminder that, during group work, everyone has an equal chance to contribute and members can evaluate whether or not anyone is dominating the group’s time.

*Address the whole group , open the floor so everyone can have a chance to speak
ex-Who else would like to share feelings about this issue?”

You may then ask the patient to limit contributions to a spe- cific number of times, such as two or three.

May be necessary to speak directly to the monopolizing group member (in group orMay be necessary to speak directly to the monopolizing group member (in group or
privately) Privately you can directly discuss your observationsprivately) Privately you can directly discuss your observations

Question 24

Disruptive/Demoralizing Group Member behavior and Interventions

Answer 24

Challenges the leader, angry, rude
 Person may be self-centered, angry, lack empathy or concern for others.
 Refuse to take personal responsibility
Disruptive

Intervention
The leader may choose to speak to the group member in private and ask what is causing the anger.

This intervention will likely decrease hostile behav- ior and increase the group’s benefit. Angry patients may be extremely vulnerable, and the practice of devaluing or demoral- izing keeps others at a distance and maintains the patient’s own precarious sense of safety. Leaders empathize with the patient in a matter-of-fact manner, such as, “You seem angry that the group wants to support you.”

Leader should listen objectively, speak to the person in private and ask what isLeader should listen objectively, speak to the person in private and ask what is
causing the anger. This can help facilitate a connection with the nurse.causing the anger. This can help facilitate a connection with the nurse

Question 25

Silent Group Member behavior

Answer 25

Little to no response
May feel self-conscious to speak in front of others/crowds
Furthermore, a silent group member may make others uncomfortable and create a sense of mistrust.

Intervention
There are several techniques that may help, including allow- ing the person to have extra time to formulate thoughts before responding.

*One might say, “I’ll give you a moment to think about that,” and then waiting or coming back to the group mem- ber later. Another tactic is to make an assignment that every person in the group respond to a certain topic or question.

*Writing assignment to get them involved
“I want everyone to write down their response, then we will go around the group and let everyone share their response”

Question 26

Expected Outcomes for Group Therapy

Answer 26

For therapy groups, the expected outcomes will focus more
on insights, behavior changes, and reduction in symptoms. For example, in an alcohol use disorder treatment group, an expected outcome might be that the patient develops insight into the connection between drinking and negative consequences. An expected behavioral outcome would be abstinence from alcohol use or decreased risky use. In groups that focus primarily on emotional issues such as depression or anxiety, leaders can use standardized symptom surveys to measure symptom reduction as an outcome of group participation.

-Gain on insights,
-Behavior changes,
-Reduction in symptom

Question 27

Which of the following is expected outcome of group therapy?SELECT ALL THAT APPLY
A. Gain insight on coping strategies
B. To encourage the reduction of psychiatric disorder symptoms
C. Encourage behavior changes to improve daily life
D. To learn the new techniques in group therapy
E. Get to know the members of the group on a more personal level

Answer 27

A. Gain insight on coping strategies
B. To encourage the reduction of psychiatric disorder symptoms
C. Encourage behavior changes to improve daily life

Question 28

Group members are having difficulty deciding what topic to cover in today’s session. Which nurse leader response
reflects autocratic leadership?
a. “We are talking about fear of rejection today.”
b. “Let’s go around the room and make suggestions for
today’s topic.”
c. “I will let you come to a conclusion together about what
to talk about.”
d. “I’ll work with you to find a suitable topic for today.”

Answer 28

a. “We are talking about fear of rejection today.”

Question 29

A patient continues to dominate the group conversation despite having been asked to allow others to speak. What is the group leader’s most appropriate response?
a. “You are monopolizing the conversation.”
b. “When you talk constantly, it makes everyone feel angry.”
c. “You are supposed to allow others to speak also.”
d. “When you speak out of turn, I am concerned that others will not be able to participate equally.”

Answer 29

d. “When you speak out of turn, I am concerned that others will not be able to participate equally.”

Question 30

What group would benefit most from a laissez-faire leader?
a. Art group
b. Grief group
c. Social skills group
d. Anger management group

Answer 30

a. Art group

Question 31

Which outcome would be appropriate for a group session on medication education? Select all that apply.
a. Patient will identify three side effects of prescribed
medication.
b. Patient will verbalize the purpose of taking the medication.
c. Patient will acknowledge and accept the financial cost of
prescribed medications.
d. Patient will correctly identify time of day and dose for
each prescribed medication.
e. Patient will list two potential drug–drug and drug–food
interactions for prescribed medications.

Answer 31

A
B
D
E

Question 32

What question by the nurse leader is helpful in managing a
monopolizing member of a group?
a. “You seem angry. Is there something you want to discuss
with the group?”
b. “Would it be helpful if you had time to think about the
question?”
c. “Would you tell us about experiences that have fright-
ened you?”
d. “Who else would like to share feelings about this issue?”

Answer 32

d. “Who else would like to share feelings about this issue?”

Question 33

What advantages does group therapy have over individual therapy? Select all that apply.
a. Groups are less expensive than one-on-one therapy.
b. Groups provide an opportunity to learn from others.
c. Groups are homogeneous in composition.
d. Feedback is available from the group leader and group
members.
e. Interpersonal skills can be practiced in a safe environment.

Answer 33

A
B
D
E

Question 34

The nurse describes the purpose of psycho-educational groups as providing group members with the knowledge and skills necessary to manage psychiatric symptoms. Which phase of group development is represented?
a. Planning (formation) phase
b. Orientation phase
c. Working phase
d. Termination phase

Answer 34

b. Orientation phase

Orientation Phase
Introduction - Group rules , or Hello, My name is…

 Leader structures an environment of respect, trust and confidentiality. (ground rules)

 Leader provides introduction and purpose of the group.

 Members are encouraged to provide introduction