GROUP THERAPY:

INTRODUCTION:

It is less time consuming procedure in which 10 people can be treated at one time. Joseph pratt
uses it first in 1905 on tuberculosis patient. Group therapy may utilize psychoanalytic
,supportive, transactional or behavioral approaches. over the years many types of group
therapies have emerged like self help groups(alcoholics anonymous for alcoholics, weight
watchers for obese) transactional analysis groups, psychodrama and the like.

Group therapy sessions are held once or twice a week ,with each sessions lasting 1-2 hours and
the patient usually sit in circle. In group therapy approximately 6-10 individuals meet face-to-
face with a trained group therapist. During the group meeting time, members decide what they
want to talk about.

Members are encouraged to give feedback to others. Feedback includes expressing your own
feelings about what someone says or does. Interaction between group members are highly
encouraged and provides each person with an opportunity to try out new ways of behaving; it
also provides members with an opportunity for learning more about the way they interact with
others. It is a safe environment in which members work to establish a level of trust that allows
them to talk personally and honestly. Group members make a commitment to the group and are
instructed that the content of the group sessions are confidential. It is not appropriate for group
members to disclose events of the group to an outside person.

DEFINITION:

IT is a form of treatment in which carefully selected, emotionally ill persons are placed into
groups ,guided by a trained therapist for the purpose of changing the maladaptive behavior of the
individual member.

PURPOSES:

1. To intervene in psychopathology.
2. To reveal ,examine and resolve distortions in interpersonal relationships.
3. To improve the skill of relating to others.
4. To learn coping styles.

THERAPEUTIC FUNCTIONS OF GROUP THERAPHY:

1 . imparting of information:
Psycho education /health education information that are structured and planned are given
through lecture method in the group.
2. Instillation of hope: Helps the client maintain faith in the therapeutic modality. The
client is optimistic he believes he will get better.
 3.Universality: Client learns that others in the group have problems ,thought and feelings
similar to his own.
4.Altruism:
Is the process of client s’ aiding or helping each other. The act of giving to others
becomes therapeutic for the giver, which increases the self esteem of the giver.
5.Correctives recapitulation of the primary family group:
Means that the client is influenced in therapy group by his history. Initially in group
therapy the client is influenced in therapy group by his history. Initially in group therapy
the client perceives the behavior of other members as being like his siblings and the
behavior of the therapist as being like his parents have in the past the client begins to gain
insight into his own behavior.

6. DEVELOPMENT OF SOCIALIZING TECHNIQUES:

Role play and feedback in group therapy helps to develop social skills.

7.IMITATIVE BEHAVIOR:
The client identifies with the healthier aspects of the other members and the leader and
gains growth imitation.

8. INTERPERSONAL LEARNING:
The client learns to profit from the therapeutic use of anxiety when anxiety is minimized
the client relates more openly he learns to trust, to expose himself ,to give of himself ,to
expect from others ,to test reality ,and therefore to experience growth .

9.GROUP COHESIVENESS:
Relates to bonding the feeling of “we instead of “I” .cohesiveness is demonstrated
through attendance and ability of the group to communicate positive and negative
expressions to each other without the group disintegrating.

10. CATHARSIS:
IS The expression of feelings deep emotions and anxiety provoking problems in the
group . this enables the client to find a practical solution.

11. EXISTENTIAL FACTORS:

The group is able to help individual members take directions of their own lives and to
accept responsibility for the quality of their existence.

SETTINGS:

Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit or
ambulatory psychiatric Partial hospitalization (also known as Day Hospital treatment) .In
addition to classical "talking" therapy, group therapy in an institutional setting can also include
group-based expressive therapies such as drama therapy, psychodrama, art therapy, and non-
verbal types of therapy such as music therapy. Group psychotherapy is a key component of
Milieu Therapy in a Therapeutic Community. The total environment or milieu is regarded as the
medium of therapy, all interactions and activities regarded as potentially therapeutic and are
subject to exploration and interpretation, and are explored in daily or weekly community
meeting.

