Advanced Nursing Skills Group Process and Therapy - Essay Example

Advanced Nursing Skills – Group Process and Therapy Introduction Group therapy and group dynamics have been employed in many fields such as education, healthcare, counseling and rehabilitation centers, addiction treatment centers, child abuse centers, and juvenile training schools. Group process and therapy have been proved to be immensely beneficial to patients in the mental healthcare. Patients in the mental healthcare are greatly in need of counseling, guidance and therapies. However, it may not be possible for the mental healthcare professionals to offer a one to one counseling to all the needy clients. Therefore, it is imperative that nurses assume the role of nurse therapists and offer group therapies to the needy patients making use of their theoretical insights in group process and group dynamics. However, it is important that the group members are selected after careful screening so that the group leader (therapist or counselor) can address the psychiatric problems of group members who share certain common problems. 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). The skills of the group members are strengthened in group therapy with a view to enabling them to face future problems of similar nature. The scope of group therapy in mental healthcare setting is greater as this would enable a psychiatric patient to correct emotional and behavioral disorders that impede one’s functioning or to remediate in-depth psychological problems” (Corey, 2008, p. 7). However, it is essential that the group therapists guard themselves against any sorts of cultural or racial stereotyping and cultural encapsulation within a multicultural group setting. As pointed out by Corey (2008, p. 4), group therapies and counseling have “preventive as well as remedial aims.” However, one needs to differentiate between counseling groups and therapy groups. Group counseling is often problem oriented and addresses a specific educational, vocational, social, or personal issue. Similarly, group counseling is “growth oriented in that the emphasis is on discovering internal resources of strength” to face situational crises, temporary conflicts, or self-defeating behaviors (Corey, 2008, p. 4). On the other hand, 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. In this respect, Corey (2008, p. 7) observes that “counseling groups focus on growth, development, enhancement, prevention, self-awareness, and releasing blocks to growth, whereas therapy groups focus on issues such as remediation, treatment, and personality reconstruction.” 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). This paper seeks to explore the various aspects of group process and therapy with special emphasis on the various types of groups, the development of group dynamics, the characteristics of functional and dysfunctional groups, the role of the nurse in group therapy, and the ethical issues arising in group therapy. The various types of groups As group therapy is being practiced in many fields, one can come across different classifications of groups. However, group therapy can be categorized into support groups, reeducation and remotivation groups, problem-solving therapy groups, counseling and therapy groups, insight without reconstruction groups, psychosocial groups, and personality reconstruction groups (Shives, 2007, p. 211). Among these groups support groups aim at promoting the self-esteem and emotional well-being of the participants; reeducation and remotivation groups have been found beneficial for psychiatric patients to train them in socially appropriate behavior; problem-solving therapy addresses specific issues and their solutions; reconstruction groups focus on interpersonal communication; and personality reconstruction groups would address personality disorders through psychoanalytical theories (Shives, 2007, p. 209). On the other hand, in counseling and therapy groups the therapist will have to deal with more complex group dynamics as the participants are more vulnerable. The members of counseling and therapy groups vary considerably in the degrees of mental health, making the job of the counselor or therapist difficult as well as complex. Therefore, it is imperative that the members in a therapy group be so carefully screened so that the therapist can handle group members who suffer from similar issues, diseases, or problems. The development of group dynamics The theoretical approaches to group counseling consist of the psychoanalytic approach to groups, Adlerian group counseling, psychodrama in groups, the existential approach to groups, the person-centered approach to groups, gestalt therapy in groups, transactional analysis in groups, cognitive behavioral approaches to groups, Reality Therapy in groups and Solution-Focused brief Therapy in Groups (Corey, 2008, p. 125). Cognitive behavioral theories and psychoanalytical theories have, in particular, contributed to the theoretical backgrounds for group therapy. While cognitive behavioral theorists hold that one’s feelings are caused by one’s