1. Intervention in Groups
Chapter 9
Intervention in Groups

2. Introduction
Health-care professionals not only share their personal lives with groups of people, but also encounter multiple group situations in their professional operations
Clients learn from each other in a group setting (active learning)

3. Group, Defined
A collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose

4. Functions of a Group
Socialization: the teaching of social norms occurs through group interaction
Support: fellow group 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

5. Functions of a Group (cont.)
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

6. Types of Groups
Task groups: this is a group formed to accomplish a specific outcome or task
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

7. Types of Groups (cont.) 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; the focus is on group relations, interactions among 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) and group content (the topic or issue being discussed in the group)

8. Types of Groups (cont.) 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; leadership often rotates from member to member
Alcoholics Anonymous

9. Physical Conditions That Influence Group Dynamics
Seating: best when there is no barrier between the members; for example, a circle of chairs is better than chairs set around a table
Size: size of the group makes a difference in the interaction among members; seven or eight members provide a favorable climate for optimal group interaction and relationship development

10. Physical Conditions That Influence Group Dynamics (cont.)
Membership: two types of groups exist
Open-ended groups: members leave and others join at any time during the existence of the group
Closed-ended groups: all members join at the time the group is organized and terminate membership at the end of a designated period

11. 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

12. Curative Factors of Groups (cont.)
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 to learn and develop new social skills

13. Curative Factors of Groups (cont.)
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 individual (“I am”) from group (“we are”)

14. Curative Factors of Groups (cont.)
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 take direction of their own lives and to accept responsibility for the quality of their existence

15. Phases of Group Development
Phase I. 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

16. Phases of Group Development (cont.)
Phase II. 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 among the members and cohesiveness exists
Conflict is managed by the group members themselves

17. Phases of Group Development (cont.)
Phase III. Final or termination phase
A sense of loss, precipitating the grief process, may be experienced by by group members
The leader encourages the group members to discuss these feeling 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

18. 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

19. Leadership Styles (cont.)
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

20. Leadership Styles (cont.)
Laissez-faire: there is no focus in this type of leadership. Goals are undefined, and members do as they please; productivity and morale are low

21. 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

22. Psychodrama
Defined as a type of group therapy that employs a dramatic approach in which clients become “actors” in life-situation scenarios
An identified client (called the protagonist) is selected to portray a life situation
Other members of the group play the roles of people with whom the protagonist has unresolved issues
Group members who do not participate in the drama act as the audience, and the group leader is called the director
The purpose is to provide the client with a safe place in which to confront unresolved conflicts in an effort to progress toward resolution

23. The Family as a Group
Family therapy: focus of the treatment is on the family as a unit
Goal: to identify and change problematic, maladaptive, self-defeating, repetitive relationship patterns

24. The Family as a Group (cont.)
The family is viewed as a system in which the members are interdependent
A change in one part (member) within the system affects or creates change in all the other parts (members)

25. The Family as a Group (cont.)
Genograms
A study of multiple generations within a family
Identifies roles of specific individuals
Highlights relationships among family members
Reveals a large amount of information in a small amount of space
Can be used as a teaching tool with families

26. The Family as a Group (cont.)
The nurse’s role
Family therapy may be conducted by advanced practice nurses (APNs)
Generalist nurses should have knowledge of family dynamics and contribute to the assessment and planning phases of family therapy and to ongoing observation and evaluation

27. Role of the Nurse in Group Interventions
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

28. Role of the Nurse in Group Interventions (cont.)
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
Additional specialist training beyond the master’s level is required to prepare nurses to conduct psychodrama