Group Therapy Ideas

Hukilau · Aug 12, 2004

Hi
I'm new in the area of psych and the ward I work on runs regular group therapy sessions.
I'm just wondering if other nurses who work in the area would mind sharing what type of group sessions they run within their work setting, and exactly how they carry them out, etc.
Any help would be appreciated, as I'm after ideas for my turn!

I believe the definitive work is still Yalom's "Inpatient Group Therapy." Trouble is, this won't work very well if it's not used consistently. If you're taking "turns" with other staff and everyone decides what they are going to do, you're better off doing some kind of structured group like assertiveness, medications, stress reduction, etc.

The absolute WORST thing you can do is have the pts. tell their "problem" and then have either the group leaders or other group members suggest solutions. This is a perfect way to have the pts. continue to experience failure, and yet it seems to be the most common form of "therapy."

By reading Yalom you can at least get the concept of promoting "here-and-now" interactions in groups and perhaps tailor your own group session.

Part of the theory in a nutshell: Problems have to do with interactions. Small groups are microcosms of our outside lives. If we can learn to interact honestly and supportively in a small group, it will carry over into our outside lives and help us find our own solutions.

I have more thoughts on this if you're still interested! :)

Delz · Aug 13, 2004

Thanks Hukilau. The latter you referred to is what I'm talking about. So yes, I am still interested to here further thoughts of yours.

elkpark · Aug 13, 2004

Staff nurses typically are not doing group psychotherapy (outside the scope of practice), but structured psychoeducational groups -- like medication education, anger management, coping skills, relaxation/stress reduction techniques, assertiveness training, etc. There are lots of materials and curricula out there to help with planning a program. (Much as I hate to say anything good about the big drug companies,) many of the psychotropic manufacturers offer (typically for free to staff! :) ) things like videotapes on psych topics with discussion guides.

Hukilau · Aug 13, 2004

Thanks Hukilau. The latter you referred to is what I'm talking about. So yes, I am still interested to here further thoughts of yours.

One thing I didn't mention: The type of group you do depends somewhat on the functioning level of the group. With lower functioning groups it is best to do structured exercises. With higher functioning groups you can be more creative. These are sometimes called "Process Groups" because the real value in the group is the immediate interaction rather than a specific outcome.

I really urge you to get a copy of Yalom's book. (Make sure it's the Inpatient book, he wrote another one on standard group therapy and those ideas won't work as well.)

The less structured group still has a definite format.

Introduce yourself. (Hi, my name is John and this is group therapy. We will be here until 2:00.)

Explain the group, go over ground rules. (To make the best use of our time I am going to have you help me decide what things we should talk about. I'd like to ask that only one person speak at a time. I hope that you will be able to stay for the whole group. If you must leave I'll ask that you don't come back for this session, to cut down on distractions for the rest of the group...and so on with whatever ground rules your unit has decided on.)

The go round. try not to take more than 10 minutes. (I'd like to ask each of you what you want to get out of this group today. Andrew, will you start?)

This is the hardest part. You are trying to steer people toward something that others can provide feedback about. You have to guide and manipulate because they won't at first know what you're talking about. Here's an example.

"I want to find out how to make my family stop nagging me."

Can you think of a way the people in this group could help you work on that?

"Maybe they could give me some ideas."

Maybe they could, but that might be difficult since they don't know your family. Would it help if you learned some things about yourself so that you understood how your family reacts to you.?

"I don't know"

Would you be willing to try it?

"OK"

Good. We're not going to do it yet. We're going to go around and find out what others want to do in the group first, and then we'll come back and work on this with you.

Then on to the next person. If you are really struggling finding something for one pt., just move on. You only need one or two good openings to have a successful session. When you get back to the first person, ask for volunteers to tell him something about how he comes across to them.

There's a very rough outline. These groups are hard work! But they are very satisfying when you see people learn something that is actually of some use to them and see them developing trust with other group members.

Don't worry if it feels awkward and the first couple of times don't seem to go well. You are still probably giving people more than they would get with the typical "talking" groups that pass some time but don't really accomplish anything.

There's a lot more. If you have specific questions about any part of this I'll try to answer them. But get that book!!

