Psychotherapy for the advanced practice psychiatric nurse

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Additional resources you can use

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

“Culture and Psychiatric Diagnosis”

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

Chapter 12, “Group Therapy”

Yalom, I. D., & Leszcz, M. (2005). The therapeutic factors. In The theory and practice of group psychotherapy Download The theory and practice of group psychotherapy(5th ed.) (pp. 1–18). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Yalom, I. D., & Leszcz, M. (2005). Interpersonal learning. In The theory and practice of group psychotherapy Download The theory and practice of group psychotherapy(5th ed.) (pp. 19–52). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Yalom, I. D., & Leszcz, M. (2005). Group cohesiveness. In The theory and practice of group psychotherapy Download The theory and practice of group psychotherapy(5th ed.) (pp. 53–76). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Analyzing Group Techniques

Week 3: Assignment

Group for Schizophrenia

Tita

College of Nursing-PMHNP, Walden University

NRNP 6645: Psychotherapy with Multiple Modalities

Dr.

September 18, 2022

 

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Introduction

A group leader guides the patients toward decisions that are safe, fulfilling, and healthy

without projecting their own personal moral values or judgments onto group members. The

leader creates a welcoming environment for group participants. The leaders are compassionate

communicators who use active listening skills to interpret the needs and feelings of clients in the

group (Wahlig, 2018). The leader differentiates strategies in response to the needs of a particular

group. The leader does not become angry with clients when they are disrespectful or combative.

Group Therapy Techniques

Before promoting group discussion, the leader which is the therapist should remind the

group of the ground rules for acceptable and unacceptable conduct to establish a safe

environment (Wahlig, 2018). The group will meet in a room where the chairs are arranged in a

large circle so that members can see everyone in the group. Group sessions can begin with each

of the members introducing themselves and sharing reasons why they are in the group or sharing

their experiences and progress since the last meeting. They are reminded about the

confidentiality of what is being shared and being respectful to each member (Cherry, 2022). The

schizophrenia group leaders made each patient share their experiences and progress in using

coping skills discussed the previous week. This technique was well demonstrated because

everyone in the group states how they used different coping skills to help calm themself in

difficult situations. One reported having anxiety while talking to her neighbor and used breathing

techniques to calm herself, and when she felt the situation is more than she could handle, she

excused herself and went back in the house. One of the patients reports he smoked pots to help

calm himself. Another spoke about using music techniques to calm herself which worked out for

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her during the time she was having difficulty with her cat. The technique allowed everyone in the

group to contribute their experience in different ways they used in coping with situations.

The leader was able to use Cognitive Behavioral Therapy (CBT) to help people look at how they

think and behave, identify areas that are problematic or unhealthy, and begin to change thoughts

and actions into healthier responses. It teaches the patients to see situations, thoughts, feelings,

emotions, and actions individually so that the patients can notice unhealthy patterns. It also

teaches coping skills and helps one set and achieve goals, both in therapy and in day-to-day

life (Chapple, 2022).

I personally think the section was well handled by the therapist when one of

the patients reported smoking pot as his coping skill to help him feel comfortable during

difficult periods. The therapist acknowledges the patient for identifying the use of coping

skills but states smoking pot is not a better choice. The idea of having 2 therapists during the

session, will allow the other therapist to hammer on things that were not mentioned by the other

therapist. The therapist also set up agenda for the coming week and instructed all to participate.

What I Gained Watching the Group Session

The leader asked each patient to express their fear and the strategy used to overcome their

fear. By listening to different strategies used, members of the group will know that they are not

the only ones passing the same difficulties. Members of the group may want to try another

strategy that another member had used that had worked. Also, the presence of a meditation

specialist will help the individuals in the group create connections with others. It will help each

individual feel at peace, comfortable, supported, and safe (“Benefits of Group Medication,”

n.d.). Following up with patients to know how they are hoping by calling each member once a

week, I find this very impressive. It is very important for the therapist to know if any of the

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individuals are facing difficulties.

