Mental Health Nursing

Assignment
On
Group Therapy

Submitted to Submitted by

Mr. Rahul Shrivastav Mr. Shahnawaz

HOD Msc Nursing

YIPS YIPS
WHAT IS GROUP:A group is defined as two or more people who interact and influence
one another. (Shaw, 1981)

WHAT IS GROUP THERAPY:

 Intended to help people who would like to improve their ability to cope with
difficulties and problems in their lives.

 Focuses on interpersonal interactions.

 Aims to help with solving the emotional difficulties.

 Encourages the personal development.

 Members feel that he is not alone with her/ his problem and there are others who feel
the same.

 A group can become a source of support and strength in times of stress.

WHAT IS GROUP THERAPY:

Group psycho therapy is a treatment in which carefully selected people who are emotionally
ill meet in a group guided by a trained therapist, and help one another effect personality
change.

HISTORICAL BACKGROUND
 Development of group therapy can be seen in four phases.

 Currently group therapy is in its fourth phase.

 The four phases of group therapy:

 The first phase was ushered by World War 2 and the enormous amount of
psychological carnage that emerged from it.

 Second phase of group therapy’s development was the community mental health
movement in the late 1960s and 1970s.

 The third phase came in the 1990s which was the age of health care reform.

 Fourth phase of group therapy came in the first decade of this century and it was
ushered by a rise in terrorism and natural calamities to address the issues of
psychological trauma.

INDICATIONS FOR INCLUSIONS

• Slavon (1955) sets four general criteria for inclusion into groups:

 The patient must have experienced minimal satisfaction in his/ her primary relations.
  A minimal degree of sexual disturbance.

 A moderate ego- strength.

 A minimal super- ego development.

OTHER INDICATIONS
 Homogeneous groups.
 Adolescents and patients with personality disorders.
 Families and couples where the system needs change.

CONTRAINDICATIONS
 Antisocial patients.

• Actively suicidal or severely depressed patients.

• Patients who are delusional and who may incorporate the group into their delusional
system.

GROUP SIZE
Optimal size for group therapy is 8 to 10 members

FREQUENCY AND LENGTH OF SESSIONS

Most group psychotherapists conduct group sessions once a week; each session may last for
45 minutes to 1 hour.

APPROACHES TO GROUP THERAPY

• The therapist’s role is primarily that of a facilitator; he should provide a safe,
comfortable atmosphere for self- disclosure.

• Focus on the “here and now”.

• Use any transference situations to develop insight into their problems.

• Protect members from verbal abuse.

• Whenever appropriate, provide positive reinforcement, this gives ego support and
encourages future growth.

• Handle circumstantial patients, hallucinating and delusional patients in a manner that

protects the self esteem of the individual and also sets limits on the behaviour so as to
protects other group members.

• Develop ability to recognize when a group member is “ fragile ”; he should be

approached in a gentle, supportive and non- threatening manner.
 • Use silence effectively to encourage introspection and facilitate insight.

THERAPEUTIC FACTORS
These involve :

 SHARING EXPERIENCE: This help the patients to also realize that they are
not isolated and that others also have similar experiences and problems. Hearing from
other patients that they have shared experiences is often more convincing and helpful
than reassurance from the therapist.
 SUPPORT TO AND FROM GROUP MEMBERS:Receiving help from
other group members can be supportive to the person helped. The sharing action of
being mutually supportive is an aspect of the group cohesiveness that can provide a
sense of belonging for patients who feel isolated in their everyday lives.
 SOCIALIZATION: It is acquisition of social skills (for example, maintaining
eye contact) within a group through comments that members provide about one
another’s deficiencies in social skills. This process can be helped by trying out new
ways of interacting within the safety for group.
 IMITATION: It is learning from observing and adopting the behaviours of other
group members. If the group is run well, patients imitate the adaptive behaviours of
other group members.
 INTERPERSONAL LEARNING: It refers to learning about difficulties in
relationships by examining the interaction of individuals with the other members of
the group.

SOME TECHNIQUES USEFUL IN GROUP THERAPY

• Reflecting or rewarding comments of group members.

• Asking for group reaction to one member’s statement.

• Asking for individual reaction to one member’s statement.

• Pointing out any shared feelings within the group.

• Summarizing various points at the end of session.

STAGES OF GROUP THERAPY

THE BEGINNING STAGE:

The time period used for introduction and for discussion of such topics as the group, what to
expect, fear, group rules, comfort levels, and the content of the group.

• In this stage, members are checking out other members and their own level of comfort
with sharing in the group.
 • Members determine the focus of the group.

• May take more than two sessions to feel enough trust and comfort.

THE MIDDLE OR WORKING STAGE:

 The members focus on the purpose.

 Learn new material, thoroughly discuss various topics, complete tasks, or engage in
personal sharing and therapeutic work.

 This stage is the core of the group process.

 It is the time when members benefit from being in a group.

THE CLOSING OR ENDING STAGE

• Develop to terminating the group.

• Members share what they have learned, how they have changed, and how they plan to
use what they have learned.

• May be an emotional experience.

• Most groups need only one session for this stage.

COMMON MISTAKES MADE WHEN LEADING THERAPY GROUP

 Attempting to conduct therapy without a conduct.

 Not involving the other members.

 Spending too much time on one person.

 Spending too little time on one person.

 Focusing on an irrelevant topic.

 Letting members rescue each other.

 Letting the session become an Advice- Giving –Session.

DEALING WITH PROBLEM SITUATION IN GROUPS

THE CHRONIC TALKER:

 Leader could attempt to speak to the member about his “talkativeness”.

 Other strategy involves seeking feedback from the members.

 Another method could be to ask a question to the group and encouraging members
who have not spoken yet to speak up.
THE RESISTANT MEMBER:
 May have negative expectations about the effectiveness of a group.

 Believe that the group will not be helpful, and therefore they refuse to participate
cooperatively.

 Leader should let the member share his feelings in the group or to talk to him in a
dyad or after the session and try to help him work through his resistance.

 Do not to spend too much time with the resistant member if it takes productive time
away from the other group members.

THE MEMBER WHO TRIES TO “GET THE LEADER”:

 This occurs when a member attempts to sabotage what the leader is saying or doing in
the group.

 Leader should try to understand why the member has targeted him.

 Talk to the member at the end of the session.

 The leader might be able to gain some insight from talking to other members.

DEALING WITH CRYING:

 Important to take into consideration when a member is crying is whether the crying is
a result of some struggle or painful event or is an attempt to gain sympathy.

 Members may reach out and touch the person who is crying.

 It is appropriate to ask a member not to touch or hug another member.

 Shift the focus away from that member and then seek him/ her out after the group.

CENTRE OF GROUP THERAPY IN INDIA

1. Mount camel college Bengaluru area.

2. ISISD Patna area.

3. Counselling psychologist and college advisor at vasant valley school, new delhi.

4. Montfort College, Zakir Husain college Guwahati.

5. Fergusson college, university of pune, pune.

6. Christian counselling centre, vellore, shreematinathibaidamodarthackersey women’s

university.

7. Cunseling at cadabam’s Thiruvananthapuram area.

8. Counselling MIND India Guwahati.

9. NIMHANS bengalore.

10. IHBAS delhi.

 BIBLIOGRAPHY

 R Shreevani, “A GUIDE TO MENTAL HEALTH & PSYCHIATRIC NURSING”,

3rd Edition 2010, Jaypee Brothers Medical Publication (P) LTD. Page no.117, 131,
112.
 en.wikipedia.org
 www.mayoclinic.org
 www.slideshare.net