Strategies Used In Dealing With Psychiatric Clients

STRATEGIES USED IN DEALING WITH PSYCHIATRIC CLIENTS Kenn S. Nuyda, RN Aquinas University MAN 2008

1) WORKING WITH THE AGGRESSIVE

PATIENT 2) WORKING WITH GROUPS OF CLIENTS 3) WORKING WITH THE FAMILY

2

WORKING WITH THE AGGRESSIVE PATIENT  ANGER

– Is it normal? – Does it result to problem solving and change? – Is it destructive and life threatening?

3

ANGER  What is ANGER? – Normal human emotion crucial for growth – When handled properly, it is a + force that leads to px solving and change – When handled aggressively it is destructive and life threatening – assault, battery and violence – PHYSICAL AGGRESSION – PASSIVE AGGRESSION

4

HOW IS ANGER MANIFESTED?  AGGRESSION – Aggressive person: verbal expression (assault), may carry out the verbal threat (battery) – Recipient: fear. Frustration and avoidance of that person, helplessness, defensive, guilty or angry, may retaliate, revenge or hold grudge towards the person

5

Questions: 1) What if two competent clients are heard

arguing by the nurse, would you intervene? Why? 2) What if the other one is less competent, as a nurse would you act stopping the argument? Why?

6

 VERBAL AGGRESSION – Serves as warning signs of assault or impending battery – May provoke counteractions = fighting / violence

7

VERBAL AGGRESSION  Passive-aggressive = expression of anger in

subtle and evasive ways, denies its source > coz afraid of punishment and rejection > inefficient to accomplish task  Passive – inward manifestations of anger > may damage, destroy or avoid relationship and intimacy > may lead to low self-esteem, depression, substance abuse, somatoform, suicide attempts 8

 ASSERTIVENESS – Accepted: HEALTHY ASSERTIVENESS • Respecting the rights of others and the self while expressing emotions

9

EXPRESSIONS OF ANGER 

TURNED OUTWARD  OVERT

ANGER  PASSIVE AGGRESSION 

TURNED INWARD  SUBJECTIVE  OBJECTIVE

10

OUTWARD EXPRESSION OVERT ANGER

PASSIVE AGGRESSION

Verbalization of anger Pacing with agitation Hostility Contempt Clenching of fists Insulting remarks Provoking behaviors Sadistic acts Temper tantrums Screaming Deviance Rage Damage to property Threats: words and weapons Rape, assault, homicide

Impatience Pouting Tensed facial expression Annoyance Pessimism Complaining Stubbornness Sarcasm Manipulation Noncompliance Resistance Bitterness Procrastination Unfair teasing domination

11

INWARD EXPRESSION SUBJECTIVE

OBJECTIVE

Feeling upset Tension Unhappiness Feeling hurt Guilt Disappointment Low self-esteem Envy Powerlessness Somatization Inferiority Depression Hopelessness Desperation Humiliation

Crying Self-destructive behaviors Self-mutilation Substance abuse Suicide

12

THE DEVELOPMENT OF AGGRESSION BY AGE  Infancy: Uncontrollable crying and screaming,

profuse perspuration, DOB, flailing of arms and legs  Toddlerhood: temper tantrums  SAC: hitting one another  Preadolescents: hitting each other  competitive sports, “tsimis”, practical/sarcastic jokes, fighting is controlled and purposeful, gangs

13

 22 – 45 y/o: aggression and fighting  After 45 y/o: stopped fighting  70 y/o: diminished impulse control and

cognitive impairment  decreased expression of anger

14

15

INDIVIDUAL MODELS Violence – quality of being human and use biologically based expressions of aggression – Neuroanatomy • Limbic system, frontal and temporal lobe

– Neurophysiology • Neurotransmitters (sero, GABA, dopa)

16

Common Problems r/t aggression Bifrontal injuries AD

Damage to limbic system Inc. dopamine

Dec. serotonin, GABA, Ach Imbalance hormones

Alcohol/drug abuse / withdrawal Nutritional deficiencies

17

Social – Psychological – interaction with the environment and the frustrations met

