The purpose of theory is to have a solid foundation when you are studying, assessing, or implementing an intervention. This is what honestly sets a PMHNP (or nurses) apart from other disciplines. Theory helps with expressing the dynamics of nursing care and patient outcomes.

If documentation is difficult for an individual, imagine trying to document and track the progress of group therapy.  Most of the time, it doesn’t occur or the group leader has to be mindful of the privacy and ethical concerns, which can make it complicated…So far the previous subjects of group therapy are on the PMHNP main page of topics. To continue the little series, the next portion is an overview of the theory for group therapy and a comparison of group perspectives:

A Quick Review of the Group Stages

• Forming: members become acquainted and consider their task
• Primary Tension: social unease in the getting-acquainted process. Resolution: remain positive, energetic, patient, and open-minded. Be prepared and informed.
• Storming: members compete for status and try to resolve conflict. Challenge: balance conflict and cohesion, openly disagree on issues.
• Secondary Tension: the frustration and personality conflicts experienced by group members as they compete for acceptance and achievement of tasks.
• Norming: members resolve conflicts and develop “rules of engagements”.  Challenge: balancing (none)conformities, and resolve secondary tensions. The group develops norms and ground rules.
• Performing: members focus energy on achieving group goals. Challenge: balancing tasks and maintenance. Group also focuses on productivity and member satisfaction. Group adapts/changes if necessary.
• Adjourning: members achieve the group’s goal and may begin to disband. Challenge: balancing engagement/disengagement. Members may leave, and some may take on a new group task. Read more about group stages.

Theories	Analysis	Focus	It's Purpose or Additional Info & Key Authors
Field Theory	Patterns of interaction between the individual and the environment	The influence behind the group members' action	Understanding why group members interact the way they do -Kurt Lewin
Interaction Theory	Patterns of social interaction of group with its "activities" in relation to each other with other variables	Groups balance 2 fundamental tasks: related needs & emotional needs (field and psychology themes)	Problem solving, managerial processes, assessment, team effectiveness, feedback, and rewards -Robert Freed Bales, George C. Homans William F. Whyte
Systems Theory	Holistic view of the individual, group, and environmental factors including processes and outputs	Group members in relation to inputs, process, and outputs	Groups are complex, adaptive, and dynamic (changing) systems of individuals and their interactions. Units attached via relationships of the members/interactions -Niklas Luhmann, Talcott Parsons
Psychoanalytic Theory	Group acting as a single entity and interactions are at a conscious and unconscious level	Groups that may be struggling to perform	To study failed tasks. Assess leader/member dynamics. Members positions and roles. Group splits, attack, or gets stuck - W.R. Bion, Smith & Berg
General Psychology	Individual and group interactions from a psych perspective	Understanding the characteristics of how groups operate	Natural groups emerging, group cohesion and conformity, and social communication. -Solomon Asch, Leon Festinger

Putting it all Together

Tommy has an angry outburst…

• Field: What are all past and present influences on Tommy, including his morning coffee, the office layout, and his neighbors’ dog’s tendency to “use” his yard?
• Interaction: What happened so far in this meeting today is all you need to explain.
• Psychoanalysis: That’s Tommy’s “fight” response. No one can have another point of view
• Psychology: Tommy was not hugged enough as a child.
• Systems: Simply an expected symptom of Stage 2: Storming

Comparative Overviews & Integration of Various Theories

Model	An Overview	Leader's Roles & Functions	Group Techniques
Psychoanalytic	Provide a climate of early family relationships. Uncover repressed feelings and connect past events to current behavior. Stimulate a corrective emotional experience.	Focus on transference within group, signals resistance, interprets responses/set limits for a therapeutic frame.	Dream analysis, interpretation, free associations, and analyzing resistance/transference-designed to make the unconscious more significant and bring insight.
Adlerian	Explore basic life assumptions and achieve a broader understanding, help members recognize their power/strength, find a purpose in life.	Assist members to gain insight into patterns via lifestyle assessment. Help members accept and utilize their assets.	Family exploration/assessment, reporting earliest recollections, cognitive reconstructing, challenging belief system and explore social dynamics.
Psychodrama	To release pent-up feelings, provide insight to develop new/effective behaviors. Encourage clients to live in the present. Solve conflicts, improve creativity.	Direct reenactments, assigns tasks, process the outcomes w/members.	Self-presentation, role reversal, mirroring, interviewing specific roles.
Existential	Maximize self-awareness, reduce barriers of growth, help clients assume responsibility for decisions, use the group to overcome alienation.	Grasp the member's subjective world, disclose meanings, confront in caring ways.	This approach stresses understanding first and then techniques (i.e. patient education) by focusing on the subjective.
Person-Centered	Provides a safe-warm climate where members can explore full-range of feelings, develop confidence in themselves and their judgements.	Facilitate and Not direct group tasks, establish trust, members guide the therapy.	Focus is on the leader's attitude and behaviors. Structure/techniques are not planned, provide support, empathy, reflection of feelings, "being there" for member's needs.
Gestalt	Enable members to pay attention to their moment-to-moment experiences, integrate disowned areas of themselves.	Suggests experiments to help improve group interactions, assist with identifying and achieving goals.	Action-orientated to intensify current feelings. Techniques include a game of dialogue, exaggerating, fantasy approaches, role-playing. Experiments are designed to increase awareness of improving behavior and best done in a collaborative manner; btw. leader and member.
Transactional Analysis	Assist members to reexamine early decisions and make better ones based on experience.	Recognize self-defeating aspects and adopt solutions based on didactic roles.	The use of a script-analysis check list, questionnaire to detect injunctions, family modeling/role-playing with structural analysis.
Cognitive Behavior Theory	Encourage members to evaluate how their thinking influence behaviors and eliminate maladaptive responses. Learn new, more effective behavior patterns.	Leader functions as the expert, impart information, and directs improved coping skills and healthier thought processes.	Techniques aimed at behavioral changes, including self-monitoring, self-help techniques, reinforcement/supportive measures, coaching, feedback, procedures for evaluating, and changing cognition.
Rational Emotive Behavior Therapy	Members achieve both unconditional self-acceptance and eliminate self-defeating outlook on life and replace it with a more rational and tolerant one.	Functions didactically; explains, teaches, and reeducate. Help members to confront illogical, self-defeating behavior. Leader teach how to change thinking patterns/behaviors.	Use a wide-range of emotive inteventions to bring change. Leaders teach, model, probe, confront, challenge, and direct for change faulty beliefs. Cognitive methods include role playing, homework assignments, and skills training.
Choice Therapy/Reality Therapy	Guide members towards more realistic and responsible actions. Encourage members to evaluate behavior, deciding plan of action for change.	Teach members based on the "choice theory" to help explain their actions. Encourage members to evaluate current behavior. Help formulate/implement a plan for change.	Broad range of techniques are used i.e. role playing, contracts, using the WDEP model, design specific plans for action.
Solution-focused Brief Therapy and Motivational Interviewing	Discussing solutions, choose goals to accomplish a change of lifestyle patterns.	The group elicits perspectives, resources, and unique experiences. Assist memebrs to function as co-facilitators to support and encrouage each other. Identify discrepancies/strengths to instill hope to make changes.	SFBT includes raising questions, ask about exceptions to the problem, focus on strengths, carrying out homework assessments. Main techniques for MI is asking open-ended questions about the reason for the "status quo", rank the possibility of to change (i.e. scale 1-10) affirm strengths, summarize/recap session, encourage client to explore ambivalence, meet/challenge their resistance.