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?

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 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

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 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

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 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?

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

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 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

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

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EXPRESSIONS OF ANGER
 TURNED OUTWARD
 OVERT ANGER
 PASSIVE AGGRESSION

 TURNED INWARD
 SUBJECTIVE

 OBJECTIVE

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 OUTWARD EXPRESSION
OVERT ANGER PASSIVE AGGRESSION
Verbalization of anger Impatience
Pacing with agitation Pouting
Hostility Tensed facial expression
Contempt Annoyance
Clenching of fists Pessimism
Insulting remarks Complaining
Provoking behaviors Stubbornness
Sadistic acts Sarcasm
Temper tantrums Manipulation
Screaming Noncompliance
Deviance Resistance
Rage Bitterness
Damage to property Procrastination
Threats: words and weapons Unfair teasing
Rape, assault, homicide domination 11
 INWARD EXPRESSION
SUBJECTIVE OBJECTIVE
Feeling upset Crying
Tension Self-destructive behaviors
Unhappiness Self-mutilation
Feeling hurt Substance abuse
Guilt Suicide
Disappointment
Low self-esteem
Envy
Powerlessness
Somatization
Inferiority
Depression
Hopelessness
Desperation
Humiliation 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

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 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

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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)

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Common Problems r/t aggression
Bifrontal injuries Damage to limbic
system
AD Inc. dopamine

Dec. serotonin, GABA, Alcohol/drug abuse /

Ach withdrawal
Imbalance hormones Nutritional deficiencies

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

Socio – Cultural
– Social structures, norms, values

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

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STAGES (A, R, E)
ALARM RESISTANCE EXHAUSTION
F or F Coping / Stress that
response defense lasts too long
Alertness mechanisms leading to
to focus initiated inability to
immediately Psychosom cope
with the px atic begins >+ 3
+1 to +2 +2 to +3
anxiety anxiety

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21
Sm ith ’s St r ess Mo del
 According to Smith,  As the acuity of the
patients who are aggressive response
repeatedly assaultive increases:
exhibit behavior  Dec. px solving
patterns that are: abilities, creativity,
 Ritualistic spontaneity and
 Stereotypical behavioral options
 Automatic

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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
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T he Assa ult Cy cle

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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

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 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

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 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

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

 ADMISSION  EVENING
 CHANGE OF  ELEVATORS
SHIFTS  DURING
 MEALTIMES TRANSPORTATION
 VISITING HOURS  PERIODS OF
CHANGE

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 Hospitalization is a stress-
producing 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

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

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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

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• Assess at safe • If patient is less
distance verbal, take an
• Warmth and active, supportive
empathy, but be and directive role
firm in setting • Ask pts to ventilate
limits their feelings,
thoughts, situations

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

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 NI BASED ON THE ASSAULT
CYCLE … TRIGGERING
PHASE
BEHAVIORS NI
Muscle tension, changes in 1) EMPHATIC,
NONDIRECTIVE,
voice quality, readiness to CONCERNED TECHNIQUE
retaliate, tapping of fingers, 2) ENCOURAGE VENTILATION
pacing, repeated 3) PROVIDE QUIETER
verbalization, noncompliance, ENVIRONMENT
restlessness, irritability, 4) USE RELAXATION
TECHNIQUES
anxiety, suspiciousness, 5) FACILITATE PROBLEM
perspiration, tremors, glaring, SOLVING BY DISCUSSING
changes in breathing ALTERNATIVE SOLUTIONS
6) PRN ORAL MEDS
7) EMPIRICAL SUPPORT
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 NI BASED ON THE ASSAULT
CYCLE … ESCALATION
PHASE
BEHAVIORS NI
Pallor, screaming, anger, 1) TAKE CHARGE WITH
CALM, FIRM DIRECTIONS,
agitation, hypersensitivity, DON’T PUNISH/THREATEN,
threats, demands, loss of AVOID LOUD SOUNDS
reasoning ability, provocative 2) DIRECT CLIENT TO A
behaviors, clenched fists QUIET ROOM FOR A “TIME
OUT”
3) ASK ANOTHER STAFF TO
BE ON STANDBY AT A
DISTANCE
4) PRN MEDS
5) PREPARE FOR A “SHOW
OFF DETERMINATION” – 4-6
STAFF WITHIN THE SIGHT
OF CT. 36
NI BASED ON THE ASSAULT
CYCLE … CRISIS PHASE
BEHAVIORS NI
Loss of self control, fighting, • INVOLUNTARY SECLUSION,
RESTRAINTS
hitting, rage, kicking, • IM MEDS
scratching, throwing things

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NI BASED ON THE ASSAULT
CYCLE … RECOVERY PHASE
BEHAVIORS
Accusations, lowering of 1)
voice, decreased body
tension, change in 2)
conversational content, more
normal responses, relaxation
3)
4)
NI
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
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NI BASED ON THE ASSAULT
CYCLE … DEPRESSIVE PHASE
BEHAVIORS NI
Crying, apologies, 1) PROCESS INCIDENT WITH
THE PT
reconciliatory interactions,
2) DISCUSS ALTERNATIVE
repression of assaultive SOLUTIONS TO THE
feelings – hostility, passive SITUATIONS AND FEELINGS
aggression 3) PROGRESSIVELY REDUCE
THE DEGREE OF
RESTRAINT AND
SECLUSION
4) FACILITATE REENTRY TO
THE UNIT

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NICE TO KNOW!!!

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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

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Reasons for Seclusions

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

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• “TIME OUT”

• BED, MATTRESS, WINDOW, SECURITY

CAMERA
• REMOVE DANGEROUS ARTICLES
FROM THE PT.

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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

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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
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TYPES OF RESTRAINT

2. PHYSICAL
3. CHEMICAL

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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
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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?

