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."

 

1. What term describes the type of group behavior Howard is demonstrating? How might Colleen address this behavior most effectively?
2. 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?
3. 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?

Q1. It can be seen that Howare directly manifests an aggressive attitude, with which he expresses his refusal and can at some point lead to hurting others or himself both physically and mentally, he also has traits of misogyny or cultural aspects against women, as well as manifested by an authoritarian and contemptuous attitude towards other members of the group.

One of the best ways to deal with the situation is for the nurse to focus on another aspect and remain indifferent to the comments without gestures and without words, which will reduce the importance of the content of what this patient says.

Q2. Patients in a group may have different personalities, in Fatima's case, she tends to be introverted so. their responses will be poor, their participation reduced, however group work requires that all its members be integrated, so a strategy can be generated to promote their participation without overdoing it, regulating a balance so that they feel comfortable, not It should be isolated because they may feel belittled or not involved in the activities, taking into account that each patient has individual problems, they will also require individual advice to study you have other problems that require both physical and mental management and cause their low participation

Q3. To approach the team, it is necessary for the leader to previously know their medical records to recognize possible personality traits or diseases that cause particular behaviors during group therapy, it will not be the same if there is a patient with a diagnosed mental illness than a patient who has a respiratory infection and although both have delusions, it is possible that the recovery and management are different, after this it is important to know each patient individually and guarantee their participation, respect and autonomy during group work, as well as at the end of going By evaluating the achievements of the group and individuals, the leader will also be open, empathetic, respectful and trustworthy in order to provide a good working environment.

If it is known that the patients are hospitalized, the work can be strengthened and generate a family atmosphere, because the frequency of visits will be greater both with the leader and among themselves and ties of friendship and care behaviors can be promoted between what can be work with patients and therefore conflicts that can make the group not work if its members do not feel well should be avoided.