Socio – Cultural – Social structures, norms, values

18

STRESS MODEL (GAS) Hans Selye Stress – wear and tear Stressors - + / - stimuli that requires a response

19

STAGES (A, R, E) ALARM

F or F response Alertness to focus immediately with the px +1 to +2 anxiety

RESISTANCE

EXHAUSTION

Coping / defense mechanisms initiated Psychosom atic begins +2 to +3 anxiety

Stress that lasts too long leading to inability to cope >+ 3

20

21

Sm ith ’s St r ess Mo del  According to Smith, patients who are repeatedly assaultive exhibit behavior patterns that are:   

Ritualistic Stereotypical Automatic

 As the acuity of the aggressive response increases:  Dec. px solving abilities, creativity, spontaneity and behavioral options

22

1)

TRIGERRING PHASE - Stress- producing events

2)

ESCALATION PHASE - Escalating behaviors leading to loss of control

3)

CRISIS PHASE - Emotional and physical crisis, loss of control

4)

RECOVERY PHASE - Cooling down, slowing down and return to normal responses

5)

POST CRISIS DEPRESSION PHASE Attempts to be reconciled with others 23

T he Assa ult Cy cle

24

WHA T WI LL THE NURSE FE EL IF PT S. B ECOM E AGGR ESS IVE TO THEM?    

FRUSTATION PROFESSIONAL INADEQUACY SENSE OF FAILURE STIMULATE POWER STRUGGLES W/ PTS 25

HOW WILL THE NURSE CONTROL PATIENT’S AGGRESSION?      

N must be know the factors that may contribute to the escalation of aggression of the pt. Env’t that HAS EXCESSIVE STIMULI Env’t that is OVERCROWDED Facility that has NO OUTLET FOR ENERGY – DRAINING Pt’s perceived lack of CONTROL OF LIFE AND FREEDOM BOREDOM d/t lack of STRUCTURED ACTIVITIES 26

 Staffing must be sufficient  Staff must have fair philosophies and

policies – Over-controlled env’t : aggression and rebellion – Reasonable, flexible: reduce risk for power – ESTABLISH THERAPEUTIC MILIEU 27

Nurses must be able to recognize when the patient would most likely become aggressive or assaultive:

ADMISSION  CHANGE OF SHIFTS  MEALTIMES  VISITING HOURS 

 EVENING  ELEVATORS  DURING

TRANSPORTATION  PERIODS OF CHANGE

28

Hospitalization is a stressproducing situation. NURSES' ROLES: 1) Explain rules and policies - the searches, the removal/restriction of personal items, physical examinations 2) Introduce unfamiliar professionals and other patients 3) Integrate pt slowly to the unit 4) Decrease the stimuli if possible 29

5) Explain all medications/treatments in advance 6) Assess history – family violence/abuse, previous history of assault, destruction of property 7) Render documentation

30

NURSING INTERVENTIONS in ANGER AND NONVIOLENT AGGRESSION

FACTORS TO CONSIDER IN INTERVENING WITH ANGER AND NONVIOLENT AGGRESSION

• SOURCE – manifests inwardly • TARGET – may aim at no one in particular • LIKELIHOOD OF ESCALATION – may be defused if dealt appropriately

32

• Assess at safe distance • Warmth and empathy, but be firm in setting limits

• If patient is less verbal, take an active, supportive and directive role • Ask pts to ventilate their feelings, thoughts, situations

33

Forget these things not!!! • CHOOSE THE LEAST RESTRICTIVE MEASURES BEFORE RESTRAINTS/SECLUSION • DOCUMENT PT’S RESPONSES • APPROACH THE PT IN CALM, POSITIVE MANNER

