Why is Group Therapy Difficult?
Group therapy is another wonderful tool in a PMHNP’s box. It’s cost-effective and you can reach or help more people in a smaller amount of time. It’s a great consideration and almost mandatory for psych hospitals and residential facilities but there are some major considerations with incorporating group therapy in practice:
Some Group Problems in Practice
- It Takes ENERGY: imagine listening to one psychotherapy session, then multiply it by more than 6x’s (all of the 6+ members), for a couple of days per week and it’ll easily become a grueling process. If the bulk of PMHNP care comes from the number of patients they see, group therapy is not a good option. It will create burnout and liabilities due to just being too tired to manage the treatment modalities. Therefore, group therapy is normally delegated, which simply makes it difficult to track and maintain.
- It’s Difficult to Generate Revenue: Insurance companies may compensate but sometimes the best option is to accept cash/credit cards only to guarantee revenue. However, using unconventional methods of payment may lead to another issue, what happens if the group members aren’t satisfied? want a refund, claim they didn’t receive services or felt robbed? Once again this goes back to having a good screening process, realistic expectations, and having informed consents/malpractice insurance. However, more paperwork and legalities make group therapy an uphill battle and sometimes not worth the hassle.
- Documentation May or May Not Apply: most of the textbooks and facilities, display how documenting group therapy is not only rarely done but not even discussed. How and who is keeping track of the therapy? what’s the prognosis or even the purpose? because (as always) nurses are told, if it wasn’t documented, then it wasn’t done. However, in individual therapy sessions, people may want to include a partner, family members, a teacher, loved ones, their kids, in other words, a PMHNP still has to deal with groups and that element needs to be documented. A patient’s environment/support system is the source of their improvement or detriment and those moments should be monitored (in case something goes wrong). Evidence-based practice and knowing about theories (a framework) are helpful for documenting all forms of group therapy but it’s also difficult to implement.
- There’s Only Time for MED REVIEWS: even while doing med reviews, a PMHNP can still squeeze some time for psychotherapy, education, comfort, support, and guidance. I have given homework to someone who only had 5 mins and when I saw that person again, I was able to see an improvement in them identifying a problem with their thought process. Miracles do happen! Also, you can easily gauge who needs more assistance and if it’s a number of people, offer a quick one-time group session i.e. learning how antidepressants work. It also helps to keep information fresh and anew. In other words, make the time, nurses are the kings of innovation but yes it definitely requires some extra work 🙂
All Sections of Group Therapy:
- Introduction & Purpose
- Stages and Yalom’s Therapeutic Forces
- Types of Leadership & Conflicts
- Ethical Topics & Types of PMHNP Group Therapies
- Theoretical Perspectives
This concludes the mini-series about group therapy, Thanks for reading!
Additional Help & References
- About the WDEP Model
- Dr. Irvin Yalom’s Website
Texts
- Corey, G. (2016). Theory & practice of group counseling. (helped with summarizing various group therapies in chp.17)
- Yalom, I. D., & Leszcz, M. (2015). The theory and practice of group psychotherapy.
PowerPoints