A form of group therapy has been reported to be effective in psychotic adolescents and
recovering addicts. Patient groups read a novel or collectively view a film. They then participate
collectively in the discussion of plot, character motivation and author motivation. . Under the
guidance of the therapist, defense mechanisms are bypassed by the use of signifiers and semiotic
processes. The focus remains on the text rather than on personal issue

Physical Conditions That Influence Group Dynamics:

Seating : the physical conditions for the group should be set up so that there is no barriers
between the members. For eg a circle of chairs is better than chairs set around a table. Members
should be encouraged to sit in different chairs each meeting. This openness and change creates
an uncomfortableness that encourages anxious and unsettled behaviours that can then be
explored within the group.

Size: various authors suggested different range of size as ideal group interactions: 4to 7 (Huber
1996) 2 to 15 (Sampson & marthas 1990) and 4 to 12 (clark 1994) . group size does not make a
difference in the interaction among members. The larger the group the less time is devot to
individual member. In larger group aggressive individual are most likely to heard where as
quieter members may be left out discussion . the larger group provides more opportunities for
individual to learn from other members. The wider range of life experience and knowledge
provides a greater potential for effective group problem solving.

Membership: whether the group is open ended or close ended is another condition that
influence the dynamics of the group process. Open ended groups are those in which members
leave and others join at any time while the group exists. The continuous movements of
members in and out of the group creates the type of uncomfortableness. These type of group held
in short term inpatient unit or in long term facilities as well as. Closed groups are fixed frame.
All members join at the time of group organized and terminate at the end of designated time
period. These groups are composed of individual with common issues or problems they wish to
address.

Dealing with challenging group behaviors: problematic behaviors occur in all groups. They
can be challenging to the most experienced group leaders and frustrating to new leader . in
dealing with any problematic behaviors the leader must remember to support the integrity of the
individual members and the group as whole.

Monopolizer: some people monopolize group by talking others. It causes anxiety among the
members. Within few sessions person relaxes no longer attempts to monopolize the group. The
leader support the group in establishing rules that allows everyone to participate . the leader can
interrupts monopolize by acknowledging the members contribution.

Yes , but: some people agree with suggestions from others but they add ,yes but”and give
several reasons so leader must avoid problem solving for the member and encourage the person
to develop his or her own solutions.

Disliked member: in some group members dislikes one particular member so in this situation
leader must move the member to better match group. Whether the person stay or leave the leader
must stay neutral and avoid displaying negative and non verbal behaviors that indicate he or she
too dislikes the group member. Or leader must show respect for disliked member and
acknowledging his contribution.

The silent member: the member who does not participate in group discussion the leader must
respect the person silent nature and get to know the member and understand the meaning of the
silence before encouraging interactions.

Group conflict; groups experienced conflict. The leader must decide it is a natural part or
addressing any issues. Member to member conflict can be handled but leader to member conflict
is more complicated. The leader can use conflict resolution strategies but should be sensitive to
the power differential between leader role and member role.

Why is group therapy helpful?

1. When people come into a group and interact freely with other group members, they
usually recreate those difficulties that brought them to group therapy in the first place.
Under the direction of the group therapist, the group is able to give support, offer
alternatives, and comfort members in such a way that these difficulties become resolved
and alternative behaviors are learned.

2. The group also allows a person to develop new ways of relating to people.

3. During group therapy, people begin to see that they are not alone and that there is hope
and help. It is comforting to hear that other people have a similar difficulty, or have
already worked through a problem that deeply disturbs another group member.

4. Another reason for the success of group therapy is that people feel free to care about
each other because of the climate of trust in a group.

As the group members begin to feel more comfortable, you will be able to speak freely. The
psychological safety of the group will allow the expression of those feelings which are often
difficult to express outside of group. You will begin to ask for the support you need. You will be
encouraged tell people what you expect of them.
In a group, you probably will be most helped and satisfied if you talk about your feelings. It is
important to keep in mind that you are the one who determines how much you disclose in a
group. You will not be forced to tell you deepest and innermost thoughts.

