Nurses and Groups: Person-Centered Approach to Group Counseling among People with Depression - Essay Example

?Nurses and groups: Person-centered approach to group counseling among people with depression Introduction Group therapy and group dynamics have beenemployed in many fields such as education, healthcare, counseling and rehabilitation centers, addiction treatment centers, child abuse centers, and juvenile training schools. Group therapy is aimed at offering empathy and support to all the group members by creating an atmosphere of trust that leads to sharing and exploring of each one’s concerns (Corey, 2008, p. 4). As the group consists of members belonging to various cultures and value systems, interpersonal relationships are very much significant in group therapies and as such, these therapies stress the thoughts, feelings and behavior patterns of the participants as well. No doubt, group therapy is capable of yielding “empowering experiences” to the patients and the group members can both “serve as change agents and facilitators” (Norcross & Goldfried, 2005, p. 366). Group therapies, in general, aim at promoting the self-esteem and emotional well-being of the participants and person centered group therapies rely on the potential of the clients to find solutions for their own problems. The therapist remains as a catalyst agent who initiates change among the group members through congruence, unconditional positive regard and empathy (Rogers, 1989). Studies have shown that person centered group therapies are highly beneficial to such groups of people who suffer from depression and substance abuse (Corey 2011). Similarly, people with depression are more likely to suffer from feelings of alienation, loneliness, and isolation and group therapies are capable of offering solace to them (Anxiety & Panic Disorders Health Center, 2012). This paper seeks to design a six weeks person centered group therapy session for people with depression and in doing so the paper deals with the target population, outlines the purpose and objectives of the therapy sessions, explains the various theoretical aspects of the person centered therapy approach, analyses the role of the therapist as well as the group members during the therapy sessions, and finally evaluates the effectiveness of the group therapy on the people with depression. Methodology and target group for the therapy The target population for the person centered therapy consists of 30 people with depression who will randomly be selected. These target population can comprise of those who already undergo treatment for depression or those who are identified as depressed people. Six sessions of person centered group therapy will be administered on the target population. The goals and objectives of each therapeutic session will be determined beforehand. An evaluation regarding the accomplishment of these objectives will be done at the end of each session. At the end of all the therapy sessions an overall evaluation of the effectiveness of the person centered therapy on the participants will also be undertaken comparing and contrasting the physical and mental well being of each participants before and after the therapy sessions. The purpose and objectives of the therapy sessions The group therapy aims at the overall physical and mental well-being of all the participants. The ultimate aim of the therapy is to see the participants come out of their depressed state. For this, it is essential that the therapist creates an open and accepting climate within the group so as to promote positive self-concept, self-direction, self-acceptance, of self-respect and personal worth, and self-actualization among the participants. Similarly, following the key principles of person centered approach the therapist needs to maintain sense congruence, unconditional positive regard, and empathy towards the participants all throughout the therapeutic alliance. The objectives of each of the therapy sessions are briefly mentioned below: Session one: The first session of the therapy aims at building rapport and trust between the therapist and the participants. The session also ensures the same among the participants as well. Session Two: Session Two aims at identifying the resources within the group that can be converted to positive therapeutic outcomes. Section Three: The objective of the third session is to make the clients feel the congruence and unconditional positive regard, and empathy of the therapist towards them. Session Four: Session four aims at promoting self-awareness and positive self-concept among the participants. Session Five: Session five of the therapy is linked to the previous session and this aims at developing self-acceptance, self-respect and a sense of personal worth among the clients. Section Six: Section six aims at self-actualization of clients whereby they can make choices, decisions, and solutions that will help them out of their current depressed state. The person centered approach to