Hukilau · Aug 13, 2004

Staff nurses typically are not doing group psychotherapy (outside the scope of practice), but structured psychoeducational groups -- like medication education, anger management, coping skills, relaxation/stress reduction techniques, assertiveness training, etc. There are lots of materials and curricula out there to help with planning a program. (Much as I hate to say anything good about the big drug companies,) many of the psychotropic manufacturers offer (typically for free to staff! :) ) things like videotapes on psych topics with discussion guides.

Elkpark is correct that typically staff nurses don't do group therapy but I disagree that it is outside the scope of practice. (You just can't call it "psychotherapy" since that refers to a specific form that requires specific credentials.) A Psychiatric Nurse who is trained in group techniques can do just as good a job as a Master's (or higher) trained outsider who comes in just to do groups. I have an MA in Counseling and I can tell you I received no training in inpatient group therapy. The training I got was due to a couple of progressive hospitals who realized the value of training staff to actually understand what they were doing! That may be a thing of the past in these hard economic times, but there are still ways to acquire specific skills.

I am new to this group but maybe there should be a forum specifically about group therapy skills?

elkpark · Aug 13, 2004

So it's ok to do it, even though you aren't educationally prepared and the relevant professional organizations say it's outside the scope of practice for generalist nurses, as long as you don't call it psychotherapy? Does that mean it's ok for me to do neurosurgery as long as I don't call it neurosurgery? :)

I'm sure your MA in counseling is a great advantage to you in your nursing career. However, the nursing profession says that generalist registered nurses (minus other degrees or credentials) are prepared to do "counseling" and psychoeducation with individuals and groups. Psychotherapy (process groups) requires advanced academic preparation. I've spent years watching (some, not all) staff nurses get in over their heads in groups and not know how to get out, and it's not a pretty sight ... :)

Delz, there's lots of good material out there on structured formats for psychoeducational groups on topics that are relevant and helpful for psychiatric inpatients. You mentioned that you are a psych newbie -- for your own safety and comfort, please be careful not to bite off more than you can chew for the time being! :balloons:

And, Yalom is a great resource and would be helpful for you to read ... :) Welcome to psych nursing!

CliveUK · Aug 19, 2004

I don't think psychotherapeutic groups are at all appropriate for acute inpatients, nor do I think it appropriate for untrained nursing staff to be blundering about trying to run them. Specific psychoeducational groups with a definite focus (hearing voices; medication; occupation and employment) are a much more sensible option. Either that or low-level activity groups. The kinds of problems which bring people into hospital are not really amenable to the kind of psychodynamic group therapy some contributors to this thread seem to be advocating.

Why do our poor patients have to be therapised to death? How about just giving them something nice to do? Why does everything have to have the tag "therapy" dangling from it?

Hukilau · Aug 19, 2004

I don't think psychotherapeutic groups are at all appropriate for acute inpatients, nor do I think it appropriate for untrained nursing staff to be blundering about trying to run them. Specific psychoeducational groups with a definite focus (hearing voices; medication; occupation and employment) are a much more sensible option. Either that or low-level activity groups. The kinds of problems which bring people into hospital are not really amenable to the kind of psychodynamic group therapy some contributors to this thread seem to be advocating.
Why do our poor patients have to be therapised to death? How about just giving them something nice to do? Why does everything have to have the tag "therapy" dangling from it?

A couple of points and then I'm done with the debate about whether inpatient therapy groups are appropriate and who should do them.

1) Educational groups are extremely valuable and should be a part of any inpatient program.

2) It is correct that inpatient groups cannot adequately address the specific problems patients come in with. I (and Yalom) specifically advocate directing away from specific problems. The focus of the group is on interactions.

3) Yalom comments on on how poorly some highly credentialed therapists handle the unique needs of an inpatient group, and how well some nurses with a solid understanding of the dynamics of an inpatient unit handle the same group. I am not suggesting stumbling around blindly. I have worked on units where the staff decided to educate themselves as a group and provided some of the most valuable group therapy I have seen anywhere in the country.

4) Psychotherapy refers to a specific form, and I am not suggesting using that form, got it? :rolleyes: That requires a specific degree and training.

