Group Therapy for a Case Study

Group therapy is an approach used by psychiatrists in evaluating the different issues patients may be experiencing and helping them solve them. The formation of a group is dependent on a number of factors, and being the objectives is one of them. However, a number of issues are involved in the initial stages of making a decision, which influences the results. The members are selected with consideration of their situations and the impact they will have on other group members. To ensure the initial success and progress of the group, the facilitator has to consider the member to include the objective aimed and the role it will play in the lives of those attending. Therefore, the initial stages of group formation are addressed considering all the dependents of a therapy session. The establishment of the group therapy undergoes the stages of planning, development, facilitation, and evaluation. This paper seeks to discuss the different approaches that would be efficient in addressing the various stages of group therapy, with consideration of the case study provided.

Respondents Secluded from the Group

From the responses collected, three of the responders Jenna and Allan, Fatima, and Margaret will not be included in the group. Jena and Allan have responded that they have a 12-month-old young son James whose condition presents a situation that cannot be handled in the therapy group. According to Terracciano, Chiurazzi, and Neri (2005), children with fragile X syndrome are taken care of in a specialized setting, which also includes the participation of their parents. As the child will be developing, the parents should be aware of their responsibilities to ensure that their child grows to become an independent member of the society. The group is based on providing support and information through the knowledge or experience of an individual in the same situation.

However, Classen, et al. (2001) claim that a new situation adds content for the discussion in a therapy session, which does not prevent the involvement of any willing participant. For more information on how to help them understand the different variables and issues they may face while upbringing their child, it is advisable that Jenna and Alan visit Fragile X Clinics. In the clinics, they will get counseling and awareness programs that will prepare them mentally and psychologically on how to provide their child with a favorable environment.

In the case of Fatima, the condition of Sam has progressed from the early stages of ADHD (Attention Deficit Hyperactivity Disorder) to an advanced stage, which involves aggression both physically and verbally. According to Kidd (2000), there are different stages that are used to classify patients with ADHD with reference to their symptoms. In the advanced stage, the patient is admitted to a care facility that will be responsible for him or her (Unnever, Cullen, & Pratt, 2003). On the other hand, the development of aggression in Sam complicates the admission of drugs or medications that would have been easily done under the supervision of the mother or any other guardian. According to the symptoms identified by Adler and Chua (2002), ADHD is viewed from different perspectives, which might be positive in one patient and negative in another.

However, in the advanced stages that are beyond management, Gureasko-Moore, Dupaul, and White (2006) advise that better care provision and medical care be provided for the patient. Across the country, there are ADHD centers that offer treatment and accommodation for patients having ADHD. These institutions can help Fatima ensure that Sam is put under the correct medications, which will help in her situation (Wilens et al., 2008). Fatima could be advised to contact such an institution to learn more about the conditions of Sam and the best approach she might use to help Sam live an ordinary life as a member of the society.

In regard with the case of Margaret, she is not considered as a potential member of the group since her brother is at an age that would be best-taken care of in an institution for the elderly. Margaret is 60 years and her brother David is 55, which makes taking care of David a responsibility that would overwhelm Margaret. Attending the group will not help Margaret provide enough care for David taking into consideration her age and the slowness in response to the various needs he might need. Virone et al. (2008) mention that the age limit for the admission of a patient to an elderly center is 60 for long-term care. On the other hand, other organizations, such as the All-Inclusive Care for the Elderly, maintains that the minimum age limit for a patient admitted to an elderly institution should be 55.

Planning

Formation of group therapy is done in three steps: planning, implementation, and evaluation. The first stage, planning, involves the establishment of different variations and crucial components in the establishment of the group and its successful execution. It is meant to forecast on every issue that will be addressed by the members of the group and approaches to use. Jacobs, Masson, Havril, and Schimmel (2012) suggest that the planning phase should help provide all the details involved and the roles that every participant will have. The challenges that are expected and the best approach to solving these issues are identified and addressed in the planning stage before the group sessions begin.

