Therapeutic Groups

Therapeutic Groups

Gail W. Stuart

Groups offer members a variety of relationships as they interact with each other and with the group leader. Because group members come from many backgrounds, they have the opportunity to learn from others outside their usual social circle. They are confronted with envy, anger, aggression, fear, joy, generosity, attraction, competitiveness, and many other emotions and motives expressed by others (Yalom, 2005). All this takes place within the dynamics of the group process in which, with careful leadership, members give and receive feedback about the meaning and effect of their interactions with each other.

Groups can be formed to address the needs of many different populations and can be conducted in a variety of settings. Facilitating group work is an important skill for all nurses to master, regardless of their practice setting or specialty area.

Overview of Group Therapy

A group is a collection of people who have a relationship with one another, are interdependent, and may have norms in common. Therapeutic groups have a shared purpose. For example, a group’s purpose may be to help members who consistently engage in destructive relationships identify and change their maladaptive behaviors.

Each group has its own structure and identity. The power of the group lies in the contributions made by each member and the leader to the shared purpose of the group. These contributions are content and process oriented.

For example, a member who complains that his wife is always accusing him of being domineering may receive feedback from the group about whether others see him acting in a similarly domineering way. He then can work on changing his behavior in the group setting before risking the change in the outside world.

The group has primary and secondary tasks. The primary task is necessary for the group’s survival or existence; secondary tasks may enhance the group but are not basic to its survival. An example of a primary task for a group of mothers is to improve mothering skills; a secondary task is to add to the mothers’ social network. Relationships in the group may limit or enhance their willingness to share concerns about mothering.

Components of Small Groups

Various approaches can be used to increase the therapeutic potential of the group for its members. The components of small groups are summarized in Table 31-1.


A primary task of the group leader is to observe and analyze the communication patterns within the group. Using feedback, the leader helps members become aware of the group communication patterns so that they realize the significance of these patterns for the group and for themselves. The group or individual members may then experiment and change these patterns if they choose. Observable verbal and nonverbal elements of the group’s communication include the following:

These behaviors help the leader assess the following: resistance within the group, interpersonal conflict, the roles assumed by some members, the level of competition, and how well the members understand and are working on the task.


In studying groups it is important to observe the roles that members assume in the group. Each role has certain expected behaviors and responsibilities. The role a member takes can be determined by observing communication and behavioral patterns.

The following factors influence role selection: the member’s personality, the interaction in the group, and the member’s position in the group. People can play three types of roles in groups (Benne and Sheats, 1948):

These roles are summarized in Table 31-2. A person who acts as a harmonizer and peacemaker is taking a maintenance role. A person in the task role of questioner may clarify and seek new information.

Members may experience a conflict when there is a difference between the role they seek or assume and the role given to them by the group. For example, a member may be expected to be a peacemaker because of having performed that role previously. However, this member may be under additional stress or feel angry with someone in the group and may choose to start rather than resolve conflict. The group often is confused and upset by the person assuming this new role.


Power is the member’s ability to influence the group as a whole and its other members individually. The power structure in the group is usually resolved in its initial stages. To determine the power of various members, it is helpful to assess which members receive the most attention, which are listened to most, and which make decisions for the group. Power may be granted or assumed based on any number of factors, including gender, age, previous experience, length of time in the group, or willingness to speak in the group.

Resolution of the power struggle does not necessarily mean that everyone will be satisfied with the arrangement. A continual struggle for power sometimes occurs. This may be functional if the members are trying to gain new leadership that can contribute to their therapeutic goals. The power struggle can be dysfunctional when it takes the group’s energy and attention away from other tasks.


Norms are standards of behavior. They are expectations of how the group will act in the future based on its past and present experiences. It is important to understand norms because they influence the quality of communication and interaction within the group.

The observance of norms results in conforming behavior by group members. The other group members may consider any member who does not follow the norms of the group rebellious or resistant.

Conforming to group norms is essential to being a fully accepted member. For example, if the group norm is to start meetings on time, a member who is always late to meetings is not conforming to group norms. The group decides to what extent it can tolerate nonconforming behavior.

Norms are created to do the following:

Norms may be communicated overtly or covertly. Overt expression of norms may be written or clearly stated. For example, members may tell a new member that smoking is not allowed in the group. Covert expression of norms may be implied through members’ behavior. For example, the other members may ignore a member who uses foul language.

A highly cohesive group may have appropriate or inappropriate norms. For example, a group of patients may unite to help a patient sneak a cigarette when such behavior is not allowed because of that patient’s health problems. The group also may unite to do what it can to prevent that patient from smoking.

One concern that is vitally important for a group to address is confidentiality. For a group to be most effective, members need to feel free to talk about issues that may be painful, embarrassing, or disturbing. The group members must agree that whatever is discussed in the group belongs to the group and that group content will not be discussed outside the group unless a different approach is specifically addressed beforehand and agreed to by all members. This norm of confidentiality should be communicated directly. Some groups may want members to sign an agreement of confidentiality.


Cohesion is the strength of the members’ desire to work together toward common goals. It influences members to remain in the group and is related to each member’s attraction to and satisfaction received from the group.

Cohesion is a basic aspect of any group because it affects its life span and success. Many factors contribute to the level of cohesion, including agreement of members on group goals, interpersonal attractiveness between the members, degree to which the group satisfies individual needs, similarities among members, and satisfaction of members with the leadership style.

Cohesion is such an important dimension that some group leader interventions are specifically aimed at promoting it. Activities may include encouraging members to talk directly with each other, discussing the group in “we” terms, and encouraging all members to sit within the space reserved for the group. A leader also can promote cohesion by pointing out similarities among group members, helping members listen to each other, and encouraging cooperation among the members.

The group leader continually monitors the level of cohesion in the group. Group leaders may observe how much members express interest in other members and recognize other members for their individuality. Another way to measure cohesion is to find out whether members identify with the group and whether they want to remain in the group.

Group Development

Groups, like individuals, have the capacity for growth and development. They also have the ability to regress and resist working effectively. Every group develops according to a series of three interpersonal stages:

Each stage is characterized by members expressing various aspects of the same interpersonal issue or conflict.

In group development, phases may overlap, or a group may regress to a previous phase. For example, group regression can occur when a new member is added. Phases of group development can be thought of as a path that a group takes to form and accomplish its objectives. The leader’s task is to understand and assist the group as it moves along its growth path.

Pregroup Phase

An important factor to consider when starting a group is what its goals will be. The group’s purpose greatly influences many of the leader’s behaviors. The group may have more than one goal; if so, the primary goal should be clearly stated. To guarantee success, the group’s goals must be understood by all people involved, including the members and sponsoring agencies. It is the leader’s role to clarify the task and help the group achieve it.

After the purpose is established, the leader must be sure that the group has administrative permission. A written group proposal is one effective way to request this permission. Box 31-1 provides information to include in a group proposal.

Feb 25, 2017 | Posted by in NURSING | Comments Off on Therapeutic Groups
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