feelings, the psychoanalysts attribute the root of the problems to the complex working of the human mind. Recent understanding of multiculturalism and multicultural group work has also contributed to the effective practice of group therapy in mental healthcare. For Corey (2008, p. 10), “multicultural group work involves attitudes and strategies that cultivate understanding and appreciation of diversity in such areas as culture, ethnicity, race, gender, class, ability/disability, language, religion, sexual identity, and age.” Similarly, theoretical advancements in meta-communication and non-verbal behavior have also contributed to the development of group dynamics (Brown, 2011). Feelings of alienation, loneliness, and isolation govern patients in the mental healthcare and as such, group therapy provides them with both support and empathy (Anxiety & Panic Disorders Health Center, 2012, para. 3). However, it is imperative that group therapy be led only by those therapists who possess “an in-depth knowledge of counseling theories” and the basic psychological and cognitive theories that govern group dynamics (Jacobs, 2011, p. 296). An effective group therapist, through carefully designed tasks and processes, can bring about the group dynamics among the participants and these groups can be converted to positive functional groups. It has also been pointed out that the feelings, attitudes, and the view points of the group therapist either positively or negatively affect the therapeutic process within the group. Functional and dysfunctional groups Therapy groups can either be functional or dysfunctional depending on how they function and serve the purpose for which they were formed. Functional groups can be perceived as those that serve the needs of the group whereas in dysfunctional groups the actions and behavior of the group members do not cater to the purpose of the therapy making the group inefficient or weak. As observed by Champoux (2010, p. 266), a functional group “works toward the goals of an organization or a group” whereas a dysfunctional one “blocks an organization or a group from reaching its goals.” While initiating activity, offering information, seeking opinions, sharing knowledge, giving opinions, encouraging, mediating and relieving tensions can be regarded as signs of functional groups, dysfunctional groups are characterized by aggression, negativism, argument, unnecessary involvement and interference, domination and competition. One can come across both functional and dysfunctional behaviors in any therapy group. This has been observed by researchers when they stated that in group therapy, “functional and dysfunctional behaviors, strengths and vulnerabilities, become apparent as individuals relate to each other and to the therapist” (Norcross & Goldfried, 2005, p. 365). Therefore, it is the responsibility of the nurse therapists to ensure that the therapist groups entrusted to their care are functioning well and that the participants in the group therapy are benefiting from it. The role of the nurse in group therapy The nurses have a pivotal role in group therapy in the mental healthcare. In fact, nurses need to be therapists as well as counselors as they need to handle patients who suffer from mental problems or psychiatric disorders. As pointed out by Shives (2007, p. 210), one of the primary roles of the nurse-therapist in group therapy” is to guide individuals through a problem-solving process by anticipating and responding to the needs and concerns of group members” and in doing so the nurse-therapist has to fulfill both task and maintenance role functions (Shives, 2007, p. 210). The task functions of the nurse therapist consist of the various tasks undertaken by him/her to lead the group whereas the maintenance functions of the nurse-therapists are related to the group processes. The task role functions of the nurse-therapist include identification of the goals and plans of the group, selecting an appropriate time and place for the group to meet, selection of suitable members for the group, deciding the co-therapist, deciding whether the group will be open or closed, and deciding frequency and length of group meetings (Shives, 2007, p. 211). The maintenance role functions of the therapist nurses consist of managing group processes, facilitating creative problem solving and acting as a support and resource person (Shives, 2007, p. 211). In a diverse group the nurse-therapists have a significant role in preventing any sorts of racial discrimination or stereotyping. As such, nurses who play the role of group therapists need to be “responsible for the attention of group members to unconscious racism and other forms of prejudice” (Kindred & Kindred, 2011, p. 12). On the other hand, it is the duty of the nurses to promote multicultural perspectives and values among the group members. Every nurse-therapist should specially be trained in the basic concepts and practices regarding group therapies and counseling. They should always bear in mind that “the role of the group counselor is to facilitate interaction among the members, help