Question

Case Study

Colleen, a psychiatric mental health RN, is leading a therapeutic group for inpatients who have a history of alcohol abuse. The group is in the orientation phase, and members are still getting to know one another. Even at this early stage, however, Colleen recognizes behavior and personality traits of two members, in particular, that could pose potential problems in the group. One member, Howard, comes across as extremely negative and fairly aggressive. At times, he directly criticizes and belittles other members. When one group member discusses his wife’s disapproval of his drinking, Howard replies in disgust, “I don’t understand spineless guys like you who let women run your life. No wonder you can’t quit drinking.” When not confronting members directly, Howard makes dismissive and disparaging sounds or gestures. Other members seem offended by his behavior. Another member of the group, Fatima, has not spoken at all, except when directly asked a yes-or-no question. She does not seem unpleasant or unhappy to be in the group, but she keeps her eyes down, as though she’s afraid to be “called on.”

What term describes the type of group behavior Howard is demonstrating? How might Colleen address this behavior most effectively?

Fatima is what type of group member? How is this best addressed? Should Colleen leave Fatima alone since she is not disrupting the group or causing any trouble? Or should Colleen be more proactive with this member?

The members of Colleen’s group are inpatients. What bearing, if any, should this have on your suggestions above for Colleen in addressing member behavior? How might this affect Colleen’s overall leadership style for this group?

Answer 1

1. The type of group behavior Howard showing is ' disruptive behavior '. Howard is a disruptive group member and he should be well handled by Colleene . Colleen can address this behaviour by :

* Be a confident and enthusiastic therapeutic group leader , Colleen has to present the strict ' non violence poicy ' in group therapy .

* Identify the disruptive behaviours , shown by Howard and its effect on other team members.

* Identify the positive qualities of Howard

* Schedule an appointment with Howard and talk to him personally about the rules of group therapy and the identified list of his disruptive behaviours and its effects on other group members.

* Encourage him to demonstrate the desirable behaviour, also emphasise his positive behaviour and strictly tell him to adhere to group norms, ( If he is continuing the desruptive behaviour , even after first counselling session, warn him that  he will be no more be able attend group therapy,with the repitation disruptive behaviour)

* Encourage desirable behaviour in him also tell him that the list of undesirable behaviors in the group.  

2. Fatima is a type of non- participating and withdrawn member of the group.  

Colleen should not leave Fatima alone, even if she is a silent member and not causing any trouble to group . Colleen should be more proactive with Fathima and be with her to support and encourage her.

Fatima' s behaviour can be well addressed by Colleen through the following tips:

* Encourage participation but don't force her. Forcing may make  her  uncomfortable and she may develop the tendency to be absent in the successive sessions.

* As she already taken steps to face the challenges of life or alcoholism addiction by being ready for a group therapy, the group leader has to Encourage her for the same.

* Encouragement should be as gentle as possible . Never force her to do , before she us ready. With the continuing session , she may become alright to speak to the group members.  

* Ensure tge confidentiality of the information, that she shares.

* Instruct her to maintain eye to eye contact with Colleen and other group members.  

3. Colleen , a registered Mental health nurse , is a leader of group therapy for a group of alcohol abuse patients. In this type of group , there will be a variety of members like members with withdrawn behaviour, active behaviors , agitated behaviour or disruptive behaviours etc. Colleen's overall leadership style may get improved by working with different type of group members. Understanding, empathy and respect for others are the necessary for the group leader. She should be straight forward and direct in giving the instructions and opinion but not assertive. Encourage the silent or withdrawn members in participating for group activities. Control the disruptive behaviours by setting the boundaries and also present the strict policy of non- violence and a list of undesirable behavios in the beginning of the group therapy or in the orientation phase. Make the group fun for a more lively group by adding games and other activities. As a leader Colleen should emphasise the group ethics to the group members like confidentiality and respect for privacy etc. Leadership qualities may get improved significantly with this type of  leader role.