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Older adults present with various chronic illnesses that affect both their physical health and mental health. This means that as psychiatric and mental health nurse practitioners deal with older adults, group therapy may be an effective way of making sure that mental health services are accessible to this growing population. However, there are various factors which may make it difficult to provide effective mental and psychiatric health services to this patient population through group therapy. Taking note of such challenges and addressing them as early as possible during the initial stages of the group formation and processes is an important way of making sure that group therapy actually works for older adults.
The group therapy that shall be described here focused on a particular population of older patients. These are patients that are being rehabilitated due to complications associated with heart failure or those that have been diagnosed with congestive heart failure and other cardiovascular risks for heart failure. These patients were also diagnosed with depression and this is why the group therapy was started. Research has established that there is close relationship between heart failure and depression, in that the two conditions exacerbate each other in elderly patients (Liguori et al., 2018). Therefore, while the older patients were taking part in a cardiac rehabilitation program in the nursing home, the services of the therapist were procured to help them in dealing with depression and associated disturbances in order to improve their physical and mental health. This is why the group therapy was considered necessary.
After the formation of the group through the identification of the older patients that actually presented with depression, based on the geriatric depression scale as well as the DSM-5 criteria for major depressive disorder, the next session fell under the storming. This is the stage where power and control issues are established. It is also where differences can be seen before they actually lead to conflicts. Issues pertaining to hierarchy also come out in this stage (Malhotra & Baker, 2019). In this particular group, it was evident that since the members were living together in the nursing home, they had already developed hierarchies, associations and conflicts. Such issues however manifested themselves in a clear manner once they were put together in the group therapy. For instance, members started describing how a different resident made life hard for them in the nursing home because of various reasons. Others had the perception that a different resident simply did not like them because of how they looked at them. One member said that she felt uneasy and uncomfortable in the home and in the group because she felt like everyone else was avoiding her. All these issues were revealed during the storming stage and it was clear that the facilitator had so much on his hands when it comes to solving the conflicts.
Conflicts in a group therapy may prevent members of the group from being able to offer or receive the curative factors that come from being part of a group therapy. For example, low self esteem as was noted in one of the members from the description above can prevent the member from sharing her insight that may benefit the others. She may also be distracted with how others perceive her, hence preventing her from benefiting from what the rest have to say. In dealing with this issue, the facilitator ensured that an atmosphere of open communication was developed and that members of the group could freely discuss their fears and others were allowed to freely give their insight without judging or vilifying each other. This was effective especially because imparting of advice assigns power to the person being advised (Bonhote, Romano & Cornwell, 1999). The facilitator maximized on open communication to bring the best out of each member. However, more challenges are expected because of old age such as short attention span and the need to meet individual needs specific to each member due to their multiple chronic illnesses.
Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expression in a long-term older adult psychotherapy group. Issues in mental health nursing, 20(6), 603-617
Liguori, I., Russo, G., Curcio, F., Sasso, G., Della-Morte, D., Gargiulo, G., … & Testa, G. (2018). Depression and chronic heart failure in the elderly: an intriguing relationship. Journal of geriatric cardiology: JGC, 15(6), 451
Malhotra, A., & Baker, J. (2019). Group Therapy. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549812/
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