34

NI BASED ON THE ASSAULT CYCLE … TRIGGERING PHASE BEHAVIORS

Muscle tension, changes in voice quality, readiness to retaliate, tapping of fingers, pacing, repeated verbalization, noncompliance, restlessness, irritability, anxiety, suspiciousness, perspiration, tremors, glaring, changes in breathing

NI

1)

2) 3) 4) 5)

6) 7)

EMPHATIC, NONDIRECTIVE, CONCERNED TECHNIQUE ENCOURAGE VENTILATION PROVIDE QUIETER ENVIRONMENT USE RELAXATION TECHNIQUES FACILITATE PROBLEM SOLVING BY DISCUSSING ALTERNATIVE SOLUTIONS PRN ORAL MEDS EMPIRICAL SUPPORT 35

NI BASED ON THE ASSAULT CYCLE … ESCALATION PHASE BEHAVIORS

Pallor, screaming, anger, agitation, hypersensitivity, threats, demands, loss of reasoning ability, provocative behaviors, clenched fists

NI

1)

2)

3)

4) 5)

TAKE CHARGE WITH CALM, FIRM DIRECTIONS, DON’T PUNISH/THREATEN, AVOID LOUD SOUNDS DIRECT CLIENT TO A QUIET ROOM FOR A “TIME OUT” ASK ANOTHER STAFF TO BE ON STANDBY AT A DISTANCE PRN MEDS PREPARE FOR A “SHOW OFF DETERMINATION” – 4-6 STAFF WITHIN THE SIGHT 36 OF CT.

NI BASED ON THE ASSAULT CYCLE … CRISIS PHASE BEHAVIORS Loss of self control, fighting, hitting, rage, kicking, scratching, throwing things

NI • •

INVOLUNTARY SECLUSION, RESTRAINTS IM MEDS

37

NI BASED ON THE ASSAULT CYCLE … RECOVERY PHASE BEHAVIORS Accusations, lowering of voice, decreased body tension, change in conversational content, more normal responses, relaxation

NI 1)

2)

3) 4)

CONTINUE NURSING CARE, ALLOW CLIENT TO RELAX AND SLEEP PROCESS THE INCIDENT WITH THE STAFF AND OTHER PATIENTS ASSESS PATIENT, STAFF EVALUATE PT’S PROGRESS TOWARD SELF-CONTROL

38

NI BASED ON THE ASSAULT CYCLE … DEPRESSIVE PHASE BEHAVIORS Crying, apologies, reconciliatory interactions, repression of assaultive feelings – hostility, passive aggression

NI 1) 2)

3)

4)

PROCESS INCIDENT WITH THE PT DISCUSS ALTERNATIVE SOLUTIONS TO THE SITUATIONS AND FEELINGS PROGRESSIVELY REDUCE THE DEGREE OF RESTRAINT AND SECLUSION FACILITATE REENTRY TO THE UNIT

39

NICE TO KNOW!!!

40

SECLUSION • Principle of containment • Placing of ct alone in a lockable room designed with window and camera • Minimize violence of aggressive client to himself, others • To reduce stimuli • To increase nursing care to agitated/violent/aggressive pt

41

Reasons for Seclusions • Agitation • Disruptive behavior • Inappropriate sexual behaviors • To avoid aggressive assaults and have a responsive action

42

• “TIME OUT” • BED, MATTRESS, WINDOW, SECURITY CAMERA • REMOVE DANGEROUS ARTICLES FROM THE PT.

43

RESTRAINT • Protective devices used to limit the

physical activity of a ct or to immobilize a ct. or an extremity • To safely control the ct and assure that there’ll be no injuries to himself, other cts and the staff

44

INDICATIONS • Falling out of a bed/chair • Pulling out IV lines, NGT, catheter • Breaking open sutures • Unsafe ambulation • Wandering and entering an unsafe place • Causing harm to others, self, staff

45

TYPES OF RESTRAINT 2. PHYSICAL 3. CHEMICAL

46

CHOOSING THE RESTRAINT • It restricts the ct's mov’t as little as possible • It is the least obvious to others • Does not interfere with the ct's tx and health px • It is readily changeable • It is safe for a particular ct

