Group therapy | Definition, Goals, Principles, Indication and Contraindications.

The Contents Includes:

• Definition of Group therapy,
• Aim's and goal's of Group therapy, 
• Principles of Group therapy,
• Indications and Contraindication of  Group therapy, 
• Advantages and disadvantages of Group therapy.
  

INTRODUCTION

Human beings are complex creatures who share their activities of daily living with various groups of people. Healthcare professionals not only share their personal lives with groups of people but also encounter multiple group situations in their professional operations. Team conferences, committee meetings, grand rounds, and in-service sessions are but a few. In psychiatry, work with clients and families often takes the form of groups. With group work, not only does the nurse have the opportunity to reach out to a greater number of people at one time, but those individuals also assist each other by bringing to the group and sharing their feelings, opinions, ideas, and behaviours. Clients learn from each other in a group setting.

This topic explores various types and methods of therapeutic groups that can be used with psychiatric clients, and the role of the nurse in group intervention.

DEFINITION:

Group: A group is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose. Membership in a group is generally by chance (born into the group), by choice (voluntary affiliation), or by circumstance (the result of life-cycle events over which an individual may or may not have control).

Group Therapy: A form of psychosocial treatment in which a number of clients meet together with a therapist for purposes of sharing, gaining personal insight, and improving interpersonal coping strategies.

Group therapy is considered a cost effective alternative, or adjunct, to traditional individual therapy and may be reimbursed by insurance.

AIM / GOALS OF THE GROUP THERAPY:

• To assist each individual in emotional growth and personal problem solving.
• To help individuals better understand themselves in the context of their relationships so that they can make more knowledgeable, healthy, and adaptive choices based on a deeper awareness of their feelings, interpersonal behaviours, reactions and patterns.

Research shows that group therapy is actually the treatment of choice for many relational issues such as certain forms of depression, anxiety, isolation, anger, shyness, intimacy concerns, friendship troubles, and work issues.

PRINCIPLES OF GROUP THERAPY:

Yalom's therapeutic factors (originally termed curative factors but renamed therapeutic factors in the 5th edition of 'The Theory and Practice of Group Psychotherapy').

Universality

The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member's sense of isolation, validate their experiences, and raise self-esteem.

Altruism

The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self-esteem and help develop more adaptive coping styles and interpersonal skills.

Instillation of hope

In a mixed group that has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems with which they are still struggling.

Imparting information

While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group. For example, about their treatment or about access to services.

Corrective recapitulation of the primary family experience

Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference specific to group psychotherapy. The therapist's interpretations can help group members’ gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships.

Development of socializing techniques

The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behaviour and improving their social skills.

Imitative behaviour

One way in which group members can develop social skills is through a modelling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.

Cohesiveness

It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.

Existential factors

Learning that one has to take responsibility for one's own life and the consequences of one's decisions.

Catharsis

Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.

Interpersonal learning

Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member's behaviour and impact on others.

Self-understanding

This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one's problems and the unconscious motivations that underlie one's behaviour.

INDICATION:

While group therapy can technically be applied to a variety of approaches and a variety of concerns, there are certain areas that may particularly benefit from a group dynamic. The following topics are examples

Addiction: Having a strong support network is key when it comes to overcoming addiction. For some people, this kind of network isn't available at home and they may benefit more from the support of others with an addiction. Hearing how others cope, learning interpersonal skills and uncovering how your behaviours can impact other people can all help you on your journey to overcoming addiction.

Anxiety: For people suffering with anxiety, getting out and interacting with those who understand can be helpful. Knowing you aren't alone in your feelings and hearing how others manage their anxiety can be invaluable. You are also likely to develop better social skills, which can help if you suffer from social anxiety.

Depression: Those dealing with depression may find themselves feeling vulnerable and isolated. Getting out of the house and talking to others is always useful and in a group therapy session it can be even more so. Reaching out to others going through similar issues and discussing coping mechanisms can help you to help yourself. You may also find that imparting your own advice helps to boost your sense of self-esteem.