them learn from one another, assist them in establishing personal goals, and encourage them to translate their insights into concrete plans that involve taking action outside of the group” (Corey, 2008, p. 4). The nurse therapists need to keep in mind that they are to bring about constructive changes within the group. Similarly, nurse therapists “should have a strong basic knowledge of theory as applied to individual counseling before taking on the challenge of group therapy” (Jacobs, 2011, p. 296). It is, therefore, imperative that the nurses realize the significance and depth of their roles as nurse therapists engaged in group therapies among patients in the mental healthcare. Ethical issues in group therapy The group therapists are supposed to stick on to the same ethical principles and ethical responsibilities that are shown in individual counseling and psychotherapy. While maintaining confidentiality, trust and mutual respect is essential in any therapy, developing multicultural perspectives within the group is a major challenge for the group therapist. This has been pointed out by Michael R. Durr when the author purports that “one of the most pressing ethical issues surrounding group work is the leader’s ability and need to develop a multicultural perspective” (Durr, n.d., p. 5). The leader has to intervene in the group process as and when it is necessary to meet the diverse needs of the group. However, the personal attitudes, beliefs, values and socio-cultural preoccupations of the group therapist have no role in the group therapy. On the other hand, the group therapists are supposed to maintain the ethical guidelines specified by the ASGW, ACA, and APA. In this respect, it is worthwhile to analyze the ethical guidelines put forwarded by the Psychotherapy and Counseling Federation of Australia (PACFA). The federation exhorts the counselors to respect humanity and the dignity of all people; to respect diversity and to oppose all sorts of discrimination; to ensure privacy and confidentiality to the clients; to protect the rights as well as the informed consent of clients; and to improve their professional competencies (PACFA, 2001, p. 1). The group therapists also need to understand the cultural similarities and differences in the group and they should always “be willing and able to challenge the culturally encapsulated view of a group’s structure, goals, techniques, and practices” (Corey, 2008, p. 11). It is also essential that the group therapists build bridges of understanding with all the group members irrespective of their ethnic, cultural, and racial background and guard themselves against all sorts of stereotyped generalizations. Similarly, the group therapists need to promote client autonomy while maintaining professional boundaries with the clients. In the same way, the group therapists need to keep away from any sorts of unhealthy relationships with the clients that would adversely affect the therapeutic process. Conclusions To conclude, it can be stated that group therapy assumes a significant place in today’s mental healthcare as more and more patients are in need of counseling, guidance and therapy. The group members in a therapy can benefit not only from the therapist but also from the other group members as well. As pointed out by Norcross and Goldfried (2005, p. 366), “group therapy provides a context in which individuals can experience consensual validation, hear others report familiar struggles, recognize similarities, and reframe elements of their personal dilemma as part of the human dilemma.” However, group therapy is to be led only by those nurses and healthcare professionals who are specially trained for the purpose. They should possess professional expertise and should also be willing to assist the needy patents. There should also be a competent monitoring system to assess whether these groups violate the ethical guidelines or whether they are functional or dysfunctional. References Anxiety & Panic Disorders Health Center. (2012). WebMD, LLC. Retrieved 29 July 2012, from http://www.webmd.com/anxiety-panic/guide/mental-health-group-therapy. Brown, N. (2011). Psychoeducational groups: Process and practice (3rd edn). New York: Brunner Routledge. Champoux, Joseph. (2010). Organizational behavior: Integrating individuals, groups, and organizations (4th Illustrated ed.). Taylor & Francis. Corey, G. (2008). The theory & practice of group counseling (7th ed., p. 5). Belmont: Thomson/Brooks Cole. Durr, Michael R. (n.d.). Ethical issues and standards in group counseling. Retrieved 29 July 2012, from https://portfolio.du.edu/portfolio/getportfoliofile?uid=115716. Jacobs, E. (2011). Group counseling: Strategies and skills (7th edn.). Belmont: Thomas Learning. Kindred, M., & Kindred, M. (2011). Once upon a group (2nd ed.). London: Jessica Kingsley Publishers. Norcross, J. C., & Goldfried, M. R. (2005). Handbook of psychotherapy integration (2nd Illustrated ed.). Oxford University Press. Shives, L. R. (2007). Basic concepts of psychiatric-mental health nursing (Illustrated 7th ed.). Lippincott Williams & Wilkins. Read More