Group Process

A patient has just come home from the hospital following treatment for major depression in a psychiatric unit after a radical mastectomy. She states:

I can't stand it in my home. Three nephews are there and there is a tent in the living room with two dogs and three cats. My cousin is there too and they have to move and we are waiting for checks to come in.

TH: Can you share with us why you are allowing this?

PT: They are my family. I can't tell them it is too much for me.

Multiple questions are then asked by other group members. My focus is toward the inability, of the patient, to assert herself and get her needs met. Some questions that could be asked:

• Are you able to speak up in other situations?

• What do you think would happen if you asserted yourself?

• As a child were you encouraged to speak up?

• Who in your family system encouraged you to assert yourself?

• What did your mother/father say if you spoke up?

• Did your family system value assertiveness or see it as selfish?

The Ability to Verbalize One's Needs Clearly in a Geriatric Population 235

Various group members support the patient and her need to be able to assert herself.

Inquire into the consequences of assertiveness and role-play:

• Will you feel good, bad, kind, unkind and to whom-yourself or others?

Role-playing is done in the group with further exploration and explanation of feelings with the patient playing both sides in order to determine if the patient is projecting her personality onto others. This could be one of the inhibitory factors for the patient not disclosing to others how she is feeling. She may believe that on hearing what she feels, the other person would experience the same narcissistic injury the patient would experience if someone said that to her.

The discussion, after role-playing, considers how it feels to speak up, emphasizing self-love, self-care, appropriate assertiveness, and communication skills.

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