Eating disorders: For some people, the support network created by group therapy can aid recovery from an eating disorder. For others however, it can be counterproductive. If you find that you are comparing yourself to others in the group (for example their weight/size) it may be worth seeking individual therapy instead.

Obsessive compulsive disorder: Being alone with your own thoughts during times of anxiety can trigger symptoms when you suffer from obsessive compulsive disorder. Speaking to others who understand your feelings and behaviours can help you understand your condition better. Together you can support one another and look to find ways of coping.

Relationship difficulties: If you find it difficult to forge and maintain relationships, attending group therapy could help. Being around other people on a regular basis can help you to develop interpersonal and social skills that you can go on to practice outside of your sessions.

Schizophrenia: Group therapy for those with schizophrenia can be beneficial, depending on the severity of the condition. It can be helpful to reach out to others who experience similar symptoms to yourself, and learning more about the disorder can help you understand your own thoughts better. If you find you are feeling unsafe or paranoid during group therapy sessions however, it is important to discuss your feelings with your therapist.

Self-harm: Meeting with others who struggle with self-harm can help you feel less alone. Hearing how others cope with their problems, including practical tips you may not have thought of, can also be incredibly helpful.

CONTRAINDICATION:

• Antisocial personality disorder
• Acute or severe ill cases like suicidal tendency where individual attention is required
• Clients with delusions.
• Older age.
• Low intelligence.
• Unwillingness
• Lack of adequately trained staff.

ADVANTAGES:

• More clients can be treated at once, fostering cost effectiveness. 
• Members benefit by hearing others discuss similar problems; feelings of isolation, alienation, and uniqueness often decrease, encouraging members to share problems. 
• Group therapy allows clients to explore their specific styles of communication in a safe atmosphere where they can receive feedback and undergo change. 
• Members learn from others multiple ways to solve problems, and group exploration may help them to discover new ways. 
• Members learn about the functional roles of individuals in a group. Sometimes, a members share the responsibility as the co-therapist. Members become culture carriers. 
• The group provides for its members understanding, confrontation, and identification with more than one person.

DISADVANTAGES;

• A member’s privacy may be violated, such as when a conversation is shared outside the group. This behaviour obstructs confidentiality and hampers complete and honest participation.
• Clients from various diagnostic groups may differ based on neurobiological functioning.
• Clients may experience difficulty exposing themselves to a group or believe that they lack the skills to communicate effectively.
• Group therapy is not helpful if the therapist conducts the group as if it is individual therapy. Such a therapist may see dynamics and groups.

CONCLUSION

The use of groups organized for psychotherapy developed in the 20^th century along with the popularization of psychoanalytic theory. Therapy groups have been used as a mechanism for both intra-psychic and intrapersonal change. The significance and meaning of expression and exposure of the individual is seen in terms of the connections and bonds made among the group members. A number of social trends are contributing to the increased use and relevancy of the groups. One purpose of group therapy is to intervene in mentally disordered behaviour, thinking, and feeling. Group therapy offers multiple stimuli to reveal, examine, and resolve distortion in interpersonal relationships.

REFERENCES:

• Mary C. Townsend, Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, Sixth Edition (pp 161-168), Philadelphia: F. A. Davis Company.
• Vyas JN, Ahuja Niraj, Textbook of Postgraduate Psychiatry (vol 2) (pp 833-840), Second Edition, Delhi: Jaypee Medical Publishers.
• Neeraja KP, Essentials of Mental Health and Psychiatric Nursing(pp 233-234), Volume 2, Delhi: Jaypee Medical Publishers
• Sreevani R, Essentials Of Mental Health And Psychiatric Nursing, Volume- 1, Jaypee Publications, Page No 233-235.
• Kathrine M Fortinash, Patricia A Holoday Worret, Psychiatry Mental Health Nursing, 3^rd Edition,Page No 444-449.
• Wanda K Mohr, Evidence Based Concepts Skills And Practices,7^th Edition, Page No 251-256.

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