group counseling and people with depression It is worthwhile to analyze the rationale for administering person centered group counseling among people with depression. Previous studies on people with depression, hospitalized patients and counseling center clients have clearly demonstrated that the clients have made remarkable improvements by participating in person centered group therapies (Corey, 2011, p. 279). Similarly, person centered group therapies have also been found to be immensely beneficial to patients who suffer from feelings of alienation, loneliness, and isolation (Anxiety & Panic Disorders Health Center, 2012). Similarly, a research undertaken by Kagee & Le Roux (2009, p. 206) also found that person-centered counseling was ‘effective in ameliorating general psychological distress and symptoms of depression’ among clients. The common symptoms of depression are sadness, depressed mood, dissatisfaction, frustration, poor self-concept, low self-esteem, loss of interest and indifference towards everything (Evans & Radunovich, n.d). All these have prompted me to administer person centered group therapy on a group of depressed people. The person centered group therapy is based on the assumption that the clients themselves have the potential to find solutions to their problems. Unlike many of the group therapies that put undue importance on ‘the therapist’s techniques and procedures as the most powerful agents that lead to change’ the person centered group therapy strongly believes ‘the client’s capacity for self-healing’ (Corey, 2011, p. 279). The therapist’s primary responsibility is to create ‘an open and accepting climate within the group’ that would facilitate self-healing among the group members. As pointed out by Corey (2011, p. 279), when the leader is able to create an open and accepting climate within the group “the members’ self-healing forces and the healing forces present in the group as a community will become operant and members will engage in the kind of individual and interpersonal work that will enable them to find their own resolutions that lead to self-acceptance.” Thus, in the person centered group therapy the clients themselves make their ultimate choices and identify solutions for their state of depression. According to Corey (2011) the core underlying principles that govern the person centered approach are creation of positive self-concept, recovering self-direction, promoting self-acceptance, yielding congruence, showing unconditional positive regard and empathy, and facilitating self-actualization of the clients. For Rogers’ congruence, unconditional positive regard and empathy lie at the core of the therapeutic process in person centered group therapy (Rogers, 1989). As rightly pointed out by Corey (2011, p. 281), “the most important contribution of the person-centered approach to group work is that it challenges group therapists to trust the resources of group members and to trust the relational characteristics of leaders (and other members) to cultivate these resources.” In a culturally diverse group it is significant to promote multiculturalism and mutual respect for the values of all group members. In a person centered therapy the client stands at the centre of the therapeutic process. The therapist’s role is to listen to the client, his family and friends and enable the client to take responsible decisions for his life. The therapist needs to take into account the ‘personal, social and cultural circumstances’ and pay heed to the ‘aspirations and hopes and dreams’ of the clients (NSW Department of Ageing, Disability and Home Care, p. 8). Similarly, it is also imperative from the part of the therapist to foster social mediation and to identify the resources within the group. According to Norcross and Goldfried (2005, p. 16), the person-centered counseling therapy holds that “all clients have within themselves vast resources for development” and that the clients “have the capacity to grow towards the fulfillment of their unique identities.” This belief lies at the core of Roger’s conceptualization of person centered therapy. To quote Roger’s own words, “the individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes and self-directed behavior” and “these resources can be tapped if only a definable climate of facilitative psychological attitudes can be provided” (Rogers, 1989, p. 135). Therefore, it is essential that the six therapy sessions on people with depression also facilitate the clients to form positive self-concepts and attitudes. Congruence, unconditional positive regard, and empathy: The primary task before the therapist is to create three necessary conditions that are essential for the therapeutic process- congruence, unconditional positive regard, and empathy. Rogers regarded these three as the core conditions of person centered therapy. Congruence focuses on the realness, or genuineness of the counselor and the therapist is not supposed to put any sorts of ‘professional front or a