Mastering group leadership. An active learning experience

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. this article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses. Therapeutic groups are both exciting and cost-effective treatment strategies for use with mentally ill clients. The skills of an accomplished group leader are transferable from within the psychiatric population to working with families, bereavement groups, and other client populations, ranging from people with diabetes to survivors of catastrophic crises. Group leadership ability complements the management and negotiation skills needed in professional nursing roles. When students and staff nurses grow in group leadership expertise, clients in various settings will be better served with this currently underused treatment option.     

Therapeutic Return to Work: Rehabilitation in the workplace

Therapeutic Return to Work is a work rehabilitation program linking graded work exposure with functional restoration therapy for chronic low back pain. This study evaluates the impact of the program on stable return to work (RTW) and compares it with the impact on RTW of three frequently used ways of management of back pain (normative comparison). At two year follow-up, 93% of participants of the Therapeutic Return to Work program were working. This rate was higher than in the comparison groups. Although limited by its norm-referenced evaluation design, the results of this study indicate the importance of placing the work site in the center of the of work rehabilitation process. In this program occupational therapists make full use of the client's natural environment.     

Maximizing learning outcomes by videotaping nursing students' interactions with a standardized patient

1. Videotaping is a beneficial instructional methodology to help undergraduate students develop awareness of their strengths and opportunities for growth in therapeutic interactional skills. 2. Educational interventions with undergraduate students provide an opportunity to involve doctoral students in vital instruction, research, and knowledge dissemination through publication and presentation. 3. Allowing novice nurses to view their interactional skills with a simulated patient can reduce the anxiety they experience in first therapeutic encounters with assigned patients. 4. Continuous quality improvement in educational methodology is dependent on listening carefully to students who have invaluable feedback to offer and making appropriate correction as indicated.     

Emotional Triggers: Listening Barriers to Effective Interactions in Senior Populations

Given the scarcity of scholarly studies on the impact of effective listening and senior populations, this study sought to explore senior participants' interactions especially as they related to emotional triggers and listening effectiveness. Participants with a mean age of 84 participated in one of four focus groups. Results suggest that emotional reactions inhibiting effective listening can be language or behaviorally based. The four primary language triggers gleaned from the data included words that implied false familiarity, made assumptions, indicated poor topic choice, or demonstrated poor grammar. Behavioral triggers included use of pause fillers, repetition, ineffective vocal cues, and poor turn-taking skills.     

Listening Is… Five Personal Worlds of Listening: An Auto-Ethnographic Approach

What is effective listening? This question intrigues both scholars and the general public. Theoretical explorations provide insight into the listening process as well as pragmatic guidelines for how to be a good listener. But even the most learned listening scholar will often fall back on the observation that they know effective listening best when they experience it.

Five renowned listening experts were asked to respond to the question, “What is listening from the perspective of your lived experience?” Each was asked to work from an auto-ethnographic methodology. The five lifeworlds described in this study represent their responses to this question and offer unique, individual ethnographic contexts describing the listening experience of each of the participants.     

Integrating three approaches to counter resistance in a noncompliant elderly client

1. The term "resistance' has been defined primarily in the psychoanalytic literature and is a significant issue in the treatment of mentally ill people. This issue needs to be addressed for the change process to begin. 2. An understanding of resistance from psychoanalytic, cognitive, and behavioral perspectives will enable the nurse to assist the client in achieving mental health. 3. Countertransferance can be used to understand the client's motives, hence becoming aware of therapeutic goals, or it can hinder the therapeutic process. 4. The psychiatric-geriatric population is complex. With the acceptance that an elderly client can benefit from psychotherapy and with an understanding of different approaches, the client may experience symptom relief.     

A spiritual framework in incest survivors treatment

Through an examination of recent incest treatment development, this article emphasizes the theoretical concept of integration within the treatment process for female adult incest survivors. Spirituality as a therapeutic foundation is discussed with examples of therapeutic techniques. A case study illustrates the psycho-spiritual process of treating a 29-year-old female incest survivor and describes how self-integration has helped this client heal from trauma and change her worldview. Significant outcomes of treatment include the client's gaining of self-awareness and freeing herself from emotional blindness. The recommended practice framework includes a three-step healing process of building alliance with the client in a safe environment, disputing faulty religious assumptions in a learning process, and affirming the needs for reconnection and continuous spiritual support.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

Intimate partner violence & depression: a deadly comorbidity

(1) Clients exposed to intimate partner violence (IPV) are at considerable risk for depression, suicide, and homicide. (2) Disclosure of IPV should be accompanied by nonjudgmental, careful, clear documentation of physical and emotional findings by nurses, including direct statements in clients' own words. (3) Frequent, consistent support of clients experiencing IPV from their families and friends (including nonjudgmental listening, unconditional acceptance, discussion of options, and exploring decisions) is of considerable importance and can facilitate the buffering effects of such support against suicidal ideation and suicidal attempts.     