Diversity will be a major principle to uphold in gathering information from the selected eight participants. Their different experiences in various situations are a major tool in ensuring that other members get to learn about the different approaches to use in facing their situation. According to Piper and Ogrodniczuk (2004), the formation of a group should bring in different extremes of a situation, which helps increase the achievement of the objectives set. Variation of issues and experiences will help build a better group that offers information to the members from different perspectives. An evaluation system will be established, which will provide an analysis valuing system for all the members selected as a part of the group. The evaluation model will help in determining the performance indicators that also indicate the achievement of the group’s objectives.  

Facilitation

The group members include members who have knowledge or experience in how to handle a disabled patient. Similarly, others included in the group will have no knowledge or experience of dealing with a disabled patient, which will help in addressing the new issues or questions that other members might have overlooked. Including the members with knowledge or experience of how to handle someone with a disability will increase the effectiveness of the group.

As a result, the major theme that is expected to involve the group most is how people can manage their time in other activities and, at the same time, devote their effort to attending their sick family members. Asner-Self (2009) states that the greatest challenge a care provider can face is to balance their personal lives and devote their efforts to helping a disabled member of the family or society. However, the Association for Specialists in Group Work (2008) reports that it is possible for members of the family to take care of another member with a disability just as in the care centers. A home setting could be of great help in ensuring that the disabled member has all his needs taken care of and could be an environment that will help him increase social attachments with the other family members.

Another concern to address in the group is the possibility of a change in the lives of the disabled as they grow older. There are numerous concerns to be considered if the condition of a member of the family remains the same, and it is important to understand whether there could be any change as they grow up. Many parents or guardians of people who are disabled never stop hoping that an alternative to their current situation might appear. Similarly, it would help address the possibility of a permanent condition, which could be a challenge to many others.

However, Corey (2011) says that a therapy group is meant to revitalize the hope and encourage members of a group to increase their effort in being part of the lives of those who are disabled. Care has an important role in the life of the disabled, with or without a medication plan being administered to them. Barnes and Mercer (2005) mention that a disability makes a patient feel rejected or different from the society. Compared to how the other members of the community relate, associate, or interact, they are unable to do all these things. Their immobility or body weakness denies them the opportunity of being active members of the society. Their family members or friends could take the responsibility of involving them in their daily activities to ensure that they feel they are part of the community. The concern should help identify the different roles and activities that a parent or guardian can play in the lives of their family member who is disabled.

Leadership

Three different kinds of leadership styles are established by Okech (2008) for group therapy sessions: authoritarian, democratic, and Laissez-Faire. Authoritarian leadership is centered on the leader. These groups undertake research conducted by the leader on different issues affecting the selected group. In-depth representation of information and systems on different ways that victims can use to change their lives or avoid a situation are the major focus. Democratic leadership is a system that includes all the members of a group in the facilitation of the activities they are meant to take (Posthuma, 2002). Every member is an active participant in the progression of the group. They have a role to play that does not create bias or unequal participation with other members or the leader. The system is based on the principle that sharing one’s issues helps unburden their worries and increase their ability to live a different life. Lastly, Laissez Faire style does not have a defined system to determine the role of the leader or members of the group. It is defined by the objectives and the members present. The group being established will implement a democratic leadership system. The members of the group are to be active members in the achievement of the objectives for the group. The leader will have the role of facilitating the different activities and the transition from one activity to another.

Intervention Strategies

The facilitator of a group is a major contributor to the success of the group and achievement of its objectives (Anderson, 2007). A leader should be an active listener who is attentive to every contribution made by members of the group. On the other hand, a leader should also devote time to relate the different issues presented by a member. In addition, the leader should be in a position to offer direction, which all will follow (Jeff, Douthitt, Ellis, Wade, & Plemons, 2008). They also should have total command of the activities of the group directing the activities and participation of the members of the group.

However, to achieve the objectives of the group, a number of styles can be used to include the contribution of the other members of the group. In case members are shy to participate, they will be asked to write down their issues or contribution. Questions discussed in the group will be predetermined and recorded down. In the next session of the discussion, the questions will be given beforehand, and the members will write their perspectives or views of the issue. Another approach that will be used is visualization, which implies giving different members time to meditate on a problem that affects one of the members before they respond. The procedure can take a day or half a day to ensure that the contributions are well researched. As a result, the member who brought up the situation gets to learn from the different contributions.