TYPES OF GROUP THERAPY:

1. TASK GROUPS : Task groups are designed to accomplish a particular task. The
emphasis of these groups is on decision making and problem solving . they often have
specific goals to accomplish and a deadline for completion of the work.
2. SELF HELP GROUP:
Groups organized around a common experience are labeled self –help group.eg
alcoholics anonymous, smoking cessation group and numerous groups related to
specific health problems . they may not receive consultation from a health care
provider . although some self-help group are established and organized by
professionals the groups are run by the members alone and often do not have a
designated leader. Leadership evolves with in the group depending on the need that
arises.
3.EDUCATIONAL GROUPS:
The goal of teaching group is to provide information.eg child birth preparation
,patient education groups, medication groups and psychoeducation group . inservice
education for staff are also included in this category.
4. SUPPORTIVE THERAPY GROUP:
The primary goal of supportive therapy group is to help the members cope with life
stress. The focus is on dysfunctional thoughts ,feelings and behavior . it has value for
patient of all ages and with both medical and psychiatric diagnoses.
5. PSYCHOTHERAPY GROUP:
The goal of psychotherapy group is the treatment of emotional ,cognitive , or
behavioral dysfunction. Group techniques and processes are used to help members
learn about their behavior with other people and how to relates to core personality
traits. The intent is for members to change their behavior ,not just to understand oa
seek support for it.
6. BRIEF THERAPY GROUP:
The purpose of brief therapy group is to focus on the actions participants can take to
improve their current situation .these group target what can be done now to change a
patient problem solving approach and help the patient implement more adaptive
coping skills. The establishment of recognized and self sustaining group program is
greatly facilitated by advanced planning ,well thought out structure and clearly stated
goal.
7.INTENSIVE PROBLEM –SOLVING GROUPS:
These are designed for 6to 10 patients each working on the identification and
resolution of specific target problems ,goals, and problem solving strategies related to
 an individual treatment plan . they based on cognitive ,behavioral , and interpersonal
therapy models implemented in a structured problem solving format. The goal is to
identify and clarify the problem ,explore alternatives solutions and get action oriented
commitments for change. The therapist act as a leader ,techer, and coach whose
purpose is to teach group members the interpersonal skills needed to solve the
problems identified in their treatment plans.
8. MULTIDISCIPLINARY TEAM: Nurses are often members of
multidisciplinary teams consisting of psychiatrists psychologist, social worker, and so
on. the pooling of all of these resources allows for efficient use of available resources
for the benefit of the patient. One drawback of these groups is the tension that can be
manifested between the different professional disciplines because of status issue,
communication issue, leadership issues conflict for whose is the leader.
9.ACTIVITY GROUPS:
It is designed to enhance the psychological and emotional well being of patients . task
include drawing ,exercise to music, arts and crafts, reviewing current events. The
benefits that have been reported from the participation of patient in such group
activity groups include the expression of positive and negative feelings and the
greater acceptance of oneself.

10. PEER SUPPORT GROUPS:

Is effective way of professional to share the stress and problems related to their work.
group purposes may include case consultation ,sharing information, about educational
opportunities providing information about management skills, and decreasing
professional isolation.

ACCORDING TO THE PURPOSES:

1. PSYCHOANALYTIC GROUP THERAPY:

Group communication is focused on the here level of unconscious ,semiconscious
and conscious material .the group focuses on interpretation of dreams ,free
association, and other latent content produced in the group. The therapist turns
these experiences into conscious, healthy learning experience for the client.

2. TRANSACTIONAL A NALYSIS:
The three ego states of the individual the parent ,the child ,and the adult –are
examined in TA group.

