NRNP 6645 WEEK 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

NRNP 6645 WEEK 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

NRNP 6645 WEEK 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

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There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

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To prepare:

Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.
By Day 3
Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

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Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Cognitive Behavioral Therapy (CBT) is a structured, instructive, and goal-oriented type of psychotherapy. It is the first type of psychotherapy mostly recognized as evidence-based in a majority of clinical guidelines (das Nair, 2018). It has been modified and researched for implementation in children, adolescents, adults, couples, and families. CBT has been established as an effective adjunctive therapy to pharmacotherapy for severe mental conditions including schizophrenia and bipolar disorder (das Nair, 2018). It has an assumption that psychiatric disorders and psychological distress are upheld by cognitive factors. The purpose of this assignment is to explore how the implementation of CBT in group therapy compares to family or individual therapy and the challenges PMHNPs may come across when implementing CBT in these settings.

CBT in Group versus Family/Individual Settings

Similarities   

CBT in group settings is similar to family and individual therapy in the approach used by the therapist. The therapist uses a hands-on and practical approach in both group and individual settings. The therapist works collaboratively with the client to modify the clients’ thinking and behavior patterns to bring a positive change in the clients’ mood and lifestyle (Fawcett et al., 2020). In addition, the therapist trains clients in both settings to recognize distortions in how they think, which primarily cause psychological distress. The therapist also trains the clients to reassess the identified distortions bearing in mind the reality of their situation.  

           Clients in both group and individual/family therapy go through problem-solving training to equip them with skills to cope with day-to-day challenges. For instance, the therapist conducting group therapy guides every member to assess how their thinking patterns could be impacting their behavior and psychological wellbeing (Fawcett et al., 2020). In family and individual therapy, the therapist has a one-on-one conversation with the client and guides them to identify their distorted thinking patterns. Furthermore, the therapist collaborates with clients in both group and individual/family settings to help them understand their identified challenges and create a plan to address them (Karsberg et al., 2021). The sessions begin with a brief update, and the therapist assesses the mood of the clients. The therapist then bridges the previous session to the current one to promote continuity. In addition, the therapist gives homework in both settings, which is reviewed at the beginning of the next session. 

Differences

           Group therapy differs from family/individual therapy in the aspect of context. The context of individual/family therapy is broad has a wide range, and the topic often diversifies to sensitive topics (Fawcett et al., 2020). Personal feelings are also discussed during one-on-one individual or family therapy. On the other hand, group therapy has a more specific context, and personal feelings are not usually discussed during group settings. It focuses on a specific topic, which relates to all clients, such as substance abuse, depression, gambling, and alcohol use disorder (Karsberg et al., 2021). In addition, the two therapies differ in the aspect of the type of client. Individual therapy has one client and one therapist, while group therapy has several clients with one or more therapists. The number of clients in group therapy range from a minimum of two to a maximum of 20 clients. In individual settings, the therapist focuses on the needs of a single client while in group settings the focus is on the unique needs of each client (Karsberg et al., 2021). As a result, the therapist has to assess the mood of every client in a group setting which is more challenging than when assessing a single client’s mood. 

Challenges PMHNPs Might Encounter When Using CBT in Group Settings

           The PMHNP might encounter challenges when implementing CBT in a group setting, including lack of full participation among all clients and compromised confidentiality. In a group setting, not all members might participate fully in the group therapy (Dilgul et al., 2018). The phenomenon, diffusion of responsibility occurs when people in groups do not put as much effort as they would in the individual setting (Dilgul et al., 2018). This is because an individual expects other group members to bear the weight for them. The PMHNP can put a lot of effort to create a supportive environment for all group members. However, the success of the therapy is determined by the readiness of all participants to participate in the process.

Confidentiality of clients’ information is at risk of compromise. People in group settings do not have the same degree of confidentiality about their problems as those in individual therapy (Doshi et al., 2019). Although members of the group are required to restrict themselves from discussing issues that arise in the group outside the group’s environment, the PMHNP has no assurance that they will uphold this. Besides, there are no ethical standards for clients to hold the group members to uphold confidentiality (Doshi et al., 2019). Consequently, the PMHNP must assess the participants’ understanding of the importance of confidentiality in group therapy. 

Conclusion

The basis of CBT is that maladaptive cognitions result in an individual experiencing behavioral problems and emotional distress. In both group and individual/family settings, the therapist uses a practical approach. The therapist trains clients to recognize distorted thinking patterns and equip them with problem-solving skills. Individual therapy is broad and addresses sensitive topics, while group therapy is specific to topics common among the participants. Besides, individual therapy has one client, while group therapy has more than one client. Challenges that the PMHNP may encounter in group settings include lack of full participation and compromised confidentiality.

References

das Nair, R. (2018). Effectiveness of cognitive-behavioural therapy: A protocol for an overview of systematic reviews and meta-analyses. http://dx.doi.org/10.1136/bmjopen-2018-025761

Dilgul, M., McNamee, P., Orfanos, S., Carr, C. E., & Priebe, S. (2018). Why do psychiatric patients attend or not attend treatment groups in the community: a qualitative study. PloS one, 13(12), e0208448. https://doi.org/10.1371/journal.pone.0208448

Doshi, P. V., Robak, R. W., Grffin, P. W., & Ward, A. W. (2019). Confidentiality in Counselor Experiential Training Groups: An Exploratory Study. Journal of Counseling Research and Practice, 5(1), 3. : https://egrove.olemiss.edu/jcrp/vol5/iss1/3

Fawcett, E., Neary, M., Ginsburg, R., & Cornish, P. (2020). Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study. Journal of American college health, 68(4), 430-437. https://doi.org/10.1080/07448481.2019.1577862

Karsberg, S. H., Pedersen, M. U., Hesse, M., Thylstrup, B., & Pedersen, M. M. (2021). Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial. BMC public health, 21(1), 1-9. https://doi.org/10.1186/s12889-021-10271-4