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Group and Family Therapy

• Group and family therapy involves open communication among participants and is vital in mental health settings, with leaders using different leadership styles.
• Democratic leadership encourages group interaction and decision-making.
• Laissez-faire leadership promotes autonomy with minimal leader involvement.
• Autocratic leadership involves the leader controlling the structure and direction without much group input.
• Examples of group therapy include stress management, substance use disorder recovery, medication education, understanding mental illness, and dual diagnosis support groups.

Group Therapy: Key Concepts

• Group process involves verbal and nonverbal communication and how work progresses and members interact.
• Group norms are expected behaviors within the group, like raising hands or sitting in assigned seats.
• Hidden agendas are unstated personal goals that disrupt the group process.
• Group dynamics can be open (new members join) or closed (fixed membership).
• Homogeneous groups share a specific trait like diagnosis or gender.
• Heterogeneous groups have members differing in various traits, like mixed gender.
• Subgroups are smaller groups within a larger one that work separately.
• Therapy sessions should use open communication, cohesion, guidelines, therapeutic goals, interpersonal skills development, and family/personal challenge resolution.

Focus and Goals for Therapy Types

• Individual therapy focuses on a client's needs/problems to improve decision-making and self-awareness.
• Family therapy addresses family dynamics to teach coping strategies and positive family interaction.
• Group therapy helps members develop support systems, improve relationships, share experiences, and encourage changes.
• Group therapy goals include sharing emotions, decreasing isolation, creating community, and providing cost-effective treatment.

Concerns and Phases in Group Therapy

• Concerns can include privacy issues, unequal attention, and disruptive members.
• Planning phase involves defining characteristics, composition, and choosing leadership.
• Orientation phase involves setting goals, trust, structure, and termination policies.
• Working phase promotes problem-solving, manages power struggles, and leader-guided communication.
• Termination phase involves reflection, summarizing growth, and feedback.

Roles in Group Therapy

• Maintenance roles keep the group focused on goals, with harmonizers preventing conflicts.
• Task roles help organize group activities, such as recorders tracking discussions.
• Individual roles can disrupt the group process by prioritizing personal agendas.
• Examples include dominators and recognition seekers.

Group Therapy Settings

• Acute mental health settings have daily meetings for immediate relief, with a structured leader.
• Outpatient settings offer long-term therapy with member involvement in shaping the group.
• Virtual groups used for remote sessions face challenges like technology access, nonverbal cues, and presence.

Families and Family Therapy

• Nuclear families have children living with married parents.
• Single-parent families have children living with one adult.
• Adoptive families have children living with adoptive parents.
• Blended families have children living with a biological and stepparent.
• Cohabitating families have children living with unmarried adults.
• Extended families have children living with grandparents, aunts, etc.

Family Functions and Boundaries

• Healthy families encourage clear communication, role flexibility, and emotional support.
• Dysfunctional families have poor communication, rigid boundaries, and negative coping.
• Healthy family boundaries involve defined roles with mutual understanding.
• Dysfunctional enmeshed boundaries cause members to lose individuality. Rigid boundaries lead to isolation.

Family Dysfunction Concepts

• Scapegoating involves one member blamed, like a child blamed for the family missing an outing.
• Triangulation is when one member is drawn into a conflict, such as a child caught in parents' arguments'
• Multigenerational issues are patterns of dysfunction repeating over generations, like substance abuse or trauma.

Discipline, Therapy, and Key Factors

• Healthy discipline maintains child safety, is consistent, timely, age-appropriate, calm, and private.
• Family therapy defines family as a system, focuses on the unit, and uses assessment tools.
• Nurses educate, guide meds, improve communication, and give resource access in therapy.
• Multi-family therapy has families with similar experiences working together.
• Key takeaways include that group therapy improves skills, dynamics include roles and leadership, and family therapy improves relationships. Also, healthy families have clear structures; dysfunctional ones struggle.

Brain Stimulation Therapies

• Brain stimulation therapies are nonpharmacological treatments for mental health disorders.
• Types include electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS).

Electroconvulsive Therapy (ECT)

• ECT uses electrical currents to induce brief seizures under anesthesia and enhances neurotransmitters.
• Indications include major depressive disorder, schizophrenia spectrum disorders, and acute manic episodes.
• Contraindications include cardiovascular and cerebrovascular orders.
• Treatment schedule is 2–3 sessions per week for 6–12 treatments, with informed consent.

Pre, During and Post ECT

• Discontinue benzodiazepines before ECT, as instructed by physicians.
• Injection of atropine sulfate occurs 30 min before to reduce secretions and prevent bradycardia.
• Short-acting anesthetic (propofol) is typically used during the procedure.
• Muscle relaxant (succinylcholine) is used during ECT to prevent injuries.
• Monitor blood pressure, oxygen, and cardiac rhythm, and administer 100% oxygen.

ECT: Complications and Nursing

• Short-term memory loss, disorientation, and confusion are common complications.
• Frequent orientation and safety measures are key nursing actions.
• Monitor for hypertension or dysrhythmias post-ECT.
• ECT is not permanent, and maintenance sessions may be required.

Repetitive Transcranial Magnetic Stimulation (rTMS)

• rTMS stimulates the cerebral cortex with magnetic pulsations and does not cause seizures.
• It's approved for major depressive disorder when medication is ineffective.
• A common protocol is outpatient procedures for 4–6 weeks, with an electromagnet on the scalp.
• Mild tingling or headache is a common complication.

Vagus Nerve Stimulation (VNS)

• VNS uses an implanted device; increases neurotransmitters.
• It is used for treatment-resistant depression and FDA-approved for depression unresponsive to meds or ECT.

VNS and Deep Brain Stimulation (DBS)

• VNS is a surgical procedure and causes hoarseness, throat pain, and possible dyspnea.
• DBS involves surgically implanting electrodes and is more invasive than VNS.
• DBS is FDA-approved for Parkinson's & treatment-resistant OCD where pulses are continuously delivered
• Both VNS & DBS have antidepressant effects and the client can deactivate it with an external magnet.

Key Takeaways

• ECT is effective for severe depression, schizophrenia, and acute mania.
• rTMS is a noninvasive alternative to ECT, with VNS and DBS being surgical procedures.
• Memory loss is a common ECT side effect, and proper care is essential to ensure safety.