3. RATIONAL EMOTIVE THERAPY :

It aims to maximize a person rational thinking.
4. GESTALT THERAPY:
 It emphasizes self expression, self exploration, and self awareness in the patient
.clients and therapist focus on the every day problem and try to solve them.

5. INTERPERSONAL GROUP THERAPY:

It explore the members anxiety and stress and their effects on the individual . it is
believed that anxiety from interpersonal relationship is reduced or relieved
through interpersonal support.

6. PSYCHODRAMA GROUP:
It explore the truth through dramatic methods. During psychodrama the client
produces a topic to be explored .the therapist directs the subject through role
playing of scenes related to the topic and incorporates the use of therapeutic ideas
in the action. The audience experiences the feeling and identifies with the action
on the stage .a catharsis occurs for the subject and also for the audience.

7. ENCOUNTER GROUPS:
It aims at the bringing personal change as a result of deeply felt experiences.

8. T –GROUPS:
The goal is to verify experimentally the T- group method . this involves the study of groups
norms , roles , communication distortions, and the effect of authority on behavior patterns
personality and coping mechanisms. Group members receive feedback by exposing
themselves to others in the group and they also experiment with new or more productive
behavior.

9. COMMUNITY SUPPORT GROUPS:

Provides identification ,clarification ,understanding ,role modeling ,feelings of togetherness,
and group cohesion. They help prevent the individual member from feeling lonely and
isolated. They help the members decrease levels of stress and increase level of self
acceptance . the members develop new or more effective patterns of behavior.

10. MARATHON GROUP:

The term Marathon group refers to the amount of concentrated time the participants spend
together as a group. These sessions may last from 12 hours to 2,3 or more days, allowing
short period away from the group for sleeping and eating . these groups have a clearly stated
goal of personal change or growth of participants. Size of group -8-10 members duration of
each session 1-2 hours frequency everyday or 3 days in a week depending on the purpose.

PHASES OF GROUP DEVELOPMENT :

 Groups, like individual move through phases of life cycle development .ideally ,groups will
progress from the phase of infancy to advanced maturity in an effort to fulfill the objectives
set forth by the membership. Unfortunately as with individuals
some group fixed in early developmental levels and never progress or experience periods of
regression in the developmental process. Three phases of group development are:

PHASE 1 INTIAL OR ORIENTATION PHASE:

Group activities:
The leader and member works together to establish the rules that will govern the group .(eg
when and where meetings will occur the importance of confidentiality, how meetings will
be structured) goals of the group are established . members are introduced to each other.

Leader expectations:
The leader is expected to orient members to specific group processes, encourages members
to participant without disclosing too much too soon , promote environment of trust and
ensure that rules established by the group do not interfere with fulfillment of the goals.

Member behavior:
In phase 1 ,members have not yet established trust and will respond to this lack of trust by
being overly polite. There is a fear of not being accepted by the group . they may try to get
on good side of the leader with compliments and confronting behaviors. A power struggle
may ensue as members compete for their positions in the pecking order of group.

PHASE 2 MIDDLE OR WORKING PHASE:

Group activity:
During the working phase ,cohesiveness has been established has been established with in
the group. This when the productive work toward completion of the task is undertaken
.problem solving and decision making occur within the group . in the mature group
,cooperation prevails and differences and disagreements are confronted and resolved.
Leader expectations:
The role of leader diminished and become more one of facilitator during the working phase.
Some leadership functions are shared by certain members of the group as they progress
towards resolution. The leader help to resolve conflict and continues to foster cohesiveness
among the members while ensuring that they do not deviate from the intended task or
purposes for which the group was organized.

Member behavior:
At this point trust has been established among the members. They turn more often to each
other and less often to the leader for guidance . they accept criticism from each other using it
in a constructive manner to create change.