47

Is there any alternative before the use of restraint? • • • • • • • • • • •

Orient ct and family to surroundings Explain all procedures and tx Encourage family and friends to stay with the client Assign confused cts and disoriented ct's to rooms near the nurses' station Visual and auditory stimuli - clocks, calendars Place familiar items - pictures near client's bedside Maintain toileting routines Eliminate bothersome tx - tube feedings ASAP Evaluate all medications that the ct is receiving Relaxation techniques Ambulation and exercise schedule as the client's 48

WHAT EVERY NURSE SHOULD KNOW IN THE IMPLEMENTATION OF RESTRAINT?

49

• Never be used as a a punishment or for

the convenience of the staff • The least restrictive means of restraint for the shortest duration should be used • Used when physically harmful to the client or to others • Used when disruptive behavior presents a danger to the facility • Used when alternative or less restrictive measures are insufficient in protecting the ct or others from harm • Used when the ct anticipates that a controlled env’t would be helpful and requests seclusion 50 • Requires a written order, reviewed,

• In an emergency, the charge nurse may

place a ct in restraint/seclusion and obtain a written or verbal order ASAP thereafter • Laws require the of the ct unless an emergency situation exists and can be documented • The ct must be removed from restraint or seclusion when safer and quieter behavior is observed • While in restraint/seclusion, the client must be protected from all sources of harm • Documentation - behavior, time, release • Assessment q 15-30 min for physical 51 needs, safety comfort = document

~End~

52

WORKING WITH GROUPS OF PATIENTS Kenn S. Nuyda, RN

WORKING WITH GROUPS OF PATIENTS Kenn S. Nuyda, RN

NURSING CARE in Psych Cts  24/7

responsibility  Manpower to provide therapeutic intervention  Concern with how our clients solve their problems, conflicts and interpersonal relationships in order for them to learn and cope

55

TYPES OF GROUPS INPATIENT

1. -

Open membership – adding and losing members 3 – 5 x a week Short term

OUTPATIENT

2. -

Longer duration Once a week Closed membership 56

SIGNIFICANCE OF GROUPS  Deals

with “here and now”  Provides awareness and knowledge about the ct’s behavior  Teaches ct to be aware of the alternatives in decision making and making choices  Teaches the ct/family about their mental illness and make them cope up with it  Considered

as MILIEU therapy 57

BENEFITS OF THE GROUP       

Ct gains knowledge about how to relate and communicate w/ others Ct gains acceptance, reassurance and support from peers and group leader Ct gains feelings of hopefulness, sense of power Ct tests out new behaviors Ct shares feelings, problems, concerns and ideas w/ others Ct’s self- esteem is enhanced and affirmed and developed Ct feels sense of importance and worthiness 58

11 THERAPEUTIC FACTORS - Dr. Irvin Yalom INSTILLATION OF HOPE

Observe others in the group

UNIVERSALITY

Unique individual and not alone having that problem

IMPARTING OF INFORMATION

Gaining info r/t their needs

ALTRUISM

Helpful to others

CORRECTIVE RECAPITULATION

Review of previous dysfunctional family patterns and learning how to change them

SOCIALIZATION IMITATIVE BEHAVIOR CATHARSIS

Expression of feelings appropriately

EXISTENTIAL FACTORS

Acceptance of ultimate concerns – death, isolation

COHESIVENESS

Sense of being values and accepted in a group

INTERPERSONAL LEARNING

Learning of how their behavior affects others, and try out new ways of relating to others 59

60

SUPPORT GROUP 2. ACTIVITY GROUP 3. EDUCATION OR PROBLEM SOLVING GROUPS 4. THERAPY GROUPS 1.

