The purpose of this paper was to look at group therapy on a more in-depth level and to do this a case study was created. The case study was created, an individual assessment was done along with treatment recommendations given, possible problems which could arise in group therapy were discussed, and the strengths and challenges of a group setting as it pertains to this case study were brought to attention and discussed. It was discovered that depending on the approach taken in group therapy it could lead to the successful completion of each session, but that there always room for error.
Being able to understand the different elements of a case study is important in the individual and group therapeutic process. When it comes to group therapy it can be especially important because depending on the individual and/or situation at hand this will determine which type of group will be necessary, as well as beneficial for the individual when it comes to their success. To have a better understanding of these elements a case study will be created, group recommendations for the individual within this case study will be made, individual assessment of the participant will be completed, the problems which can be common among groups and/or within the group dynamic will be explained, and the strengths and challenges in leading a group. Understanding the inner-workings of group therapy can mean the difference between success and failure of the process for every client. If a client were to be placed in the wrong group due to misdiagnosis it would not only affect them negatively as their therapist will face consequences as well.
Sam (short for Samantha) is a twenty-nine-year-old female, and she is a nurse practitioner who currently works at Osceola Regional Medical center which is in Central Florida. Sam has been caught falling asleep on the job one three different occasions but most recently she gave a patient the wrong medication which resulted in a severe allergic reaction which almost killed a patient. This resulted in her employer sending her to a doctor for a full workup which included bloodwork that showed she had taken OxyContin (which is an opioid). Once her employer was informed Sam was given the option of resigning or taking a leave of absence where she must seek help for her opioid issue. Sam admitted to her boss that she has been abusing opioids for close to a year but that recently it has gotten much worse after she received the promotion to head nurse left her feeling the pressures of the added responsibility. Sam was born and raised in Central Florida by a single mother whose name was Marie. Sam’s father left when she was only six months old and did not meet him again until she was fourteen years old. When she was twelve her mother explained to her that her father struggled with alcohol abused and as a result, she could not allow him to be around them as she felt it would put them in danger as he often became abusive when under the influence. When she met her father, he was clean and sober and with the permission of her mother was given permission to visit his daughter on a weekly basis. Her father told her a different story about why he was not around which was that he met another woman and her mother became resentful and would not allow him any contact with her out of spite; this confused Sam. Sam’s father began a custody battle with her mother in order to gain joint custody, and this caused Sam to become very depressed and angry in her late teenage years. She began to rebel against her mother as she felt she was lied to and denied the right to be around her father. Between the age of sixteen and seventeen, she was picked up seven times for shoplifting. Her mother became worried and decided that she should see a counselor before things had a chance to get worse. When Maria and Sam’s father was brought into a family counseling session the story her father told her was then revealed to her mother and Maria was in shock. Over the course of a few family session’s Sam’s fathers revealed that Maria told her the truth about his problems with alcohol, and he said that he did not want his daughter to hate him for not being around. Over the next year, Sam cleaned up her act and was accepted into a nursing school where she graduated with honors and gained her nursing license at the age of twenty-five. Aside from being picked up for shoplifting a few times, Sam has not had any other legal issues, and those records were sealed when she was eighteen. Upon graduating, Sam received a job offer at Osceola Regional Medical center where she has remained employed for the last four years. Sam’s mother passed away a year prior to her beginning to abuse opioids, and when she passed Sam became very depressed along with feeling remorseful for what she put her mother through when she was a teenager. Instead of seeking out someone, such as a therapist to help her deal with the loss of her mother she started taking a low dose of opioids because for her It numbed the pain of losing her mother. Her addiction spiraled out of control a month before her job confronted her. A group type that may be beneficial for Sam and the situation she is in would be group psychotherapy. This type of therapy is used to help individuals reeducate themselves when it comes to their conscious and unconscious thoughts which include past and present (Corey, 2016). This type of group would be most beneficial to Sam and this is because upon first review of her case study the issues being seen began with her late teens, and only recently came up after her mother’s death. This type of therapy will help her to find ways that will help her to address both and find ways to cope that do not involve drug use.
Individual Assessment and Treatment Reccomendations
When partaking in group therapy it is important to look at an individual’s progress as they move through the group. Assessment tools are used in a multitude of situations for different reasons, such as gaining employment, mental disabilities, and delays, psychological disorders, drug and alcohol abuse disorders, etc. Assessments are versatile which is what makes them a useful tool with unlimited possibilities when it comes to diagnosing and formulating treatment plans which suit individual’s needs to aid in their therapy and rehabilitation. Due to the severity of Sam’s employment situation, her employers would like to know if her therapy and/or group therapy is helping her to make progress. This is important due to the severity of her mistake in giving a patient the wrong medication which led to a severe allergic reaction which could have resulted in death. The good thing is that her co-worker reacted quickly to ensure that they were able to get the allergic reaction under control and avoid any fatal outcome for the patient. If her employer is not able to be informed of her progress while in therapy then they will be unable to trust putting her back into her position as head nurse, and it could even lead to her losing her licensure. The type of individual assessment which would be most beneficial in Sam’s case would be a self-assessment tool, such as evaluating oneself on a weekly basis throughout the duration of the group and turning it into a licensed therapist approved by the hospital. According to the DSM-5 study guide, opioid addiction has become more of an issue due to the non-medical things it has been used for, such as pain, but this is not always the case as in a lot of these cases they are prescribed (Roberts & Louie, 2015).