Round Robin is another strategy that many therapy sessions have applied with positive influence on the group members. Round Robin will be used for active sessions that present an issue that affects all the members of the group. It involves immediate responses of the group members to a point that another member of the group has presented in a session. In addition, Round Robin is sufficient in other cases if it is incorporated with brainstorming. Another efficient approach to achieving the objectives of a group therapy is anonymous answers where every participant is given a writing material to answer a question suggested by another member. The answers are collected and redistributed randomly among the members; then, they are read out by the member for all to hear. It increases participation of all members and the number of alternatives that one question can have.

Success in these activities would imply that the learning be initiated by the members of the group as they discuss issues. The group should observe democracy in the contribution of ideas or passing information to consider. Dealing with adults would require that the program should initiate an environment where everyone is aware of the goals to achieve and the relevance of the group to solving their issues. On the other hand, one of the principles of adult learning is effective to conduct such a program if feedback and multi-sense learning are initiated. As they contribute to a situation affecting them, they get to expound on issues that are affecting others and learn from their experience.

Performance Indicators of the Group

The progress of the group will be measured by the participation of the members from the first day the sessions begin. The American Occupational Therapy Association (2002) identifies that it is likely to notice a change in the participation of a member in a therapy session if they are directed on how to handle issues affecting them. In the initial stages, many avoid expressing themselves or letting others know about their situations. Similarly, it is a human response to withhold information from someone who is a stranger or has just come. After they get to know each other, trust, dependence, and confiding of sensitive information will be accessible to the members of the group.

Alternatively, the productivity of the group will be evaluated by the number of patients helped through the support offered. However, the group will also increase its impact to include other identified individuals with needs that involve their loved ones. As a result, the number of those who received help in the group will help evaluate the impact of the group and the potential it has for making a change in the lives of the disabled.

These pointers will be used to identify the key areas that many care providers of individuals with disabilities have to undergo in creating a comfortable environment for their family members. The close relationship that will be created among the members of the group will be a sample that will be helpful in determining the approaches to use in any of the situation they will discuss. In addition, they present an expanse of information that could benefit in a study of different opinions on how to provide care to the disabled in a home setting. Incorporating their information with that of a study on the same topic will increase the chances of having conclusive information on disability and issues that family members face.

Ethical Issues

Any sitting group or meeting can be interrupted if one of the members decides to leave especially when another member is addressing the group. It is unethical that one of the members would interrupt another in the middle of their session. Remley and Herlihy (2007) mention that when one member of the group leaves without informing the leader or asking for permission from the group, such a reaction creates tension among the remaining members, which at times, might interfere with their sharing. The solution would be that the leader makes the rules of participation evident to everyone and warn them of the impact their actions could have on the progress of the group. Another factor of consideration is confidentiality among the members of the group. All the information shared among the group members should remain within the group, with no third party allowed to hear of any member’s problems shared during a session. Lack of confidentiality may ruin the activities of the group creating a vacuum that will impede participation and cause fear that the situations discussed by the members will be told to other people not involved. Laying out the rules of being a member of the group even before the first session would help reduce cases of confidentiality issues within the group.

Conclusion

Group therapy is one of the approaches therapists have used in solving an issue from different perceptions of the members. Involving different people with related issues in a joint discussion helps them learn from one another the challenges and benefits they can create in their situation. Similar to any other group formation, group therapy undergoes the basic steps of planning, implementation, and evaluation. In the planning phase, the leader identifies the important issues to discuss and the participants to be involved in the discussion. As the leader, the therapist should exercise authority to ensure that the group works in the stipulated plan. Similarly, the therapist should help create an environment that instills understanding and trust, as well as essential elements in making individuals share their experiences in the group. However, critical techniques should also be devised, which best fits each member. These techniques should be considerate of the age, gender, or intellectual of the members, with no prejudice to ensuring the total participation of each member. Similarly, another important element in the success of a therapy group is ensuring that every member is aware of their roles and the ethics of participating in a group therapy. The leader being the facilitator should ensure that every participant has a play to play in developing others either in written or spoken contribution.

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