61

SUPPORT GROUPS  Nursing

is supporting  To support = to accept, emphatize, show concern while cts talk  Nurse’s presence, interest and encouragement = ct’s ease of expressing his/her feelings and concerns  Support groups enable the ct to cope w/ feelings and situations  Reinforces or maintains the existing strengths/behaviors of cts 62

a)

REALITY – ORIENTATION GRP - deals with psychopathology, confusion and short attention span

NI: > safe env’t > reality testing > orientation to time, place, person > setting limits 63

ACTIVITY GROUPS  Facilitate

communication and interaction

- INDICATIONS  For withdrawn, depressed, regressed patients  To increase self – esteem, provide openness and expression of feelings to decrease isolation  Used to facilitate self – expression and patient interaction 64

EXAMPLES TYPE

PURPOSE/RN’S ROLE

EXAMPLES

Recreation

Fun,

relief of tension Ct experiences sense of participation, acceptance and accomplishment

Indoor/outdoor sports, field trips, exercise groups and games

Creative Expression

Expression

Arts and crafts, ADL, poetry, music, dance and pet therapy

of feelings, a form of communication with others and socialization Allow for creativity, selfexpression and praise for accomplishments

65

EDUCATION / PROBLEM SOLVING GROUPS  Teaches

ct and family about:

 Medication  Dynamics

and management of illness  Problem solving  Stress management  Social skills  Interpersonal skills  Relapse prevention 66

 The

nurse’s expertise, empathy and support help the ct to learn = ct cares for themselves/illness  Benefits to family: improved relationships with family members

67

EXAMPLES TYPE

PURPOSE/RN’S ROLE of illness, mgt of illness, crises

EXAMPLES

Psychoeducation

Dynamics

Addiction processes, coping with sx, mood mgt, relapse prevention, community resources

Medication

Dispensing

Problem Solving

Identify

and describe current px, develop solutions, its alternatives

Conflict resolutions, job concerns, relationship issues

Stress Mgt

Teach

and facilitate coping behaviors

Lifestyle balance and mgt, relaxation training, tensionreducing strategies, anger mgt

Social Skills

Teach,

Social interactions

of med, s/sx of SE, purpose of med, dosage, and therapeutic effects, support to prevent relapse

develop and practice skills, focus on realistic day-today needs

68

THERAPY GROUPS  Develops

insight, understanding of feelings, behaviors and roles in relationships in ct  Changes behaviors and healthier responses to other people  Motivates members : exposed to other members who share the same feeling

69

EXAMPLES TYPE

PURPOSE/RN’S ROLE

Insight – oriented

Understanding

Psychodrama

Intense

Sociodrama

Focus

EXAMPLES

self-esteem groups how individuals affect and be affected by others Deals with healthier ways on how to handle feelings to others

emotional release Psychodrama are achieved through intrapersonal and interpersonal conflicts Improve their roles using a script insights on role communication, roles are reenacted/role played

> Psychodrama

70

CHARACTERISTICS THAT THE NURSE MUST POSSESS IN LEADING A GROUP

71



Group Leadership   

   

Model as a leader Communication skills - reinforcement Must be aware of the environment that affects the clinical setting Assessment skills of the mental status of the ct Must be able to gain the trust of his patient Confidentiality Must be able to document

72

 Coleadership

Useful when the primary nurse is on “off” or “on leave”  They are the ones who collaborate/share responsibility for the group  Teaches ct how to relate to others with respect 

 Active  Structured/goal-directed  Empathetic

73

PHYSICAL SETTING  Adequate

space / private room  Adequate lighting, comfortable temp, seating and equipment  CIRCLE, SEMICIRCLE

 MEMBERS:

7 – 10  more members will make the group subdivide, create acting out behaviors  Audio Video, handouts

74

FORMAL GROUPS… guidelines         

N must be goal directed and focus on the here and now in each inpatient and outpatient group session N assesses the needs of the pt and formulates plans Timeframe: one hour (lower functioning), 1 ½ (higher functioning) Participants are expected to arrive ON TIME NO SMOKING/REFRESHMENT will be served One person speaks at a time May be allowed to pace/leave if pt has inability to sit still No hitting or throwing is allowed “What you see, what you here leave it here” 75

 At

the start, the N states the purpose of the group  Then working phase  Then before the end of the session, summarize and close the session for 510 mins.

