1. Therapeutic Approaches
Review chapter outlines in notes
CHAPTER OUTLINE/LECTURE NOTES
I. Introduction
operations.
of people but also encounter multiple group situations in their professional
A. Health care professionals not only share their personal lives with groups
II. The Group, Defined
B. Clients learn from each other in a group setting.
III. Functions of a Group
commonalities of interest, values, norms, or purpose
A. A collection of individuals whose association is founded on shared
A. Socialization. The teaching of social norms.
group involvement.
C. Task Completion. Assistance is provided when completion is enhanced by
B. Support. Fellow members are available in time of need.
significant others.
D. Camaraderie. Individuals receive joy and pleasure from interactions with
F. Normative. Different groups enforce the established norms in various
knowledge with the others in the group.
E. Informational. Learning takes place when group members share their
ways.
H. Governance. Large organizations often have leadership that is provided by
individuals alone are ineffective.
G. Empowerment. Change can be effected by groups at times when
IV. Types of Groups
groups rather than by a single individual.
number of individuals.
B. Teaching groups. Focus is to convey knowledge and information to a
A. Task groups. A group formed to accomplish a specific outcome.
C. Supportive/therapeutic groups. The concern of these groups is to prevent
crises.
dealing with emotional stress arising from situational or developmental
possible future upsets by educating the participants in effective ways of
a. Group therapy has a sound theoretical base and the leaders
1. Therapeutic groups vs. group therapy
b. Therapeutic groups are based to a lesser degree in theory. Focus is
nursing, or medicine.
generally have advanced degrees in psychology, social work,
on group relationships, interactions between group members, and
group process (the way in which group members interact with each
c. Leaders of both types of groups must be knowledgeable about
the consideration of a selected issue.
in the group).
other), as well as group content (the topic or issue being discussed
pathology and necessary treatment. May or may not have a professional
to reduce the possibilities of further emotional distress leading to
D. Self-help groups. Composed of individuals with a similar problem. Serve
leader. Run by members, and leadership often rotates from member to
A. Seating. It is best when there is no barrier between the members. For
V. Physical Conditions that Influence Group Dynamics
member.
B. Size. Size of the group makes a difference in the interaction among
example, a circle of chairs is better than chairs set around a table.
C. Membership. Two types of groups exist: open-ended groups (those in
optimal group interaction and relationship development.
members. Seven or eight members provides a favorable climate for
which members leave and others join at any time during the existence of
length of time).
the time the group is organized and terminate at the end of the designated
the group) and closed-ended groups (those in which all members join at
A. The instillation of hope. By observing the progress of others in the group
VI. Curative Factors
B. Universality. Individuals come to realize that they are not alone in the
problems can also be resolved.
with similar problems, a group member garners hope that his or her
problems, thoughts, and feelings they are experiencing.
group members.
with each other. Leaders of teaching groups also provide information to
C. The imparting of information. Group members share their knowledge
helping to create a positive self-image and promoting self-growth.
D. Altruism. Individuals provide assistance and support to each other, thereby
F. The development of socializing techniques. Through interaction with and
are able to re-experience early family conflicts that remain unresolved.
E. The corrective recapitulation of the primary family group. Group members
feedback from other members within the group, individuals are able to correct
psychosocial skill or developmental task serve as valuable role models for
G. Imitative behavior. Group members who have mastered a particular
maladaptive social behaviors and learn and develop new social skills.
H. Interpersonal learning. The group offers many and varied opportunities for
others.
the individual (“I am”) from the group (“we are”).
I. Group cohesiveness. Members develop a sense of belonging that separates
interacting with other people.
J. Catharsis. Within the group, members are able to express both positive and
direction of their own lives and to accept responsibility for the quality of their
K. Existential factors. The group is able to assist individual members to take
negative feelings.
VII. Phases of Group Development
existence.
group.
1. Leader and members work together to establish rules and goals for the
A. Initial or Orientation Phase
2. The leader promotes trust and ensures that the rules do not interfere
established.
3. Members are superficial and overly polite. Trust has not yet been
with the fulfillment of the goals.
1. Productive work toward completion of the task is undertaken.
B. Middle or Working Phase
exists. Conflict is managed by the group members themselves.
3. Trust has been established between the members and cohesiveness
2. Leader role diminishes and becomes more one of facilitator.
1. A sense of loss, precipitating the grief process, may be experienced by
C. Final or Termination Phase
loss, and to reminisce about the accomplishments of the group.
2. The leader encourages the group members to discuss these feelings of
3. Feelings of abandonment may be experienced by some members.
Grief for previous losses may be triggered.
dependent for problem solving, decision making, and permission to
A. Autocratic. The focus is on the leader, on whom the members are
VIII. Leadership Styles
perform. Production is high, but morale is low.
including taking action to effect change. Production is somewhat lower
participate fully in problem solving of issues that relate to the group,
B. Democratic. The focus is on the members, who are encouraged to
C. Laissez-faire. There is no focus in this type of leadership. Goals are
than it is with autocratic leadership, but morale is much higher.
XI. Member Roles
low.
undefined, and members do as they please. Productivity and morale are
A. Members play one of three types of roles within a group:
processes.
2. Maintenance roles. Roles that serve to maintain or enhance group
1. Task roles. Roles that serve to complete the task of the group.
individual needs.
3. Individual (personal) roles. Roles that serve to fulfill personal or
in which clients become “actors” in life-situation scenarios.
A. It is defined as a type of group therapy that employs a dramatic approach
X. Psychodrama
B. An identified client (called the protagonist) is selected to portray a life
not participate in the drama act as the audience, and the group leader is
whom the protagonist has unresolved issues. Group members who do
situation. Other members of the group play the roles of people with
C. The purpose is to provide the client with a safe place in which to
called the director.
the master’s degree.
D. Nurses who work as psychodramatists require specialist training beyond
confront unresolved conflicts, and hopefully progress toward resolution.
A. Nurses who work in psychiatry may lead various types of therapeutic
XI. The Role of the Nurse in Group Therapy
discharge groups, and others.
groups for clients with similar problems, parent groups, transition to
groups, such as client education groups, assertiveness training, support
nurses who serve as group psychotherapists should have a minimum of a
B. Guidelines set forth by the American Nurses’ Association specify that
master’s degree in psychiatric nursing.

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