MH 7 AND 8 PDF - Group and Family Therapy

Chapter 7: Group and Family Therapy Overview ​ ​ Group and family therapy involve open therapeutic communication among participants. ​ ​ Although individual therapy is important, group and family therapy are also vital treatment components in mental health settings. ​ ​...

Chapter 7: Group and Family Therapy Overview ​ ​ Group and family therapy involve open therapeutic communication among participants. ​ ​ Although individual therapy is important, group and family therapy are also vital treatment components in mental health settings. ​ ​ Leaders guide the therapy and use different leadership styles: Democratic leadership: Encourages group interaction and decision-making. Laissez-faire leadership: Promotes autonomy, with minimal leader involvement. Autocratic leadership: The leader controls the structure and direction without allowing much group input. Examples of group therapy include: ​ ​ Stress management ​ ​ Substance use disorder recovery ​ ​ Medication education ​ ​ Understanding mental illness ​ ​ Dual diagnosis support groups Group Therapy Key Concepts Group Process: ​ ​ Verbal & nonverbal communication between members during group sessions. ​ ​ Includes how work progresses and how members interact. Group Norms: ​ ​ Expected behaviors within the group. ​ ​ Example: Raising hands before speaking or sitting in assigned seats. ​ Hidden Agenda: ​ ​ Unstated personal goals that disrupt group process. ​ ​ Example: A group member embarrassing another rather than focusing on therapy. Group Dynamics: ​ ​ Groups can be open (new members join) or closed (fixed membership). Group Membership Homogeneous groups: ​ ​ Members share a specific characteristic (diagnosis, gender). Heterogeneous groups: ​ ​ Members differ in various characteristics (e.g., mixed gender in a mental health unit). Subgroups: ​ ​ Smaller groups within a larger one that work separately. Components of Therapy Sessions ​ ​ Use of open and clear communication. ​ ​ Cohesion & guidelines for group sessions. ​ ​ Direction toward therapeutic goals. ​ ​ Development of interpersonal skills. ​ ​ Resolution of issues related to family & personal challenges. Focus & Goals for Therapy Types Therapy Type​ Focus​ Goals Individual Therapy​Client’s needs & problems​ - Improve decision-making - Develop self-awareness - Strengthen sense of self Family Therapy​ Family dynamics & functioning​- Learn coping strategies - Improve understanding among members - Promote positive family interaction Group Therapy​ Helping members develop support systems​- Improve relationships - Share common experiences - Encourage behavioral changes Group Therapy Goals ​ ​ Encourage sharing of emotions & concerns. ​ ​ Decrease feelings of isolation. ​ ​ Create a healing community. ​ ​ Provide cost-effective treatment compared to individual therapy. Concerns in Group Therapy ​ ​ Privacy issues. ​ ​ Unequal attention among members. ​ ​ Disruptive members affecting group cohesion. Phases of Group Development ​ 1.​ Planning Phase: ​ ​ Define group characteristics, such as membership and meeting structure. ​ ​ Consider group composition (e.g., a withdrawn client may not interact well with an overly talkative member). ​ ​ Choose a leadership style ​ Orientation Phase: ​ ​ Define goals & purpose. ​ ​ Establish trust, respect, and structure. ​ ​ Discuss termination policies. Working Phase: ​ ​ Promote problem-solving and behavioral changes. ​ ​ Power struggles may arise. ​ ​ The leader guides communication toward solutions. Termination Phase: ​ ​ Members reflect on progress. ​ ​ The leader summarizes group growth. ​ ​ Group members provide feedback. Roles in Group Therapy Maintenance Roles: ​ ​ Keep the group focused on its goals. ​ ​ Example: A harmonizer prevents conflicts. Task Roles: ​ ​ Help organize group activities. ​ ​ Example: A recorder keeps track of discussions. Individual Roles: ​ ​ Can disrupt