76

GROUP MEMBER ROLES accdg TO FUNCTION  ENCOURAGER

–

praises others, agrees and accepts ideas of others  HARMONIZER

–

mediates and reconciles intragroup differences

 COMPROMISER

–

resolve conflicts

 INITIATOR

– offers

new ideas, suggestions

77

 ELABORATOR

–

gives examples  EVALUATOR

– relates the group standards to any problem

 COORDINATOR

– clarifies relationships among ideas and activities of the group

78

ANNOYING MEMBERS 

AGGRESSOR – acts negatively with hostility toward others, jokes aggressively, attacks the group/members



RECOGNITION SEEKER – calls attention to own activities, boasts achievements



HELP SEEKER / CONFESSOR – uses the group to gain sympathy, expresses insecurity and self – depreciation



DOMINATOR – asserts authority and manipulates individuals and the group as a whole 79

EXCLUSION FROM JOINING THE GROUP  MANIC  DISORIENTED  TOO

PSYCHOTIC  HOSTILE  VERBALLY THREATENING

80

STAGES… KELTNER INITIAL 2. WORKING 3. TERMINATION 1.

81

INITIAL Involves

superficial rather than open and trusting communication Member acquainted w/ each other, searching for similarities b/w themselves Member still unclear about the purpose of goals of the group Norms, roles and responsibilities takes place

WORKING Members

are familiar w/ each other, the group leader and the group roles and they feel free to approach their problems and to attempt to solve their problems Conflict and cooperation surface

TERMINATION Group

evaluates the experience and explores member's feelings about it and the impending separation Provides an opportunity for members who have difficulty w/ termination to learn to deal more realistically and comfortably with this normal part of human experience

82

STAGES OF GROUP DEV’T… MOSBY PREGROUP 2. INITIAL 3. WORKING 4. TERMINATION 1.

83

PREGROUP  Forming

of the group  Time period before people knew each other in the group setting  Select

group members  Decide length of meeting  Decide composition of members  Homogenous  Heterogenous

84

Leader Responsibilities  Establish

purpose  Secures physical space  Selects members  Screens interviewees

 Determine

member

motivation  Describes norms  Educates about the group  Secures commitment of the group  Begins leader/member rel. 85

INITIAL STAGE  Group

members have anxiety about being accepted  TASKS:  Setting

of norms  Casting of roles

86

Member Behaviors  Concerned

with acceptance  Fear of rejection  Fear of self-disclosure  Dependent on leader – look to leader for structure, approval, acceptance

87

Leader Behaviors  Directive  Active  Group

contract dev’t  Encourages interaction b/w members  Facilitates approach/avoidance  Suggests how members might be helpful to one another 88

CONFLICT STAGE within INITIAL STAGE… member  Members

concerned with status in group  Dependency conflict  Independent members attempt to make leader’s roles  Subgroups form  Hostility toward leader or other members

89

CONFLICT STAGE within INITIAL STAGE… leader  Allows

expression of - / + feelings  Helps group understand  Prevents scapegoating  Directs expression of hostility

90

COHESIVE STAGE within INITIAL STAGE… member  Form

attachment to group  + feelings toward the group/members  Self-disclosure  Suppress hostility  Limited problem solving

91

COHESIVE STAGE within INITIAL STAGE… leader  Encourages

problem solving  Demonstrates that differing opinions are acceptable

92

WORKING STAGE  Group

becomes team, complete tasks, shares responsibilities, group is stable  Anxiety is decreased

93

Member Behaviors:  Explore goals and tasks  Serious work occurs  Explore feelings  Explore new coping mechanisms

Group Behaviors:  Decreases activity  Serves as consultant  Fosters cohesion  Maintains boundaries  Encourages work on tasks  Solving the problem/s of the group

