Interventions With Groups Chapter 14

Definitions of “Group” A collection of individuals who identify with the leader, and other members, but who act independently (psychoanalytic definition) Parts or components that exist to perform some activity or purpose (systems theory) Two or more people who develop interactive relationships and share at least one common goal (this text)

Open vs. Closed Groups Open group –New members may join. –Members may leave at any time. –New members are at a disadvantage. –Advantage of this type is that group can continue. Closed group –Members join at one time. –There are no replacement members. –Group is more cohesive. –Group is more likely to dissolve when members drop out.

Group Size Small Eight to 10 people Cohesive Fewer subgroups Richer IP Led by one Large > 10 members Can be therapeutic More cost-effective Open-ended, ongoing Avoid intense transference and counter

Group Development Group development is a process. Definition: Group process is the culmination of the session-to-session interactions of the members that move the group toward its goals.

Group Process Beginning Honeymoon Conflict Working Develop rules, rituals Group realizes its purpose. Termination Members grieve for loss of the group. Reestablish themselves as individuals

Roles of Group Members Formal group roles –Leader –Member Informal group roles –Task –Maintenance –Individual

Group Membership: Roles & Functions Task roles: business of the group –Initiator, information seeker, coordinator, recorder Maintenance roles: keeping group together –Harmonizer, compromiser, gate-keeper, observer Individual roles: either detract or enhance group –Aggressor, self-confessor, recognition seeker

Group Communication Verbal Communication –Communication network Sociometric analysis Sit next to each other, talk to each other –Group themes –Mood

Group Communication Non-verbal Communication Seating arrangement Eye contact Posture Body gestures

Group Norms & Standards Groups develop norms or acceptable group behaviors. Formalized norms –Example: beginning group on time Informal norms

Group Cohesion One of the goals is usually fostering group cohesion. Encourages social interaction Helps group stay together Increases members commitment to group Disadvantage: –In very cohesive groups, members are more likely to transgress personal boundaries. –Can become dysfunctional

Groupthink Tendency of groups to avoid conflict and adopt a normative pattern of thinking Can lead to poor decision-making because the group is more concerned about being part of the group, rather than thinking independently Unclear whether cohesive groups are more likely to experience groupthink Be aware of the possibility in decision-making groups

Leading a Group Obtains and receives information Helps in the diagnosis of group goals, obstacles and consequences of decisions Facilitates communication Helps integrate the various perspectives and alternative possibilities Tests and evaluates proposals and decisions Techniques Table 14-3

Leadership Skills Listening Tracking verbal and nonverbal interactions Maintaining a neutral, nonjudgmental style Not showing preference to one member over another Providing everyone with an opportunity to contribute

Choosing Leadership Styles Led within the context of the group leader’s theoretical background Direct-indirect Continuum –Direct leadership Controls the interaction Gives direct information Allows little discussion –Indirect leadership Uses reflection and offers little guidance Does not provide information to the group

Selecting Group Members Leader responsible for membership Consider the following: –Does the purpose of group match the need of patient? –Does the patient have the skills to participate in the group? –Will other group members accept the new member? –Will the new member be able to make the commitment to attend?

Seating Arrangements Use circle seating without barriers (tables). Rectangular tables tend to promote positions of power at the end of the table. Classroom seating prevents effective interactions. No one should sit outside the circle.

Seating Arrangements Members who sit closest to the leader are more likely to have more power. Group should be held in a quiet, pleasant room with adequate space and privacy. Large rooms inhibit communication. Avoid eating during group.

Discussion of Challenging Behaviors Monopolizer “Yes, but” Disliked member Group conflict

Types of Groups Psychoeducation –Task groups –Teaching groups Supportive therapy groups Psychotherapy groups Self-help groups

Nursing Intervention Groups Medication groups (Text Box 14.2) Symptom management groups Anger management groups Self-care groups