What I Would Have Handled Differently

What I may do differently as a therapist, first thing is to remind the members about the rules

of the group: confidentiality, not coming to the group under the influence of substances,

respecting time, not cutting others off, and give other members a chance to speak. The rules will

be clear and written so everyone can see. I will instruct everyone to introduce themselves and

give few minutes for the groups to interact with each other. I will notify the group about the

week agender and then begin with a relaxation exercise, like yoga or performing breathing

exercises. Evidence from randomized controlled trials on group cognitive behavioral therapy,

group social skills training, group music therapy, and group psychoeducation suggest that group

psychotherapeutic treatments with different therapeutic orientations can be effective in

improving several clinical outcomes for people with schizophrenia (Orfanos et al., 2015).

I will receive feedback from each member in the group on how they feel about the group.

Therapists are more diligent and mindful of the treatment they provide and the environment they

create in conducting group therapy. Obtaining group feedback can improve treatment outcomes,

which can increase the ability of patients to reach their treatment goals. Group feedback makes it

easier for therapists to track the efficacy of treatment interventions. Knowing clients’ perceptions

provides therapists with concrete data to assess which treatment interventions are not working or

working. Additionally, group feedback provides context as to why certain interventions fail to

meet expectations (Wadswort, 2022).

How to Handle Difficult Situation with a Disruptive Group Member

As a leader, I will not allow one member to speak or behave disrespectfully or abusively.

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Based on the ethical principle to do no harm, I will balance shielding others from harm in a way

that is still respectful and therapeutic to the difficult member so as not to create more trouble. In

the case of a patient who talks too much and does not give the others the chance to speak, I will

say sorry to interrupt but we are close to the end of the session and others may still need a chance

to share their thoughts (Dakota, 2019). Another way to address a difficult member is to

comfort them when they are not in the group. This gives me the opportunity to address the issue.

I can even recommend that the individual seek individual counseling in exceptional situations.

Although this isn’t always an option, especially when I need to intervene immediately during a

session as with the issues of safety discussed above (Dakota, 2019).

Different Phases of Group Therapy

Form: Everything in this stage is new, forming and developing effective relationships. Learning

to work together and share common goals. Helping the group function and identify appropriate

behavior and feelings of initial attachment to the team.

Storm: Members have emotional responses to the task demanded, and they perceived

requirements for self-change and self-denial. Disunity increases tension and jealousy.

Norm: Harmony is the maximum importance, and conflicts are avoided to ensure harmony.

Perform: This stage involves diagnosing and solving problems and making decisions. The stage

promotes openness, understanding, and mutual trust. Group therapy has many benefits such as

the ability to relate to others and create a support network. Sharing experiences in group sessions

contributes to part of the healing process and overcoming obstacles. The sessions are confidential

and cost-effective treatment options (“pros and cons of group psychotherapy,” 2022).

The negative aspect involves less personal attention: being unable to say as much as one needs

and receiving detailed input compared to an individual meeting. Unable to attend group due to

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work or family commitments. Chances of individuals dropping out and meetings being canceled

by the therapist due to other reasons (“pros and cons of group psychotherapy,” 2022).

Conclusion

Group therapy can potentially address some of the negative symptoms of schizophrenia that

antipsychotic medication alone likely cannot. Cognitive behavioral therapy is effective in anxiety

disorders, relationship problems, drug or alcohol abuse eating disorders and mental health

conditions like schizophrenia disorder (Chapple, 2022).

 

 

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References

Wahlig, H. (2018). Leadership skills and strategies for group counseling. Career

Trend. https://careertrend.com/info-7840061-leadership-skills-strategies-group-counseling.html

 

Cherry, K. (2022). How group therapy

works. Verywell Mind. https://www.verywellmind.com/what-is-group-therapy-2795760

Orfanos, S., Banks, C., & Priebe, S. (2015). Are Group Psychotherapeutic Treatments Effective

for Patients with Schizophrenia? A Systematic Review and Meta-

Analysis. Psychotherapy and Psychosomatics, 84(4), 241–

249. https://doi.org/10.1159/000377705

Benefits of group meditation. (n.d.). Nymphaeum Life.

 

Chapple, R. (2022). 8 Different Types of Therapy for Schizophrenia. Talk Space Mental Health

Condition. https://www.talkspace.com/mental-health/conditions/schizophrenia/therapy-

treatment-types/

 

Beever, G. (2019). Forming, storming, norming and performing – Tuckman’s model of group

development. Extension Practice. https://extensionaus.com.au/extension-practice/forming-

storming-norming-and-performing-tuckmans-model-of-group-development/

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