94

TERMINATION STAGE Types: 2. whole group ends 3. Individual member leaves 

Involves grieving and sense of loss

95

Member Behaviors  Anger  Regression 

Dependency, competition

 Avoidance 

Do not come to the group, do not talk about the termination

 Devalue

group  Discuss other feelings (separations, death, aging)  Sense of resolution 96

Leader Behaviors  Reminisces

about the group’s activities  Evaluates group goals  Discusses the member’s contribution to each other  Encourages full discussion of termination for several sessions  Shares own experience and feelings r/t the group  Discourages premature termination of individual group members 97

COMMUNICATION SKILLS THAT THE NURSE MUST POSSESS IN LEADING A GROUP

98

 Giving

information  Seeking clarification  Encouraging description and exploration  Presenting reality  Seeking consensual validation  Focusing  Encouraging comparison  Making observations  Giving recognition/acknowledgement  Accepting  Encouraging evaluation  Summarizing

99

INTERVENTIONS

DOMINANT CLIENT •

Monopolizes the group discussion, other members feel that they do not have the opportunity to participate

•

“Mr. Antonio, you are doing well today in our session, but I would like to hear what others are thinking about at this time.” Don’t put down the feelings of the pt

•

101

UNINVOLVED CLIENT • •

Tend to be quiet d/t anxiety or fear Should be comfortable to the group

•

“It is hard to talk about ourselves in group, but I know that everyone here has something to share that can help someone else.” The N recognizes that ct is mistrustful and anxious about initiating the group sharing. Respect, recognition

• •

102

HOSTILE CLIENT •

Masks patient’s fear, self-anger and unresolved anger toward others

•

“Mr. Antonio, tila galit ka ata ngayon. Ano ba nangyari? Gusto mo bang ishare iyan sa grupo?” N is confrontational in a sense that he is still supportive in dealing with the client’s feelings

•

103

• •

N should not allow hostility in any manner – verbal, nonverbal because it endangers the group Members would feel: – – – –

Uneasy Uncomfortable Impairs group work Would feel that anger of one ct is directed to them 104

•

But, NURSES should be: – Empathic – Understanding – Respectful for each ct •

To increase their sense of worth

105

EXAMPLES OF GROUPS •

PYSCHODRAMA GROUP – explore truth through dramatic methods – individual produces a topic to be explored – therapists directs individual through role playing – audience experiences the feelings and identifies with the action on the stage – change occurs 106

CO MMU NITY SU PPO RT GROUPS • • • • • •

promote identification, clarification, understanding, role modeling, feelings of togetherness and group cohesion prevent the individual member from feelings lonely and isolated help members decrease levels of stress and increase levels of self-acceptance members are able to deal with the problems that they brought to the group dev’t of new or more effective patterns of behavior some groups evolve into educational models that enhance communication, self-image, body language, px-solving, decision making and growth processes

107

Ex: Alcoholics anonymous •

• •

Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership 108

•

•

Fellowship of relatives and friends of alcoholics who share their experience, strength, and hope in order to solve their common problems Believe alcoholism is a family illness and that changed attitudes can aid recovery 109

NARCONON • • •

Means “no drug” Drug-free rehab program in RP Uses nutrition, assists, objective exercises, and training routines

110

Other Examples • • •

Overeater’s Anonymous Women’s Groups Men’s Groups

111

GE ST ALT THERAPY GR OUP • • • •

"here and now" emphasizes self-expression, selfexploration and self-awareness in the present everyday problems and try to solve them individual becomes aware of the total self and the surrounding env’t, renders the ct. capable of change

ROLE: help the members express their feelings and grow from their experiences 112

FAM ILY THE RAPY •

therapist works to assist the family members to identify and express their thoughts and feelings, define family roles and rules, try new, more productive styles of relating and restore strength to the family

113

IN TER PER SONAL G ROUP TH ERAPY •

Promotes the individual’s comfort with others in the group, which then transfers to other relationships

114

~ END ~ SALAMAT!

115