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• 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
• Requires a written order, reviewed, 50
• 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
needs, safety comfort = document 51
~End~

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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

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TYPES OF GROUPS

1. INPATIENT
- Open membership – adding and losing
members
- 3 – 5 x a week
- Short term
2. OUTPATIENT
- Longer duration
- Once a week
- Closed membership

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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

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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

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 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
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60
1. SUPPORT GROUP
2. ACTIVITY GROUP
3. EDUCATION OR PROBLEM SOLVING
GROUPS
4. THERAPY GROUPS

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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

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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

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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

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EXAMPLES
TYPE PURPOSE/RN’S ROLE EXAMPLES
Recreation Fun, relief of tension Indoor/outdoor sports, field
Ct experiences sense of trips, exercise groups and
participation, acceptance and games
accomplishment

Creative Expression of feelings, a Arts and crafts, ADL, poetry,

Expression form of communication with music, dance and pet
others and socialization therapy
Allow for creativity, self-
expression and praise for
accomplishments

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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

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 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

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EXAMPLES
TYPE PURPOSE/RN’S ROLE EXAMPLES
Psychoeducation Dynamics of illness, mgt of Addiction processes, coping
illness, crises with sx, mood mgt, relapse
prevention, community
resources
Medication Dispensing of med, s/sx of
SE, purpose of med, dosage,
and therapeutic effects, support
to prevent relapse
Problem Solving Identify and describe current Conflict resolutions, job
px, develop solutions, its concerns, relationship issues
alternatives
Stress Mgt Teach and facilitate coping Lifestyle balance and mgt,
behaviors relaxation training, tension-
reducing strategies, anger mgt
Social Skills Teach, develop and practice Social interactions
skills, focus on realistic day-to-
day needs

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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

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EXAMPLES
TYPE PURPOSE/RN’S ROLE EXAMPLES
Insight – Understanding how self-esteem groups
oriented individuals affect and be
affected by others
Deals with healthier ways
on how to handle feelings to
others
Psychodrama Intense emotional release Psychodrama
are achieved through
intrapersonal and
interpersonal conflicts
Improve their roles using a
script
Sociodrama Focus insights on role > Psychodrama
communication, roles are
reenacted/role played

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 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

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 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

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PHYSICAL SETTING
 Adequate space /  MEMBERS: 7 – 10
private room  more members will
 Adequate lighting, make the group
comfortable temp, subdivide, create
seating and acting out behaviors
equipment  Audio Video,
 CIRCLE, handouts
SEMICIRCLE

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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”

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 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 5-
10 mins.

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GROUP MEMBER ROLES accdg
TO FUNCTION
 ENCOURAGER –  COMPROMISER –
praises others, resolve conflicts
agrees and accepts
ideas of others

 HARMONIZER –  INITIATOR – offers

mediates and new ideas,
reconciles intragroup suggestions
differences

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 ELABORATOR –  COORDINATOR –
gives examples clarifies relationships
among ideas and
 EVALUATOR – activities of the
relates the group group
standards to any
problem

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ANNOYING MEMBERS
 AGGRESSOR – acts  HELP SEEKER /
negatively with hostility CONFESSOR – uses
toward others, jokes the group to gain
aggressively, attacks the sympathy, expresses
group/members insecurity and self –
depreciation
 RECOGNITION
SEEKER – calls  DOMINATOR – asserts
attention to own authority and
activities, boasts manipulates individuals
achievements and the group as a
whole

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EXCLUSION FROM JOINING THE
GROUP
 MANIC
 DISORIENTED
 TOO PSYCHOTIC
 HOSTILE
 VERBALLY THREATENING

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STAGES… KELTNER

1. INITIAL
2. WORKING
3. TERMINATION

81
 INITIAL WORKING TERMINATION
Involves superficial Members are familiar Group evaluates the
rather than open and w/ each other, the group experience and
trusting communication leader and the group explores member's
Member acquainted roles and they feel free feelings about it and the
w/ each other, to approach their impending separation
searching for similarities problems and to attempt Provides an
b/w themselves to solve their problems opportunity for
Member still unclear Conflict and members who have
about the purpose of cooperation surface difficulty w/ termination
goals of the group to learn to deal more
Norms, roles and realistically and
responsibilities takes comfortably with this
place normal part of human
experience

82
 STAGES OF GROUP DEV’T…
MOSBY
1. PREGROUP
2. INITIAL
3. WORKING
4. TERMINATION

83
PREGROUP
 Forming of the group
 Time period before people knew each
other in the group setting

 Selectgroup members
 Decide length of meeting
 Decide composition of members
 Homogenous

 Heterogenous

84
Leader Responsibilities
 Establish purpose  Determine member
 Secures physical motivation
space  Describes norms
 Selects members  Educates about the
 Screens group
interviewees  Secures commitment
of the group
 Begins
leader/member rel.

85
INITIAL STAGE

 Group members have anxiety about

being accepted
 TASKS:
 Settingof 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

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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: Group Behaviors:
 Explore goals and tasks  Decreases activity
 Serious work occurs  Serves as consultant
 Explore feelings  Fosters cohesion
 Explore new coping  Maintains boundaries
mechanisms  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
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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
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 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
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 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 i-
share iyan sa grupo?”
• N is confrontational in a sense that he
is still supportive in dealing with the
client’s feelings
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• 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
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• But, NURSES should be:
– Empathic
– Understanding
– Respectful for each ct

• To increase their sense of worth

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 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

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 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

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 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

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• 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

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 Other Examples

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

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 GE ST ALT THERAPY
GR OUP
• "here and now"
• emphasizes self-expression, self-
exploration 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
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 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

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~ END ~

SALAMAT!

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