personal facade’ during the therapeutic process (Norcross & Goldfried, 2005, p. 17). Very often, the depressed clients enter into the therapy in a state of incongruence and it is the duty of the therapist to reverse the situation (McLeod, 2008). Once congruence has been achieved the next step required for therapeutic change “is the counselor’s ability to offer the client a total acceptance, a cherishing, an unconditional positive regard” (Norcross & Goldfried, 2005, p. 17). For this, the therapist needs to display attitude of acceptance and be non-judgmental. The therapist has to accept clients as they are and needs to show caring attitude. The third factor essential for therapeutic relationship in person centered therapy is empathy and there is no doubt that “empathetic understanding restores to the lonely and alienated individual a sense of belonging to the human race” (Norcross & Goldfried, 2005, p. 18). The therapist needs to regard the feelings, frustrations and aspirations of the client as his own. Therefore, it is significant for the therapist to maintain congruence, unconditional positive regard, and empathy during the third session of the therapy mentioned in this paper. Promoting self-awareness and positive self-concept, and developing self-acceptance, self-respect and a sense of personal worth among the clients: Once the therapist has won the trust and confidence of the depressed persons through congruence, unconditional positive regard, and empathy the next step in the fourth and fifth sessions of the therapy is to promote positive self-concept among the participants by creating self-awareness, self-acceptance, self-respect and a sense of personal worth among the clients. Very often, people with depression lack sense of self-respect or personal worth due to their ‘despair at their inability to fulfill the expectations of others, whether parents, teachers, colleagues or so-called friends’ (Norcross & Goldfried, 2005, p. 10). These conditions of worth and over expectations may lead to depression, frustration and low self-esteem. The therapist needs to convert these negative images of the client’s self into positive ones. Positive self-concept is central to Roger’s theory and he defines self-concept as "the organized, consistent set of perceptions and beliefs about oneself" (McLeod, 2008). In this respect, Norcross and Goldfried (2005, p. 10) also point out that the chances of winning positive self-esteem is distant as long as the depressed people regard themselves as ‘inept, worthless and unacceptable.’ True positive self-respect occurs only when the depressed people are able to accept themselves, respect themselves and become proud of their true identities. Preparing the clients for making choices, decisions, and solutions: During the last session of the therapy the therapist needs to prepare the clients to make choices and solutions regarding their state of depression. Rogers strongly believes that once the clients have gone through the above mentioned stages they are most likely to take responsible decisions. For Rogers, “it is the client who knows what hurts and where the pain lies and it is the client who, in the final analysis, will discover the way forward” (Norcross & Goldfried, 2005, p. 1). The therapist’s duty is to assist the depressed people to recover their lost self-direction. This has also been pointed out by McLeod (2008) that in person centered therapy “the client consciously and rationally decides for themselves what is wrong and what should be done about it.” At this stage, the therapist needs to be an effective listener who encourages the client to take meaningful choices or solutions. Group mechanisms and ethical issues It is also significant for the therapists to maintain group mechanisms and take into account the ethical issues associated with the therapeutic alliance. Ice breaking sessions are significant during the first session of the therapy to create rapport with the clients. During the first two sessions of the therapy the therapist needs to build trust with the clients. Similarly, the therapist needs to ‘create an atmosphere of safety and acceptance within the group’ and allow strong binds of support within the group (Bower, 2000, p. 276). In the same way, the therapist should take special efforts to maintain confidentiality and privacy of the information shared by everyone during the therapeutic alliance. The thirty group members can be further divided into three groups and the therapist needs to facilitate opportunities for group members to benefit from the experiences of other members of the group as well. The role of the group members in the session Each and every member of the group has to own responsibility for their actions, decisions and choices. They have to be supportive, caring, understanding and accepting. Mutual trust and strong bond of support are also essential among the group members. The participants need to be honest, open and sincere, and the group needs to be empowered so