PHASE 3 FINAL OR TERMINATION PHASE:

Group activity:
The longer a group has been in existence ,the more difficult termination is likely to be for
the members. Termination should be mentioned from the onset of group formation. It should
be discussed in depth for several meetings prior to the final session. A sense of loss that
precipitates the grief process may be evident particularly in the groups that have been
successful in their stated purpose.
Leader expectations:
In the termination phase the leader encourages the group members to reminisce about what
has occurred within the group to review the goals and discuss the actual outcomes and to
encourage members to provide feedback to each other about individual progress within the
group. The leader encourages members to discuss feelings of loss associated with
termination of the group.

Member behaviors:
Members may express surprise over the actual materialization of the end . this represents the
grief response of denial which may then progress to anger . anger toward other group
members or toward the leader may reflect feelings of abandonment. These feelings may led
to individual members discussions of previous looses for which similar emotions were
experienced. Successful termination of group may help members develop the skills needed
when losses occur in the other dimensions of their lives.

MEMBERS ROLES:
BENNE AND SHEATES IDENTIFIES THREE MAJOR types of roles of individual play
within membership of the group. These are
1. Complete the task of the group.
2. Maintain or enhance group processes.
3. Fulfill personal or individual needs.
Task roles and maintenance roles contribute to the success or effectiveness of the group.
Personal roles satisfy needs of the individual members sometime to the extent of
interfering with the effectiveness of the group.

PREPARATION : The patient is prepared for the group therapy sessions by

explaining the processes to which the patient will exposed ,emphasizing the need to be
open and honest with co- patient and finally ,alerting the patient to the possibility that he
may likely be questioned by group members explicitly share his problem to develop self
knowledge about illness.
 CRITERIA OF PATIENT TO BE INCLUDED IN GROUP THERAPY:
1. Ability to communicate .
2. Willingness to share his problems with others.
3. Motivation to change.
4. Patient with authority anxiety .
5. Patient using defense mechanism of projection, repression, denial, suppression,
transference reactions.

FACTORS CONTRIBUTING TO GROUP THERAPY:

1. Faith in the treatment procedure.
2. Universality (similar problems are seen in the others)
3. Direct guidance for the problem.
4. Altruism (patient offer each other support ,reassurance, suggestion, and
insight)
5. Development of socializing skills.
6. Imitative behavior (imitation of a healthy behavior ,especially therapist is
identified as a role model and patients imitates the therapist.)
7. Catharsis (ventilation of emotion)
8. Conflict resolutions.
9. Acceptance of the reality
10. Group cohesiveness(attractiveness that members have for their froup and for
other members )
11. Interpersonal learning.

THERAPEUTIC TECHNIQUES USED IN GROUP THERAPY:

1. Approval: -
condoning or encouraging an attitude ,feeling or action
2. Acceptance :-
An attitude or a relationship that recognizes the worth of a person without imply either
approval of particular behavior or personal affection.
3. Clarification:-
Restatement by another in what is hoped to be clearer terms of the substance of what the
client has said.
4. Exploration :-
A shift from considering one aspect of a situation to considering other.
5. Identification:-
Delineating specific factors for the purposes of understanding or clarifying.
6. Interpretation:-
Finding or explaining the meaning or significance of the information.
7. Information giving:-
 Stating facts about a problem.
8. Encouraging expression of feelings or ideas:-
Indication in some way that it is permissible or desirable to talk about feelings or ideas.
9. Reassurance :-
Offering the client confidence of a favorable outcome through suggestion, through persuasive
arguments or through comparing similar cases.

10. support :-
giving comfort ,approval or acceptance.

11. Intervention:-
An action that directs or influences the client behavior.
12. Understanding:-
Indicating verbally or nonverbally that you know or comprehened what the client is
communicating and what he is feeling.
13. Reflection:-
Repeating back to the client what he has said mirroring his statements.
14. Listening :-
Concentrating on the clients communication without interruption.
15. Teaching:-
Helping the client learn specifies in relation to events and behavior.
16. Silence:-
The use of no verbal or spoken words.
17. Structuring:-
Shaping the content of the group meetings.
18. Limit –setting:-
Deciding how far group members and the group may go before the therapist ceases or
restricts to a point ,the behavior ,activity , or verbal expression of members.
19. Transference and counter transference:-
Transference occurs when the client attributes characteristics and the behavior of the family
member to the therapist. And counter transference occurs when therapist responds in a
negative manner to the client transference. The clarification of this distortion with the client
helps to create a therapeutic process of learning.

