Group Therapy for Health Care Workers

 

Type of Group

The group is a support community for health care workers, who have suffered the loss of a loved one (a family member, a friend, etc.) due to coronavirus. A lot of medical professionals have experienced exposure to high levels of death, which might have affected their families as well. Health care providers, who have lost someone during the Covid pandemic, need to have a strong support system to help them generate healthy mental health responses to death and dying. The purpose of the support group described in this paper is to enable medical professionals to deal with grief most safely. This small group organized by me functions as a community of people, who can relate to each other. It promotes the basics of self-care, encourages the use of coping strategies, fosters a sense of connection between members, and enables stress reduction and social support.

The group consists of six members (me as the leader):

  • Medical director – label P1
  • Director of nursing – P2
  • Nurses (at the facility, where I work) – P3
  • An emergency room nurse – P4

Two nurse practitioners from nursing homes – P5 and P6. The number of members dictates the size of the group, with the one described in this paper being rather small. On the one hand, it allows each member to be heard, while, on the other hand, the group sacrificed diversity and different perspectives associated with bigger gatherings. It is a closed environment, which means that rather than being an open group that allows members to join at any time, this group has accepted all six members at once. This helped to avoid readjustment for new members and organizational issues, as well as aided in creating a safe space only a limited number of people can count on. The group met three times during the week: once throughout the weekdays (Friday evening), and twice on the weekend (Saturday and Sunday afternoons). Having the majority of sessions on the weekend enabled the group to be more accessible. In addition, it is important to note that the sessions on Saturdays and Sundays were conducted through Zoom meetings. Thus, the support group presented in this paper functioned using a hybrid approach by combining real-life interactions with web-based therapy.

Criteria for Member Selection

As for the criteria utilized to select members for the group, people needed to join voluntarily. Grief is a touchy subject for everyone, which is why all the group members needed to be comfortable enough to share their experiences. Voluntary participation in the sessions enabled the participants to feel a sense of belonging and mutual understanding since everyone joined the support group with the same goal. There were six sessions in total, a minimum of three of which health care workers had to attend to remain in the group. Another important requirement was that all the members had to be medical professionals, who were personally affected by Covid due to the loss of a loved one. The group did not include people outside the medical field.

Contract for the Group and Members’ Expectations

The contract for the group included three sections, each one designed specifically to facilitate the most appropriate conditions for all the participants. The first section deals with attendance, which is exceptionally important in psychotherapy treatment. Attendance and regularity are some of the most credible predictors of treatment outcomes. Therefore, the group contract had an extensive section allocated to attendance and active participation.

Attendance
  • You are expected to attend the group sessions three times a week, including one on Friday evening and two online Zoom meetings on the weekend. It is important that to be on time to avoid any disturbances. If you cannot attend the session, you should notify the office of your absence.
  • All members agree to work together on expressing their feelings and concerns. Active participation will be encouraged for everyone to get maximum results from therapeutic meetings.
  • Regardless of the reasons for absence, all meetings will be charged for. You may request an exception if your work/life issues may lead to a prolonged absence of 4 weeks or more.
Procedure
  • You should express your feelings honestly and take responsibility for your openness. Feelings of anger, sexuality, and others deserve special attention since they are so rarely discussed.
  • Interactions between two or more members of the group outside the central discussion are important to the process. Therefore, any such interaction will be considered group business to be examined during the meetings. You should use the relationships formed in the group setting therapeutically, and not socially.
  • The use of drugs, mind-bending substances, and alcohol is prohibited because it may interfere with the discussion.
  • All of the information shared throughout the sessions is highly confidential.
Termination
  • You should plan your termination. At the start of the sessions, all members agree to remain in the group until their issues are resolved. Leaving the program is the process that will affect other members, which is why your departure has to be coordinated and discussed in detail.

As for the members’ expectations, they may vary from case to case even though the core outcomes one might expect remain the same. For example, participants usually expect that everything discussed throughout the sessions remains confidential and does not leave the room (or Zoom meeting). People also assume that therapy is a safe space, where no one is going to judge or belittle one another. Another important expectation is autonomy: every person wants to have the freedom to leave the meeting, refuse to discuss certain subjects, or terminate their therapy program. In terms of the expectations of the members specific to the group, there are various outcomes participants wanted to achieve when joining the group. Firstly, they expected to learn the techniques to cope with their grief. Secondly, they needed to find people, who share their struggle, as a source of reassurance. Lastly, members are expected to lower the levels of their distress and ‘go back to normal’ once again.

