Group therapy Irvin Yalom, MD, has been highly influential in the development of group therapy. Dr. Yalom’s first book, The Theory and Practice of Group Psychotherapy (1970), became a foundational text for many psychotherapists and advanced practice nurses interested in group therapy. Dr. Yalom postulated that when individuals are grouped together, certain characteristics of the individuals will emerge that are reflective of family-of-origin and childhood issues (1970). In therapy sessions with groups of people, these negative or destructive childhood events can be reworked and reframed, leading to healthier adult coping responses while the group members develop identities and go through phases. In a counseling group setting, members can discuss stressors in a safe environment. The group often provides a sense of community and the feeling that the individual is not alone in dealing with their problems (Corey, Corey, & Corey, 2013). Dr. Yalom termed this concept universality (Yalom & Leszcz, 2014). Thus, universality, or the camaraderie sense of we are all in this together , serves to encourage trust and move the group into productivity. Individual group members grow and develop self- Psychoeducational groups Psychiatric nurses are often responsible for facilitating psychoeducational groups in mental health settings, where there is a defined group leader and specific content or topics to be discussed. Topics are frequently based on developing skills important to daily living and maximizing the quality of life. Some topic examples include strategic management of symptoms, medication education, coping with stress, and relapse prevention. Psychoeducational groups emphasize group member interaction and participation, but they also emphasize learning new behaviors. The facilitator may organize hands-on Cognitive-behavioral therapy (Individual therapy) Cognitive-behavioral therapy (CBT), pioneered by Aaron Beck (1967) and Albert Ellis (1973), focused on the relationship between a patient’s perceptions about events and the resultant feelings and behaviors. This cycle of thoughts that influence feelings and behaviors is demonstrated in this example: Imagine you are driving down the interstate at 75 miles per hour. You check your rear-view mirror and see the flashing lights of a state trooper. Knowing that you are driving over the speed limit, you are certain you will be pulled over and given a traffic ticket. You think of the two glasses of wine you just consumed with dinner. “What if my blood alcohol level is too high? I can’t be arrested! I would lose my job! They’ll take away my nursing license!” Your palms get sweaty and your heart starts to race. Barely able to contain your panic, you swerve quickly into the right-hand lane without signaling and cut off a car coming up behind you. The car honks, you pull onto the shoulder, and finally stop. In dread, you look out the window for the trooper, who drives past you down the highway. In this example, the driver’s thoughts of breaking the law by speeding and getting arrested for drunk driving cause the driver to feel anxious and panic, which results in erratic behavior and nearly causes an accident. Now consider this example: Imagine yourself driving down the interstate. You check your mirror and see the flashing lights of a state trooper. You know you’re driving over the speed limit, but so are many drivers around you. You think of the two glasses of wine you had with dinner, but you did eat a large portion and you don’t feel drowsy – besides, that was several hours ago. You determine that the state trooper must be on the way to the scene of a crime or accident, so you signal a right turn, check your mirrors, and carefully pull over onto the shoulder of the road. The state trooper drives past you and you continue your journey.
awareness through the relationships developed and feedback gathered from those around them (Corey et al., 2013). Yalom’s stages include orientation, conflict development, cohesion, and working (Yalom & Leszcz, 2014). There are many other theories regarding groups; although they may differ in certain ways, they all show how the group forms interpersonal relationships cohesively. The group leader recognizes what phase the group is in and helps facilitate progression toward the group’s goals. The best size for a therapy group is usually 6 to 12 members (Boyd, 2018). In larger groups, some members may be ignored or can more easily avoid participation. In smaller groups, the gatherings can turn into a series of individual therapy sessions with the group leader while everyone else watches. Training in facilitation of therapy groups is standard in graduate programs for advanced practice nurses, psychiatric and psychological master’s programs, and clinical doctoral programs. activities and sometimes give homework assignments. Other non-nursing personnel may conduct psychoeducational groups; however, psychiatric nurses are in a unique position based on their education, training, and holistic approaches, to help bridge the gap between patients’ physical and mental health. Psychoeducational groups may be larger than strictly therapeutic groups, although larger groups can be difficult to manage depending upon the personality mix of those attending (https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC7001357/). CBT is based on the supposition that behaviors are a result of distorted thinking about situations (Yalom & Leszcz, 2014). These distortions can take the shape of catastrophizing, which involves thinking that the worst that can possibly happen will happen or has happened; perceiving threats where none exist; thinking only of negative outcomes; or making over-generalizations. In anxiety disorders, fear is the driving force for distorted thoughts. These distorted thoughts impact feelings and lead to behaviors such as situational avoidance where objects or places may become a self-reinforcing behavior as the person has no additional life experience to combat the distorted thinking. Cognitive restructuring is used to help the patient examine their beliefs in more detail and to break down the resultant feelings and behaviors into A (antecedent), B (behavior), and C (consequence).
Book Code: ANCCUS3023
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