Group Therapy
Please answer the following questions presented in the Case Study book regarding group therapy: Approach to Psychotherapy for Advanced Practice Psychiatric Nurses. ISBN:978-0-8261-9503-6
1. The APPN wants to refer a patient for group therapy but the patient states he “doesn’t really like the working in groups.” How could the APPN address the resistance of this patient to join the group?
2. An APPN is leading a psychotherapy group. The group is unable to move beyond the storming phase of group development. Group members are in a state of constant confrontation with one another, and several members of the group are asserting they want to leave the group. What strategies could the APPN employ?
3. The APPN is new to the role as a group therapist and is experiencing a great deal of self-doubt and insecurity relative to group leadership abilities. How could the APPN address this self-doubt and insecurity?
4. A support group for recently diagnosed cancer patients is meeting for their eighth and final group session. At the beginning of the group, several members are visibly very upset. A group member then announces that a member of the support group died yesterday. The APPN uses the session to allow members to talk about the loss. At the end of the meeting, all group members want to have additional group sessions to continue to talk about the death. How could the APPN address this issue and what next steps could be taken as the support group was to terminate at the end of this meeting?
Sample Answer
How the APPN could address the Resistance of the Patient to Join Group Therapy
Patients’ resistance to group therapy is a common issue despite the existing evidence highlighting its effectiveness. Evidence indicates that a patient’s resistance to join or participate in group therapy may stem from a lack of adequate information about group therapy or misinformation, concerns about social interactions, and the fear of unknown or negative group dynamics (Dilgul et al., 2018). An APPN is responsible for assessing the patients and establishing a good rapport with the patient to ensure they can determine the primary cause of the patient’s resistance. An APPN can address the issues by offering the right and accurate information to the client concerning group therapy and addressing the concerns of the patient to ease any anxiety. An APPN can adopt strategies such as encouraging the patient, responding to the client’s concerns by adopting an optimal group format, and making the environment safe (Dilgul et al., 2018). The most crucial aspect is identifying the cause of resistance and addressing it.
Strategies that the APPN can employ to enable the Group Move beyond the Storming Phase
It is critical for an APPN to have an awareness of challenges at every stage of group development to help members transition through each stage successfully. Internal conflict is predominant in the storming stage due to factors such as the formation of hierarchies resulting from the formation of subgroups. A major strategy that the APPN can employ is the reinforcement of the purpose and goals of the group with the aim of resolving disruptive conflict (Malhotra & Baker, 2021). The APPN can also encourage the patients to develop strong and personal relationships to maximize their health. It is also recommended that a provider spend the last few minutes of the group therapy session engaging patients individually and allowing them to voice their concerns (Malhotra & Baker, 2021). For patients who ramble, the APPN can teach them how to express their feelings and thoughts more efficiently. The APPN can also include interactive activities to ensure that the patients are more engaged. Providers are expected to remain to understand, patient and empathetic. The APPN, however, shows be aware of their limits and respect the wishes of the patient.
How an APPN Can Address Self-Doubt and Insecurity Relative to Group Leadership Abilities
Self-doubt and insecurity are major threats to the performance of an APPN, especially in the area of decision-making as a leader. An APPN, however, should acknowledge the feelings as a reality, especially in the execution of new roles. The emotions may be due to the lack of breadth of experience required to gain confidence. The APPN can adopt a strategy of repeating optimistic self-talk phrases to motivate themselves. The APPN can also adopt realistic expectations for themselves as a novice that is progressively gaining proficiency. They can also find a supportive mentor. Mentorship is recognized as a mechanism for nurses to learn and gain emotional support from experienced professionals in the same field. A mentor offers professional support, guidance, and nurturing, increasing the self-confidence of the new professional. For successful mentorship, an APPN should ensure that there are consistent levels of communication with the mentor, consistency of perceptions and expectations between them and their mentor, one-on-one interaction with the mentor, accessibility of the ability, enthusiasm, and relevant seniority or previous experience of the mentor (Davey et al., 2020). The APPN can also build collegial and external professional relationships and professional support networks crucial in developing personal resilience to workplace-related adversity.