Boundaries

The majority of the boundaries established for the group are mentioned in the contract, including termination and procedure limitations. However, it is important to note that the time boundaries for the group include the three-day window of their meetings. Space limitations include the institutional (a hospital) and actual physical settings (a conference room or home) of the therapeutic interactions. In terms of role boundaries, all members of the group are equal in their ‘functions’ and abilities.

Process and Content

To examine the effectiveness of the group, it is essential to determine its content and process. According to Puskar et al. (2012), content refers to “the spoken words, the issues discussed, and the arguments that arise during each discussion” (p. 226). The content of the group included discussions about the stages of grief, arguments related to coping mechanisms, as well as conversations surrounding the pandemic and its impact. Every member of the group was encouraged to express their feelings regarding the loss of a loved one due to the pandemic. There were also instances, where the focus shifted to the effects of grief on the participants’ practice as health care workers. In terms of process, it is important to consider that the group setting makes it harder to examine the interpersonal relationships between the members (Gren, Torkar, & Feldt, 2017). The process of the group facilitated the necessary conditions for the members to find support and understanding in each other. The relationship between the participants was not necessarily friends, but something more specific to the shared trauma they have experienced. The members formed bonds with each other by openly communicating their fears, emotions, and concerns.

Stages of Group Theory: Concepts in Practice

The first stage of group development theory is forming, which implies the members learning about each other and the objectives of the sessions. This period was characterized by uninvolvement from two of the six group members due to them being uncomfortable with sharing their feelings and emotions. In addition, Manges et al. (2016) argue that the forming stage can include low morale and hostility even though such issues did not affect our group. Storming is the second stage of group development, which often translates into conflicts and confrontations within the group. Grief and coping with death is an extremely sensitive personal challenge, which explains why some participants have felt misunderstood and angry (Kealy et al., 2018).

Norming, also known as stage no. 3, refers to group members establishing a set of rules regulating their interaction. The main problem during this phase was to re-clarify the objectives of the group by prioritizing the interests of the community over individual ones (Kealy et al., 2018). The second to last stage is performing, which is the current stage of the group. Members are actively participating in discussions and arguments in order to find creative and original solutions to their shared problem and a multitude of symptoms associated with it. The most engaging factor of this stage is the diversity of perspectives within the group, which allows everyone to learn from each other (Kağnıcı, Cihangir Çankaya, & Burcu, 2018). The group development identifies adjourning as the last stage, which implies disbandment.

Possible Changes

All in all, the group was cohesive, which is why it is safe to assume that its creation was a success. The implementation of the mixed design of the group sessions (both offline and online discussions) minimized the absences and made the support group more accessible. According to McCoy (2017), employing a hybrid approach to group interactions helps to pave an innovative and successful path in achieving its objectives. However, if some changes had to be made, as a leader, I would put more effort into ‘setting the stage’ during the forming phase. The objectives and purpose of the support group were not clearly defined, which resulted in the members being confused about the content of their interactions. Moreover, I would be more assertive during the second stage to act as an authority figure to manage arguments and conflicts among the participants.

Seating Arrangements

When it comes to seating arrangements, the meetings were held in the conference room. There was a table in the center of the room, with three chairs on each side of it. This seating allowed members to communicate efficiently and remain in relative proximity to each other. Since the group had a small size, no elaborate seating charts were created. In Zoom meetings, the arrangement of participants’ screens was random, which did not interfere with the quality of the discussions. Web-based sessions required turned-on cameras and microphones to ensure active participation.

Seating Arrangements

References

Gren, L., Torkar, R., & Feldt, R. (2017). Group development and group maturity when building agile teams: A qualitative and quantitative investigation at eight large companies. Journal of Systems and Software, 124, 104–119.

Kağnıcı, D. Y., Cihangir Çankaya, Z., & Pamukçu, B. (2018). A cultural glance to developmental stages in group counseling. Turkish Psychological Counseling and Guidance Journal, 8(49). Web.

Kealy, D., Piper, W. E., Ogrodniczuk, J. S., Joyce, A. S., & Weideman, R. (2018). Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief. Clinical Psychology & Psychotherapy, 36(2), 241-251.

McCoy, K. T. (2017). Achieving full scope of practice readiness using evidence for psychotherapy teaching in web and hybrid approaches in psychiatric mental health advanced practice nursing education. Perspectives in Psychiatric Care, 54(1), 74–83.

Manges, K., Scott-Cawiezell, J., & Ward, M. M. (2016). Maximizing team performance: The critical role of the nurse leader. Nursing Forum, 52(1), 21–29.

Puskar, K. R., Mazza, G., Slivka, C., Westcott, M., Campbell, F., & Giannone McFadden, T. (2012). Understanding content and process: Guidelines for group leaders. Perspectives in Psychiatric Care, 48(4), 225–229.

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