Chapter 33 Flashcards
- A patient tells members of a therapy group, “I hear voices saying my doctor is poisoning me.” Another patient replies, “I used to hear voices too. They sounded real, but I found out later they were not. The voices you hear are not real either.” Which therapeutic factor is exemplified in this interchange?
a. Catharsis c. Imitative behavior
b. Universality d. Interpersonal learning
ANS: D
Here a member gains insight into his own experiences from hearing about the experiences of others through interpersonal learning. Catharsis refers to a therapeutic discharge of emotions. Universality refers to members realizing their feelings are common to most people and not abnormal. Imitative behavior involves copying or borrowing the adaptive behavior of others.
- A leader plans to start a new self-esteem building group. Which intervention would be most helpful for assuring mutual respect within the group?
a. Describe the importance of mutual respect in the first session and make it a group norm.
b. Exclude potential members whose behavior suggests they are likely to be disrespectful.
c. Give members a brochure describing the purpose, norms, and expectations of the group.
d. Explain that mutual respect is expected and confront those who are not respectful.
ANS: A
It is helpful to motivate members to behave respectfully by describing how mutual respect benefits all members and is necessary for the group to be fully therapeutic. Setting a tone and expectation of mutual respect from the outset is the most helpful intervention listed. Excluding members because of how they might behave could exclude members who would have been appropriate, depriving them of the potential benefits of the group. Conveying expectations by brochure is less effective than doing so orally, because it lacks the connection to each member a skilled leader can create to motivate members and impart the expectation of respect. Confronting inappropriate behavior is therapeutic but only addresses existing behavior rather than preventing all such undesired behavior.
- A young female member in a therapy group says to an older female member, “You are just like my mother, always trying to control me with your observations and suggestions.” Which therapeutic factor of a group is evident by this behavior?
a. Instillation of hope
b. Existential resolution
c. Development of socializing techniques
d. Corrective recapitulation of the primary family group
ANS: D
The younger patient is demonstrating an emotional attachment to the older patient that mirrors patterns within her own family of origin, a phenomenon called corrective recapitulation of the primary family group. Feedback from the group then helps the member gain insight about this behavior and leads to more effective ways of relating to her family members. Instillation of hope involves conveying optimism and sharing progress. Existential resolution refers to the realization that certain existential experiences such as death are part of life, aiding the adjustment to such realities. Development of socializing techniques involves gaining social skills through the group’s feedback and practice within the group.
- During group therapy, one patient says to another, “When I first started in this group, you were unable to make a decision, but now you can. You’ve made a lot of progress. I am beginning to think that maybe I can conquer my fears too.” Which therapeutic factor is evident by this statement?
a. Hope c. Catharsis
b. Altruism d. Cohesiveness
ANS: A
The patient’s profession that he may be able to learn to cope more effectively reflects hope. Groups can instill hope in individuals who are demoralized or pessimistic. Altruism refers to doing good for others, which can result in positive feelings about oneself. Catharsis refers to venting of strong emotions. Cohesion refers to coming together and developing a connection with other group members.
- During a group therapy session, a newly admitted patient suddenly says to the nurse, “How old are you? You seem too young to be leading a group.” Select the nurse’s most appropriate response.
a. “I am wondering what leads you to ask. Please tell me more.”
b. “I am old enough to be a nurse, which qualifies me to lead this group.”
c. “My age is not pertinent to why we are here and should not concern you.”
d. “You are wondering whether I have enough experience to lead this group?”
ANS: D
A question such as this is common in the initial phase of group development when members are getting to know one another, dealing with trust issues, and testing the leader. Making explicit the implied serves to role model more effective communication and prompts further discussion of the patient’s concern. Asking the patient to tell the leader more about the question focuses on the reason for the member’s concern rather than on the issue raised (the experience and ability of the leader) and is a less helpful response. “I am old enough to be a nurse” and “age is not pertinent” are defensive responses and fail to address the patient’s valid concern.
- A patient in a group therapy session listens to others and then remarks, “I used to think I was the only one who felt afraid. I guess I’m not as alone as I thought.” This comment is an example of:
a. altruism. c. universality.
b. ventilation. d. group cohesiveness.
ANS: C
Realizing that one is not alone and that others share the same problems and feelings is called universality. Ventilation refers to expressing emotions. Altruism refers to benefitting by being of help to others. Group cohesiveness refers to the degree of bonding among members of the group.
- A nurse at the well child clinic realizes that many parents have misconceptions about effective ways of disciplining their children. The nurse decides to form a group to address this problem. What should be the focus of the group?
a. Support c. Health education
b. Socialization d. Symptom management
ANS: C
The nurse has diagnosed a knowledge deficit. The focus of the group should be education. Support and socialization are beneficial but should not be the primary focus of the group, and symptoms are not identified for intervention here.
- Which outcome would be most appropriate for a symptom-management group for persons with schizophrenia? Group members will:
a. state the names of their medications.
b. resolve conflicts within their families.
c. rate anxiety at least two points lower.
d. describe ways to cope with their illness.