as to experience a newfound common potency to come out of their state of depression (Bower, 2000, p. 276). The experiences of each and every participant are significant in the person centered group therapy. The role of the therapist on the therapy session Even though in person centered group therapy the client plays a central role one can never undermine the role of the therapist. Even when the role of the therapist is limited to that of the facilitator the therapist also needs to be “an authentic participant and caring group member with well developed listening skills” (Bower, 2000, p. 279). The necessary skills required of an effective therapist are that of “listening, accepting, understanding and sharing, which seem more attitude-orientated than skills-orientated” (McLeod, 2008). Feeling empathetic concerns towards the client is an essential prerequisite for effective person centered group therapy. It is very much essential that the therapist always thinks in the perspective of the client. As originally purported by Rogers (1961) and reproduced by Vincent (2005, p. 60), “when the therapist does understand how it truly feels to be in another person's world, without wanting or trying to analyze or judge it, then the therapist and the client can truly blossom and grow in that climate." It can thus be concluded that within the person centered approach to group therapy the role of the therapist is that of a facilitator rather than a psychologist who dictates terms over what changes the client should undergo. Conclusions In conclusion, it is worthwhile to mention how the effectiveness of the group during the session and at the completion of the six therapy sessions could be evaluated. As already mentioned, an evaluation of the goals and objectives of each therapeutic session will be done at the end of each session. Similarly, at the end of all the therapy sessions an overall evaluation of the effectiveness of the person centered therapy on the participants will also be undertaken comparing and contrasting the physical and mental well being of each participants before and after the therapy sessions. To conclude, it can be stated that the person-centered counseling approach believes that all people are good and d that they have the potential to take the best decision required for their physical and mental well-being. As pointed out by McLeod (2008), “the philosophy that people are essentially good, and that ultimately the individual knows what is right for them, is the essential ingredient of successful person centered therapy as “all about loving.” It can also be stated that the theoretical formulations of person centered group therapy differs considerably from many of the psychodynamic and behavioral approaches because the approach suggests “that clients would be better helped if they were encouraged to focus on their current subjective understanding rather than on some unconscious motive or someone else's interpretation of the situation” (McLeod, 2008). It can thus be stated that the person centered approach to group therapy is not only client centered but also is quite humanitarian in its approach that it regards the human beings as potentially good enough to make meaningful and responsible choices, decisions and solutions to the problems. References Anxiety & Panic Disorders Health Center. (2012). WebMD, LLC. Retrieved 30 September 2012, from http://www.webmd.com/anxiety-panic/guide/mental-health-group-therapy. Bower, D.W. (2000). The Person-Centered Approach: Applications for Living. Retrieved 29 September 2012, from http://www.centerfortheperson.org/pdf/healthcare.pdf Corey, G. (2011). Theory and Practice of Group Counseling (8th edition). Cengage Learning. Corey, G. (2008). The theory & practice of group counseling (7th ed). Belmont: Thomson/Brooks Cole. Evans, G & Radunovich, H.L. Signs and Symptoms of Depression. University of Florida. Retrieved 30 September 2012, from http://edis.ifas.ufl.edu/pdffiles/FY/FY10000.pdf Kagee, A & Le Roux M. (2009). Person-centred counselling to ameliorate symptoms of psychological distress among South African patients living with hypertension and diabetes: Results of an intervention study. SA Fam Pract 51(3), 206-210. McLeod, S. A. (2008). Person Centred Therapy. Retrieved 30 September 2012, from http://www.simplypsychology.org/client-centred-therapy.html Norcross, J. C., & Goldfried, M. R. (2005). Handbook of psychotherapy integration (2nd Illustrated ed.). Oxford University Press. NSW Department of Ageing, Disability and Home Care. Exploring and Implementing Person Centred Approaches. Retrieved 29 September 2012, from http://www.adhc.nsw.gov.au/__data/assets/file/0005/228290/DADHC_PersonCentred201208.pdf Rogers, C. (1989). The Carl Rogers Reader. Houghton Mifflin Harcourt. Thorne, B & Mearns, D. (2007). Person-Centred Counselling in Action (3rd edition). SAGE. Vincent, S. (2005). Being Empathic: A Companion For Counsellors And Therapists. Illustrated edition: Radcliffe Publishing. Read More