group process by prioritizing personal agendas. Examples: ​ ​ Dominator tries to control others. ​ ​ Recognition seeker boasts about achievements. Types of Group Therapy Settings Acute Mental Health Setting: ​ ​ Daily meetings focused on immediate relief. ​ ​ Leader provides structure. Outpatient Setting: ​ ​ Long-term therapy with consistent attendance. ​ ​ Members help shape the group. ​ Virtual Groups: ​ ​ Used for remote therapy sessions. Challenges include: ​ ​ Limited access to technology. ​ ​ Difficulty with nonverbal cues. ​ ​ Lack of presence in discussions. Families & Family Therapy Types of Families ​ ​ Nuclear: Children living with married parents. ​ ​ Single-Parent: Children living with one adult. ​ ​ Adoptive: Children living with adoptive parents. ​ ​ Blended: Children living with a biological & stepparent. ​ ​ Cohabitating: Children living with unmarried adults. ​ ​ Extended: Children living with grandparents, aunts, uncles, etc.. Family Functions Healthy Families: ​ ​ Encourage clear communication. ​ ​ Support role flexibility. ​ ​ Promote emotional support. Dysfunctional Families: ​ ​ Have poor communication. ​ ​ Show rigid or enmeshed boundaries. ​ ​ Use negative coping patterns (e.g., blaming, manipulating). Family Boundaries Healthy: ​ ​ Defined roles with mutual understanding. Dysfunctional: ​ ​ Enmeshed Boundaries: Members lose individuality. ​ ​ Rigid Boundaries: Strict & inflexible roles, leading to isolation. Family Dysfunction Concepts Scapegoating: ​ ​ One member takes the blame for family problems. ​ ​ Example: A child blamed for the family missing an outing. Triangulation: ​ ​ One member is drawn into a conflict between two others. ​ ​ Example: A child caught in parents’ arguments. Multigenerational Issues: ​ ​ Patterns of dysfunction repeating over generations. ​ ​ Example: Substance abuse & trauma cycles. Discipline in Families Healthy discipline: ​ ​ Maintains child safety & security. ​ ​ Is consistent, timely, and age-appropriate. ​ ​ Should be administered calmly & privately. Family Therapy ​ ​ Defines family as a system of reciprocal relationships. ​ ​ Focuses on the family unit rather than individuals. ​ ​ Uses various assessment tools to evaluate communication, structure, and boundaries. Nurses’ Role in Family Therapy: ​ ​ Educate families on mental health management. ​ ​ Provide medication administration guidance. ​ ​ Improve communication & resource access. Multi-Family Therapy: ​ ​ Two or more families with similar experiences work together. ​ ​ Example: Families with members diagnosed with schizophrenia share coping strategies. Key Takeaways ​ ​ Group therapy improves interpersonal skills, emotional support, and problem-solving. ​ ​ Group dynamics include roles, norms, and leadership styles. ​ ​ Family therapy focuses on improving relationships & communication. ​ ​ Healthy families have clear roles, boundaries, and emotional support. ​ ​ Dysfunctional families struggle with poor communication, rigid roles, and unhealthy coping. Chapter 8 Brain Stimulation Therapies Overview ​ ​ Brain stimulation therapies are nonpharmacological treatments for mental health disorders. Types include: ​ ​ Electroconvulsive therapy (ECT) ​ ​ Repetitive transcranial magnetic stimulation (rTMS) ​ ​ Vagus nerve stimulation (VNS) ​ ​ Deep brain stimulation (DBS) Electroconvulsive Therapy (ECT) ​ ​ Uses electrical currents to induce brief seizure activity while the client is under anesthesia. ​ ​ Exact mechanism is unknown, but it is believed to enhance neurotransmitters (serotonin, dopamine, norepinephrine). Indications (Potential Diagnoses) Major Depressive Disorder: ​ ​ When symptoms do not respond to medication. ​ ​ When suicidal or homicidal tendencies require rapid treatment. ​ ​ When the client has psychotic features. Schizophrenia Spectrum Disorders: ​ ​ Effective for catatonic schizophrenia. ​ ​ Used for schizoaffective disorder. Acute