Group therapy is a treatment modality in which two or more clients and one or more therapists interact in a helping process to relieve emotional difficulties, increase self-esteem and insight, and improve behavior in relations with others.

1. CONCEPTS AND PRINCIPLES RELATED TO GROUP THERAPY:
1. People's problems usually occur in a social setting; thus they can best be evaluated and corrected in a social setting. (Table 10.15. Curative Factors of Group Therapy) is a summary of curative factors.
2. Not all are amenable to group therapies. For example:
1. Brain damaged.
2. Acutely suicidal.
3. Acutely psychotic.
4. Persons with very passive-dependent behavior patterns.
5. Acutely manic.
3. It is best to match group members for complementarity in behaviors (verbal with nonverbal, withdrawn with outgoing) but for similarity in problems (obesity, predischarge group, clients with cancer, prenatal group) to facilitate empathy in the sharing of experiences and to heighten group identification and cohesiveness.
4. Feelings of acceptance, belonging, respect, and comfort develop in the group and facilitate change and health.
5. In a group, members can test reality by giving and receiving feedback.
6. Clients have a chance to experience in the group that they are not alone (concept of universality).
7. Expression and ventilation of strong emotional feelings (anger, anxiety, fear, and guilt) in the safe setting of a group is an important aspect of the group process aimed at health and change.
8. The group setting and the interactions of its members may provide corrective emotional experiences for its members. A key mechanism operating in groups is transference (strong emotional attachment of one member to another member, to the therapist, or to the entire group).
9. To the degree that people modify their behavior through corrective experiences and identification with others rather than through personal-insight analysis, group therapy may be of special advantage over individual therapy, in that the possible number of interactions is greater in the group and the patterns of behavior are more readily observable.
10. There is a higher client-to-staff ratio, and it is thus less expensive.
2. GENERAL GROUP GOALS:
1. Provide opportunity for self-expression of ideas and feelings.
2. Provide a setting for a variety of relationships through group interaction.
3. Explore current behavioral patterns with others and observe dynamics.
4. Provide peer and therapist support and source of strength for the individuals to modify present behavior and try out new behaviors; made possible through development of identity and group identification.
5. Provide on-the-spot, multiple feedback (i.e., incorporate others' reactions to behavior), as well as give feedback to others.
6. Resolve dynamics and provide insight.
3. NURSING CARE PLAN/IMPLEMENTATION in group setting:
1. Nurses need to fill different roles and functions in the group, depending on the type of group, its size, its aims, and the stage in the group's life cycle. The multifaceted roles may include:
1. Catalyst.
2. Transference object (of client's positive or negative feelings).
3. Clarifier.
4. Interpreter of "here and now."
5. Role model and resource person.
6. Supporter.
2. During the first sessions, explain the purpose of the group, go over the "contract" (structure, format, and goals of sessions), and facilitate introductions of group members.
3. In subsequent sessions, promote greater group cohesiveness.
1. Focus on group concerns and group process rather than on intrapsychic dynamics of individuals.
2. Demonstrate nonjudgmental acceptance of behaviors within the limits of the group contract.
3. Help group members handle their anxiety, especially during the initial phase.
4. Encourage members who are silent to interact at their level of comfort.
5. Encourage members to interact verbally without dominating the group discussion.
6. Keep the focus of discussion on related themes; set limits and interpret group rules.
7. Facilitate sharing and communication among members.
8. Provide support to members as they attempt to work through anxiety-provoking ideas and feelings.
9. Set the expectation that the members are to take responsibility for carrying the group discussion and exploring issues on their own.
4. Termination phase:
1. Make early preparation for group termination (endpoint should be announced at the first meeting).
2. Anticipate common reactions from group members to separation anxiety and help each member to work through these reactions:
1. Anger.
2. Acting out.
3. Regressive behavior.
4. Repression.
5. Feelings of abandonment.
6. Sadness.
4. EVALUATION/OUTCOME CRITERIA:
1. Physical: shows improvement in daily life activities (eating, rest, work, exercise, recreation).
2. Emotional: asks for and accepts feedback; states feels good about self and others.
3. Intellectual: is reality oriented; greater awareness of self, others, environment.
4. Social: willing to take a risk in trusting others; sharing self; reaching out to others.