20. Themes:- The area of discussion that recur or relate one group session to another and then
explore the meaning of these themes.

ADVANTAGES OF GROUP THERAPY:

 1. Members profit by hearing other members discuss their problems. This discussion
decreases the members feeling of isolation alienation, and uniqueness, and
encourages him to share his feeling and problems.

2. opportunity to explore specific styles of communication in a safe atmosphere , where

they can receive feedback and can undergo change.

3. learns multiple way of solving problems from other group members and group
exploration helps them to discover new ways of solving problems.

4. the group provides for its members understanding ,confronting and identification,
with more then one individual.

5.Group therapy allows people to receive the support and encouragement of the other
members of the group. People participating in the group are able to see that there are others
going through the same thing, which can help them feel less alone.

6.Group members can serve as role models to other members of the group. By seeing
someone who is successfully coping with a problem, other members of the group can see that
there is hope and recovery is possible. As each person progresses, they can in turn serve as a role
model and support figure for others. This can help foster feelings of success and
accomplishment.

7.Group therapy is very cost effective. Instead of focusing on just one client at a time, the
therapist can devote his or her time to a much larger group of people.

8.Group therapy offers a safe haven. The setting allows people to practice behaviors and
actions within the safety and security of the group.2

9.By working in a group, the therapist can see first-hand how each person responds to
other people and behaves in social situations. Using this information, the therapist can provide
valuable feedback to each clients.

DISADVANTAGES:

1. Individual privacy is destroyed.

2. Resistance and reluctant to change.
3. Therapist at times dominant or as if he is giving individual therapy.

NURSES’ ROLES IN GROUP THERAPY:

Nurses explore the use of groups as a teaching method , a therapeutic method ,a therapeutic
tool with clients and a form of peer group supervision. Nurses participates as a leader in
many formal and informal group therapies, including resocialisation, reeducation, supportive
therapy, psychoanalytic therapy, family therapy, couple therapy etc.

Leader roles are :

1. group task roles.
2. group building and maintenance role.
3. individual roles.

Group task roles:

To identify group problems and select methods to solve those problems.

 Suggests new ideas.

 Seeks clarification.
 Ask for opinion to what the group is undertaking.
 Gives information shares experiences in relation to the group problems.
 Give opinion by stating ideas and values about group suggestions.
 Clarifies how ideas can work.
 Orients the group on target by defining where the group is in relationship to its
goal.
 Evaluates the accomplishment of the group in relation to its task.
 Motivates the group to greater productivity .
 Record the productive discussion.

Group building and maintenance roles:

To strength , regulate and perpetuate the group members to function as whole
group.

 Encourage and accepts the contributions of others.

 Reconciles differences between group members.
 Admits error to maintain group harmony.
 Keeps communication open and provides encouraging remarks.
 Sets group goals and evaluate the functioning of the group.
 Observes the group discussion , gives feedback and interprets.
 Assumes more of an audience role but gives the feeling of being with
group.

Individual role:

 To meet the needs of the group members it hampers group

functioning that need to be aware of .

 Expresses aggressions, which deflates the status of individual and

group accomplishment.
 Resists progress by arguing or disagreeing beyond reason.
  Calls attention to himself/ herself through boasting and pointing
out achievements.
 Give self confession by expressing feelings and ideology not
related to the group but uses the group as audience.
 Demonstrate individuals lack of involvement.
 Asserts authority superiority in manipulating the group.
 Seeks helps from group.
 Tries to have own biases and prejudices.

Basic roles of nurses:

 Determine setting and size of the group.