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In Sam’s case, a treatment plan needs to be put in place so that her progress can be tracked and ongoing recommendations can be made. Sam will first see a psychotherapist for an initial interview to see if there are any additional diagnoses that need to be addressed when treatment is recommended. The first recommendation, in this case, would be that Sam is put into a medical detox so that her system can be cleared of the opioids, and so she can be monitored to ensure that there are no adverse effects due to the withdrawal. During this process, medication is sometimes used to aid in the detox. One study showed that buprenorphine paired with clonidine when combined can ease the effects of withdrawal but watching the dosage is important (Jain, Chavan, Sidana & Das, 2018). Once she has completed the detox process a recommendation for group therapy will be made, as well as a recommendation for continued support upon completion of the program. Continued support will be essential for Sam as there is always the chance that her negative feelings could come back which would then open up the opportunity to relapse and use again.
Common Problems Among the Group Dynamic
Depending on the type of group that Sam is placed in she could have trouble with the initial stage which is where the group is established and rules for the group are put into place (Corey, 2016). If she arrives and the group has already been in session for a few weeks she may feel out of place, and like everyone else has already gotten the chance to get to know each other, and in return this could leave her feeling alone. To address this issue as the leader of Sam’s group I would place her with another group member so that she may become accustomed to how everything works and the rules. In the event that Sam was to enter the group once it has already begun her transitional phase in the group may also be problematic as often in this phase participants often feel anxious as they do not feel as if they belong or anyone understands them (Corey, 2016). Being that Sam does not know at what point she will be entering the group and may already be having negative feelings this could make her mental state worse. I would address the possible issues at this stage by saving a portion of the time at the end of each meeting time to address these feelings of the group members so that it can be ensured that they are feeling heard (Corey, 2016). In the working stage, Sam may find issues wanting to participate if she feels attacked by another group member for her views; if this were to happen she could become withdrawn. As the group leader, I would address this by making a rule about becoming verbally abusive and violent when in session, and if this were to happen not allow the person doing these things to return to the group (Corey, 2016). The issue with a person like thin being in the group is that seeing this kind of behavior could make others afraid to share as well which would make the group more counterproductive than anything. The final stage of the group is where participants learn how to apply what they have learned in the group to their everyday life, and this could be problematic if a participant were to have feelings of doubt when the group comes to an end (Corey, 2016). As the leader of the group, I would bring up the idea of a continued support group so that my clients understand that they can still receive help on their own.
Strengths and Challenges
Running psychotherapy groups brings about many strengths and challenges within the group dynamic. A few strengths to running this kind of group includes but is not limited to bringing people together who share a common issue so that they can heal with the help of others, teaching them how to deal with issues in their everyday life without the use of substances, and teaching them how to utilize resources to prevent relapse once the group sessions have come to an end. A few challenges that may arise would be even though they have been placed in a group setting they still feel as if no one understands them, their everyday life declines as opposed to improving, and they are unable to get through the final stage of treatment and fall back into abusing substances. For Sam, I would ask her permission to work with her individual therapist so that when in those sessions any fears that she may have could be rationalized and help her within the group session. To effectively treat her she will need ongoing care which if given permission will be discussed with her counselor. During the group any and all issues with be dealt with immediately so she is not feeling confused or as if there is something wrong with her.
Group therapy can be successful if implemented properly and the participants are not misplaced into the wrong group setting. For Sam it is more complicated because of her past, therefore a treatment plan which will include group therapy needs to be designed to meet her specific needs. Dealing with the loss of her mother seems to have been her breaking point and this needs to be addressed separately from her addiction. It seems as if she may be dealing with a co-occurring disorder which could also make her treatment more complicated. By reviewing Sam’s case study, providing a group recommendation, completing an individual assessment, problems that could arise among the group and/or within the group dynamic, and the strengths and challenges when it comes to leading a group it can be better understood how groups work. Groups may seem complex but they can also be effective in the treating of patients when they are placed into the right kind of group.
- Corey, G. (2016). Theory & practice of group counseling (Ninth Edition). Boston, MA: Cengage Learning.
- Jain, N., Chavan, B., Sidana, A., & Das, S. (2018). Efficacy of buprenorphine and clonidine in opioid detoxification: A hospital-based study. Indian Journal of Psychiatry, 60(3), 292–299.
- Roberts, L. W., & Louie, A. K. (2015). Study Guide to DSM-5® (Vol. First edition). Washington, DC: American Psychiatric Association Publishing.