Manic Episodes: ​ ​ For bipolar disorder with rapid cycling (≥4 episodes of mania in 1 year). ​ ​ For clients unresponsive to lithium & antipsychotics. Contraindications ​ ​ No absolute contraindications, but caution is needed for: Cardiovascular disorders: ​ ​ Recent heart attack, heart failure, arrhythmias, hypertension. ​ ​ ECT increases cardiac stress. Cerebrovascular disorders: ​ ​ History of stroke, brain tumors, subdural hematomas. ​ ​ ECT increases blood flow & intracranial pressure. ​ ​ Ineffective for: ​ ​ Substance use disorders. ​ ​ Personality disorders. ​ ​ Dysphoric disorder. Considerations & Procedural Care Treatment Schedule: ​ ​ 2–3 sessions per week for 6–12 total treatments. ​ ​ Informed consent is required. Pre-ECT care: ​ ​ Chest X-ray, blood work, ECG. ​ ​ Discontinue benzodiazepines (they interfere with seizures). Medication Management: ​ ​ 30 minutes before ECT: Injection of atropine sulfate to reduce secretions & prevent bradycardia. During ECT: ​ ​ Short-acting anesthetic (e.g., propofol). ​ ​ Muscle relaxant (succinylcholine) to prevent injuries. Monitoring: ​ ​ Blood pressure, oxygen levels, cardiac rhythm. ​ ​ 100% oxygen given during & after ECT. Complications Memory Loss & Confusion: ​ ​ Short-term memory loss, disorientation, and confusion are common. ​ ​ Retrograde amnesia (loss of memory before procedure) can occur. ​ ​ Memory typically improves within weeks. Nursing Actions: ​ ​ Frequent orientation & safety measures. ​ ​ Encourage good hygiene & nutrition. Reactions to Anesthesia: ​ ​ Continuous monitoring is required. Cardiovascular Effects: ​ ​ Monitor for hypertension or dysrhythmias. Relapse of Depression: ​ ​ ECT is not a permanent cure; maintenance sessions may be required. Repetitive Transcranial Magnetic Stimulation (rTMS) ​ ​ Noninvasive therapy using magnetic pulsations to stimulate the cerebral cortex. ​ ​ Does not cause seizures. Indications ​ ​ Approved for major depressive disorder when medication is ineffective. ​ ​ Similar to ECT but with fewer risks. Considerations ​ ​ Prescribed for 4–6 weeks. ​ ​ Outpatient procedure lasting 30–40 minutes. ​ ​ Electromagnet placed on the scalp. ​ ​ Client remains alert. ​ ​ Sensation of tapping or contraction may be felt. Complications ​ ​ Mild tingling or headache is common. ​ ​ Seizures are rare but possible. ​ ​ Not associated with systemic side effects. Vagus Nerve Stimulation (VNS) ​ ​ Implanted device that provides electrical stimulation to the vagus nerve. ​ ​ Increases neurotransmitter levels, similar to antidepressants. Indications ​ ​ Used for treatment-resistant depression. ​ ​ FDA-approved for depression unresponsive to medications or ECT. ​ ​ Being studied for anxiety, obesity, and pain. Considerations ​ ​ Outpatient surgical procedure. ​ ​ Device sends electrical pulses every 5 minutes. ​ ​ Effects take weeks to develop. ​ ​ Client can deactivate the device using an external magnet. Complications ​ ​ Hoarseness, throat pain, voice changes. ​ ​ Possible dyspnea with physical exertion. Deep Brain Stimulation (DBS) ​ ​ Surgical implantation of electrodes into the brain. ​ ​ Used to stimulate underactive regions. ​ ​ More invasive than VNS. Indications ​ ​ FDA-approved for Parkinson’s disease & treatment-resistant OCD. Considerations ​ ​ Outpatient procedure. ​ ​ Continuous electrical pulses delivered. ​ ​ Antidepressant effects take weeks. ​ ​ Client can deactivate with an external magnet. Complications ​ ​ Infection risk from implanted device. ​ ​ Possible hypomania episodes. ​ ​ Headaches, seizures, stroke, confusion. Key Takeaways ​ ​ ECT is effective for severe depression, schizophrenia, and acute mania. ​ ​ rTMS is a noninvasive alternative to ECT. ​ ​ VNS & DBS are surgical procedures for treatment-resistant conditions. ​ ​ Memory loss is a common ECT side effect but is usually temporary. ​ ​ Proper pre/post-procedure care is essential to ensure safety.