 Choose frequency and length of group sessions.
 Select a therapist for the group.
 Formulates policy on group therapy with other therapeutic
modalities.
 Formulating appropriate goals.
 Selecting patients who can perform the group task.
 Preparing patients who can perform group task.
 Preparing patients for group therapy.
 Explaining group members to maintain confidentiality of
group discussion.
 Identify and resolve common problems.
 Fix up time for the subsequent sessions.
 Maintain attendance of group members.
 Arrange for guard ship during session for uninterrupted
discussions.
 Maintain strict discipline and confidentiality over the
informations that are discussed in the session.
 Assists the group members for progressing and completing
the task home assignments.
 Monitor the group members behavioral changes prior to
and after group therapy sessions.
Prepare the group member physically to attend group therapy
session continuously by attending to his needs like medication,
nutritional needs and elimination need, personal hygiene.

Behavioural group therapy for obsessive–compulsive disorder in

Norway. An open community-based trial  

Behaviour Research and Therapy, Volume 48, Issue 6, June 2010, Pages 547-554
Åshild Tellefsen Håland, Patrick A. Vogel, Birgit Lie, Gunvor Launes, Are Hugo Pripp, Joseph
A. Himle
 ABSTRACT:

The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy
for OCD patients in a community-based, general Norwegian outpatient clinic. The sample
consisted of 54 patients diagnosed with OCD. The Yale-Brown Obsessive–Compulsive Scale
(Y-BOCS), the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory
(STAI-S) were administered before treatment, after treatment and at 3- and 12-month follow-ups.
Analyses with mixed models for repeated measurements showed that group behavioural therapy
offered to OCD patients significantly improved ratings of obsessive–compulsive symptoms,
depression and anxiety. These improvements were maintained at 3- and 12-month follow-ups
and an additional reduction in obsessive–compulsive symptoms was observed from post-
treatment to 3-month follow-up. However, the delayed effect of therapy was no longer present at
12-month follow-up. The results also revealed that the patients had a lower chance for an
increased outcome category (e.g. from unchanged to improved or recovered) with high scores on
STAI-S at the given observation times (post-treatment, 3- and 12-months follow-ups).
Depressive symptoms (BDI) at post-treatment and follow-ups had no significant influences on
the three categories of outcome for OCD. In conclusion, the results indicate that behavioural
group therapy can successfully be delivered to patients with considerable comorbidity in a real
world setting conducted by therapists with limited training in the CBT.

A School-Based Group Activity Therapy Intervention With At-Risk High School Students
as It Relates to Their Moral Reasoning  Original Research Article
International Journal of Play Therapy, Volume 17, Issue 2, 2008, Pages 122-137
, Jill Packman, Cleborne Maddux, Terri Rothman

Abstract

The main goal of this study was to examine whether group therapy is useful for developing
moral reasoning in at-risk youth. This research compared the impact of 10 weeks of group
activity therapy (n = 27) and group talk therapy (n = 34) on the moral reasoning of at-risk ninth
grade students. Group activity therapy is the developmentally appropriate extension of child
centered play therapy for adolescents. Using pretest and posttest scores on the Maintaining
Norms Schema subscale of the Defining Issues Test 2 (DIT–2; Rest, Narvaez, Thoma, &
Bebeau, 1999), an analysis of covariance indicated significant difference between groups. .

REFRENCES:

Townsend Mary C, “ Psychiatric Mental Health Nursing” fifth edition Philadelphia :F.A Davis
2006.

Kaplan I Harolod , Sadock J. Benjamin “,Synopsis of psychiatry” , William and William

publications ,Eight edition ,2002.

Lalitha .K., “Mental health and psychiatric nursing” , VMG Book House , first edition 2007.

Marry Ann Boyd, “Psychiatric Nursing Comtemporary Practice’’ Wolters Kluwer publication 4th
edition, 2008.

www.science direct .com.

www.google.com.