THERAPIST-CONDUCTED CONSULTATION: USING CLIENTS AS CONSULTANTS TO THEIR OWN THERAPY

Using qualitative research methodology, the authors developed an in-session therapeutic procedure called the therapist-conducted consultation (TCC) which is designed to enhance the therapist-client collaborative relationship. In the TCC, the therapist and client(s) relinquish their traditional roles and discuss the client's treatment. During this process, clients are invited to (a) share their perspective of treatment, (b) assess whether treatment is meeting their goals, and (c) suggest how treatment could change to improve their experience. The three-stage model of the TCC that resulted from the research is presented with a case example.     

The dream: Mechanisms and clinical applications

The clinician's use of client dream reports to promote self-discovery and foster a therapeutic alliance is examined in the context of borderline personality psychodynamics. The mechanisms and operations central to understanding dream processes are explained, using both Freudian and information processing models. This paper's thesis is that the effective, differential use of dream material hinges on the assessment of the client's ego functioning in the object relations sphere and relative to level of cognitive development.     

An Examination of Listening Concepts in the Healthcare Context: Differences Among Nurses,Physicians, and Administrators

This study explores the perceived conceptualizations of listening in a healthcare context. The review of literature focusing on communication and listening in healthcare supports the belief that listening is an essential element in patient satisfaction. This study sought to determine which activities physicians, nurses and healthcare administrators perceive as similar or identical to listening. A survey of 203 health care professionals, using a web-based version of the Imhof-Janusik Listening Concepts Inventory (Imhof and Janusik, 2006 Imhof, M. and Janusik, L. A. 2006. Development and validation of the Imhof-Janusik listening concepts inventory to measure listening conceptualization differences between cultures. Journal of Intercultural Communication Research, 35(2): 79–98. [Taylor &; Francis Online] , [Google Scholar]) was completed. The results suggest the listening conceptualizations vary among physicians, nurses, and administrators with administrators exhibiting the most flexibility in their conceptualization of listening. It is concluded that these conceptualizations may play a critical role in the behaviors displayed by nurses, physicians and hospital administrators.     

An Investigation of Cognitive Operations on L2 Listening Comprehension Performance: An Exploratory Study

This study examines the research being conducted in the process of defining eflective listening. Some of this work includes the compiling of lists of listening competencies; however, before this work can be completed, there are some basic theoretical questions to address in assessing listening effectiveness. This study reviews the literature relating to theoretical issues such as who decides what constitutes effective listening, how is the assessment made, when is the assessment made, and are some listening behaviors more important than others. One of the primary conclusions of the review is that there is insufficient research in real-time listening contexts to establish how speakers assess the efkctiveness of the listener in the interaction.     

Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?     

THERAPIST PHYSICAL ATTRACTIVENESS: AN UNEXPLORED INFLUENCE ON CLIENT DISCLOSURE

Existing research indicates that clients perceive facially attractive therapists as more competent, trustworthy, genuine, and effective than less attractive therapists. No Studies exist to help explain how the therapist's attractiveness influences a client's self-disclosure. Participants (n = 241) were randomly assigned to one of eight experimental groups to test the interaction of the therapist's attractiveness, client's gender, the nature of presenting problem, and the client's comfort with disclosing in a hypothetical couple therapy scenario. Analysis of variance procedures established that most participants reported feeling more comfortable disclosing a benign (communications) problem than a potentially embarrassing (sexual) problem, and more comfortable disclosing problem to an attractive than to a less attractive female therapist. Therapists are encouraged to understand the power attractiveness may have in their own and their client's lives     

Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Professional boundaries. A matter of therapeutic integrity

1. Establishing and maintaining boundaries creates a relational space in which the patient and nurse are able to explore treatment issues within the safety of the therapeutic relationship. 2. The therapeutic relationship in founded on the basis of trust, respect, and appropriate use of power. Understanding the power differential within the nurse patient relationship is critical to the establishment and maintenance of professional boundaries. 3. Therapeutic integrity is rooted in knowledge, experience, and clinical judgment. As such, there are not always clearly demarcated answers to the tough questions posed by the dilemmas in practice. 4. Questions arising from practice challenge nurses to reflect on the meaning of boundaries in their personal and professional lives.     

Treating the disconfirmed psychiatric client

Frequent disconfirmation behaviors have been documented in psychiatric clients. Individuals who demonstrate maladaptive patterns of disconfirmation can learn to understand and modify this dysfunctional sequence. Through one to one interactions and group discussions, psychiatric nurses can help clients learn more positive communication behaviors. This accomplishment will positively affect the client's interpersonal responsiveness and self-esteem.