If you are tired of having everything called "therapy", then by all means call it "Process Group" or "Focus Group" or something else.

5) I would like to see the reference that says group therapy is beyond the scope of practice of nurses. I've never seen it. Would it make you more comfortable if the nurse is ANA Psych/Mental Health Certified? I am in favor of that despite the fact that over the years it has become more and more a money making scam for ANA Credentialing. (Oops, I can feel another debate starting!)

I will still discuss the theory and practice of inpatient group therapy with anyone who is interested...

mentalhealth · Aug 19, 2004

:chuckle hi i am a 2nd year mental health student and at the mo we are in uni back for 10 whole weeks of theory before we go out in to the big wide world agian!!! We have done quite abit of work regarding group therapies.In placements, i have worked with various client groups on many health promotion topics, used problem solving tecniues, relaxation classes. It is however a must to have good communication skills in building up rapport in your group.and involving all. Most importantly ask your client groupfor ideas, share them and you will get better results

Hi
I'm new in the area of psych and the ward I work on runs regular group therapy sessions.
I'm just wondering if other nurses who work in the area would mind sharing what type of group sessions they run within their work setting, and exactly how they carry them out, etc.
Any help would be appreciated, as I'm after ideas for my turn!

elkpark · Aug 20, 2004

FAQ’s About Psychiatric Nursing
What do psychiatric nurses do?
The clinical practice of Psychiatric-Mental Health Nursing occurs at two levels :Basic and Advanced. At the basic level, registered nurses work with individuals, families, groups and communities, assessing mental health needs, developing a nursing diagnosis and a plan of nursing care, implementing the plan and finally evaluating the nursing care. Basic level nursing practice is characterized by interventions that promote and foster health and mental health, assist clients to regain or improve their coping skills or abilities, and prevent further disability.
In working with psychiatric clients or patients, basic level nurses assist then with self care, administer and monitor psychobiologic treatment regimens, teach about health and mental health individually or in groups, including psycho-education. Basic level nurses are also prepared to assist with crisis intervention, counseling and work as case managers.
Advanced Practice Registered Nurses (APRN) have a Master’s degree in psychiatric-mental health nursing and assume the role of either Clinical Nurse Specialist or Nurse Practitioner. Psychiatric-Mental Health Nursing (PMHN) is considered a “Specialty” in nursing. Specialty practice is part of the course work in a Master’s Degree Program. In addition to the functions performed at the basic level, APRN’s assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders. They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRN’s have the authority to prescribe medications. Qualified to practice independently, Psychiatric-Mental Health APRN’s offer direct care services in a variety of settings: Mental Health Centers, community mental health programs, homes, offices, HMOs, etc.
Because of their broad background in both the biological, including pharmacological, sciences as well as the behavioral sciences, APRNs in PMHN are a rich resource as providers of psychiatric-mental health services and are advocates of and partners with the consumers of their services.
Psychiatric Nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.

http://www.apna.org/faq/aboutnursing.html

The above is from the APNA (American Psychiatric Nurses Association) website. The ANA standards of practice also delineate psychotherapy as an advanced practice role (graduate-prepared), and psychoeducation as a generalist role, but, since the ANA sells the standards of practice booklets for all the specialties, I can't find a website I can copy and paste the actual language from (plenty of websites where you can order the booklet, though! :) ). The standards are not legally binding, of course, and people can choose to ignore them ...

Most of us in the therapy biz consider "process group" to be a synonym for group psychotherapy (as opposed to psychoeducation groups, which, as CliveUK points out (thank you, CliveUK! :) ), are probably a lot more pertinent and helpful for inpatients).

CliveUK · Aug 21, 2004

5) I would like to see the reference that says group therapy is beyond the scope of practice of nurses. I've never seen it.

I would like to see the reference that says brain surgery is beyond the scope of practice of nurses. I've never seen it, and yet it is generally accepted that it is, and nobody would be advocating nurses just having a rummage around in someone's cranium, but calling it something other than brain surgery so it's OK.

It's my personal opinion that sitting round in a large group with a bunch of acutely ill people all experiencing wildly different things and "talking about feelings" is highly inappropriate. I fail to see how this helps patients.