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Introduction
Corey (2015) identifies the working stage of group development as a later phase that is characterized by its productivity; in Pessagnos (2013) classification, a similar term is the performing stage. While this phase may be less challenging than the previous ones, it is also the most important one since most of the progress occurs during it. In this paper, the stages concept will be applied to a psychoeducational group for depression. The key characteristics of the stage will be explained to ensure its future identification, and a shortlist of potential interventions will be discussed to provide a rough plan for its processes. Finally, one of Coreys (2015) therapeutic factors will be applied to it. This paper will describe the plans for stage-related activities and demonstrate that their role in the groups progress is crucial.
Identifying the Characteristics of the Working Phase/Stage
As established by Corey (2015), the lines between stages in practice are not very well-defined. As a result, it is necessary to recognize the signs of the working stage to exploit its benefits. Since this stage follows the conflict management of storming and transitioning, the working phase usually involves improved cohesion (which refers to inclusiveness, solidarity, and trust) and more active, intensive interaction within the group.
According to Corey (2015), these factors can greatly facilitate progress. Furthermore, the members can be expected to become more committed to group activities, including homework tasks, and more autonomous and capable of managing themselves (Corey, 2015; Pessagno, 2013). As a result, it may become easier to manage the group; conflicts and problem behaviors should grow less frequently.
In addition, a greater awareness of ones own goals and expectations, as well as the groups ability in helping to achieve them, should be exhibited. Members are more likely to take responsibility and risks and express their opinions during this stage. Finally, the results of the activities aimed at improving the participants ability to engage in meaningful interactions should also be visible; the participants can be expected to become more effective in listening to others and expressing themselves. To summarize, this stage is defined by the members learning to understand and trust each other, the group, and their ability to achieve improvements.
It can only occur after the appropriate management of the previous stages, and it is necessary for any significant progress. A group leader will be able to exploit the opportunities of this stage upon noticing the above-described signs.
Interventions for the Working Phase/Stage
Since the working stage is focused on helping participants in achieving their aims, the interventions implemented throughout it should be considered. The proposed group is a psychoeducational one, and it will also use the principles of cognitive-behavioral therapy (CBT), which defines the types of interventions that will be employed. Two quantitative studies have been retrieved; they demonstrate the effectiveness of CBT-based psychoeducation in improving the condition of people with depression of different severity (Tanoue et al., 2018; Tong et al., 2019). In this section, they will be used for guidance as well.
The working stage is supposed to constitute the bulk of the groups sessions. Two or three sessions are meant for the previous phases, and a couple of sessions will be required for finalizing the group processes. Therefore, at least seven sessions (out of twelve) will consist of the working stage. The primary objectives of the group are to enhance the participants understanding of depression, ensure their treatment adherence, reduce their feeling of stigma, and teach them to identify and manage moods, core beliefs, and automatic thoughts. The overarching aim is to equip them with the tools meant for the management of their condition.
The first and second objectives will be achieved mostly through a direct conversation about major depressive disorder, which will involve members sharing their experiences. This activity should also help the participants to understand that they have similar struggles, assisting them in achieving the third objective as well. This intervention will be performed early, which is why it might first happen before the working stage is fully in progress, but it is likely to be a recurrent one.
Based on the recommendation by Tong et al. (2019), stigma should also be discussed with an analysis of its causes and side effects. Similarly, Tong et al. (2019) presented a session plan which addressed treatment compliance and self-management and proposed strategies for their improvement. The strategies should be tailored to the problems that the participants identify in complying with their treatment. These interventions are directly connected to the proposed groups objectives, and they will be implemented as well.
Finally, to achieve the objective of managing moods and unhelpful automatic thoughts, the approach of recording them will be used. Self-reflection and problem-solving skills will be taught in the process; problem-solving will also be directly applied to the participants goals, treatment plans, and post-group action plans. This solution will be used because it was tested by Tanoue et al. (2018). Thus, following the psychoeducation nature of the group (Mills & McBride, 2016), the leader will provide information, strategies, and tools for the management of the participants problems. Also, under the CBT approach (Corey, 2015), those tools will focus on the participants behavioral and thought patterns.
Since the phases are not very clearly delineated, the activities of the previous stages may still be applicable during this one. For example, cohesion-building and team-building activities may be required. To be more specific, it will be necessary to ensure the groups understanding of the rules, manage any conflicts and challenging behaviors, and encourage self-reflection and disclosure. However, the primary goal of this stage is progress, and it is achieved by introducing interventions aimed at it. The group will be flexible and propose solutions depending on the members needs, but its general objectives and intervention strategies have been presented here.
Therapeutic Factors and the Working Phase/Stage
Of the many factors described by Corey (2015), cognitive restructuring might be the most important one to address in a CBT group. Corey (2015) provides a discussion of CBT, in which it is demonstrated that CBT focuses on cognitive restructuring to a large extent. This term refers to a critical approach to ones thoughts and beliefs that is aimed at identifying negative, harmful patterns and reflecting on them to correct them.
In the proposed group, it will be predominantly expressed in the activities that are aimed at examining and challenging core beliefs and automatic thoughts. It will also be associated with self-reflection and problem-solving activities. As a significant aspect of the groups interventions, this therapeutic factor will be employed rather extensively; the application of the rest of the factors to planning for varied activities may also be helpful to the leader.
Conclusion
The working stage is a vital and rather large part of the proposed groups activities. It will be defined by trust and productivity, and the leader will be required to recognize its signs to employ its improved awareness and cohesion to the benefit of the members. The key interventions of the group that are aimed at achieving its objectives will be introduced during this stage. A crucial therapeutic factor will be cognitive restricting, which will be reflected in the exercises aimed at correcting negative automatic thoughts.
References
Corey, G. (2015). Theory and practice of group counseling (9th ed.). Belmont, CA: Thomson Brooks/Cole.
Mills, B., & McBride, D. L. (2016). What is group process? Integrating process work into psychoeducational groups. Georgia School Counselors Association Journal, 23, 16-24. Web.
Pessagno, R. (2013). Group therapy. In K. Wheeler (Ed.), Psychotherapy for the Advanced Practice Psychiatric Nurse (pp. 407-420). New York, NY: Springer.
Tanoue, H., Yoshinaga, N., Kato, S., Naono-Nagatomo, K., Ishida, Y., & Shiraishi, Y. (2018). Nurse-led group cognitive behavioral therapy for major depressive disorder among adults in Japan: A preliminary single-group study. International Journal of Nursing Sciences, 5(3), 218-222. Web.
Tong, P., Bu, P., Yang, Y., Dong, L., Sun, T., & Shi, Y. (2019). Group cognitive behavioural therapy can reduce stigma and improve treatment compliance in major depressive disorder patients. Early Intervention in Psychiatry, 2019, 1-7. Web.
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