ANS: D
An appropriate psychoeducational focus for patients with schizophrenia is managing their symptoms; coping with symptoms such as impaired memory or impaired reality testing can improve functioning and enhance their quality of life. Names of medications might be appropriate for a medication education group but would be a low priority for symptom management. Addressing intra-family issues would be more appropriate within a family therapy group or possibly a support group. Rating anxiety lower would be an expected outcome for a stress-management group.
- A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse leader would be most effective?
a. Say to everyone, “Most of you have become quiet. I wonder if it might be related to concerns you may have about how the group is progressing today.”
b. Say to everyone, “One person has done most of the talking. I think it would be helpful for everyone to say how that has affected your experience of the group.”
c. Say to everyone, “I noticed that as our group progressed, most members became quiet, then disinterested, and now seem almost angry. What is going on?”
d. Say to the talkative patient, “You have been doing most of the talking, and others have not had a chance to speak as a result. Could you please yield to others now?”
ANS: A
The most effective action the nurse leader can take will be the one that encourages the group to solve its own problem. Pointing out changes in the group and asking members to respond to them lays the foundation for a discussion of group dynamics. Asking members to respond to the talkative patient puts that patient in an awkward position, likely increasing her anxiety. As anxiety increases, monopolizing behavior tends to increase as well, so this response would be self-defeating. Asking members what is going on is a broader opening and might lead to responses unrelated to the issue that bears addressing; narrowing the focus to the group process more directly addresses what is occurring in the group. Focusing on the talkative patient would be less effective and involves the leader addressing the issue instead of members first attempting to do so themselves (giving them a chance to practice skills such as assertive communication).
- Guidelines followed by the leader of a therapeutic group include focusing on recognizing dysfunctional behavior and thinking patterns, followed by identifying and practicing more adaptive alternate behaviors and thinking. Which theory is evident by this approach?
a. Behavioral c. Psychodynamic
b. Interpersonal d. Cognitive-behavioral
ANS: D
The characteristics described are those of cognitive-behavioral therapy, in which patients learn to reframe dysfunctional thoughts and extinguish maladaptive behaviors. Behavioral therapy focuses solely on changing behavior rather than thoughts, feelings, and behaviors together. Interpersonal theory focuses on interactions and relationships. Psychodynamic groups focus on developing insight to resolve unconscious conflicts.
- The nurse is planning a new sexuality group for patients. Which location would best enhance the effectiveness of this group?
a. The hospital auditorium
b. A small conference room
c. A common area, such as a day room
d. The corner of the music therapy room
ANS: B
The conference room would provide a quiet, private area with few distractions, separate from other patient areas and effective for teaching and learning about a private topic. The auditorium is too large, and members’ anxiety or lack of trust might lead them to spread out too far from each other, interfering with group process. The day room and the music therapy room are too busy and exposed, reducing privacy and increasing distractions.
- Which remark by a group participant would the nurse expect during the working stage of group therapy?
a. “My problems are very personal and private. How do I know people in this group will not tell others what you hear?”
b. “I have enjoyed this group. It’s hard to believe that a few weeks ago I couldn’t even bring myself to talk here.”
c. “One thing everyone seems to have in common is that sometimes it’s hard to be honest with those you love most.”
d. “I don’t think I agree with your action. It might help you, but it seems like it would upset your family.”
ANS: D
In the working stage, members actively interact to help each other accomplish goals, and because trust has developed, conflict and disagreement can be expressed. Focusing on trust and confidentiality typically occur in the orientation phase as part of establishing group norms. Commonality and universality are also themes typically expressed in the orientation phase, whereas reflecting on progress is a task addressed in the termination phase.
- Three members of a therapy group share covert glances as other members of the group describe problems. When one makes a statement that subtly criticizes another speaker, the others nod in agreement. Which group dynamic should the leader suspect?
a. Some members are acting as a subgroup instead of as members of the main group.
b. Some of the members have become bored and are disregarding others.
c. Three members are showing their frustration with slower members.
d. The leadership of the group has been ineffective.
ANS: A
Subgroups, small groups isolated within a larger group and functioning separately from it, sometimes form within therapy groups. When this occurs, subgroup members are cohesive with other subgroup members but not with the members of the larger group. Members of the subgroup may be bored or frustrated or expressing passive aggression, but the primary dynamic is the splitting off from the main group.
- A therapy group adds new members as others leave. What type of group is evident?
a. Open c. Homogeneous
b. Closed d. Heterogeneous
ANS: A
An open group is a group that adds members throughout the life of the group as other members leave and as more persons who would benefit from the group become available. A closed group does not add new members; the membership is established at the beginning and, except for the occasional losses as some members leave, does not change thereafter. A homogeneous group includes members who are similar, and a heterogeneous group includes dissimilar members; not enough data are provided here to determine which applies in this case.
- During a therapy group that uses existential/Gestalt theory, patients shared feelings that occurred at the time of their admission. After a brief silence, one member says, “Several people have described feeling angry. I would like to hear from members who had other feelings.” Which group role is evident by this comment?
a. Energizer c. Compromiser
b. Encourager d. Self-confessor
ANS: B
The member is filling the role of encourager by acknowledging those who have contributed and encouraging input from others. An energizer encourages the group to make decisions or take an action. The compromiser focuses on reducing or resolving conflict to preserve harmony. A self-confessor verbalizes feelings or observations unrelated to the group.
