Introduction
Reflection on past experiences provides one with an opportunity to see what was done correctly and what could be changed to avoid mistakes in the future. In the sphere of healthcare, professionals are not free from making mistakes or experiencing challenging situations (Vuckovic et al., 2021). Caring for a person’s health presents many ethical issues and questions on a regular basis. Therefore, it is vital for one to step back and see whether one’s actions are helping or impeding the patient’s recovery (Aziz et al., 2020). The present reflection reviews a critical incident from my past experiences working in community mental health centers.
The paper utilizes Gibbs’ Reflective Cycle as a way of approaching and analyzing the issue. Then, it introduces evidence from practice and theory, discusses decision-making errors, and presents leadership and management practices used during the event. This reflection provides an inside view of an incident related to group therapy and intimate partner violence perpetrators’ behavior and investigates how a community mental health worker can address interpersonal conflicts in care.
Reflection Model: Gibb’s Reflective Cycle
The selected approach for this paper is Gibbs’ Reflective Cycle. It is one of the widely used models for investigating past experiences, and it was developed in the 1980s by Graham Gibbs (University of Edinburgh, 2020). The framework consists of six stages, each describing one part of an incident and moving toward its resolution and improvement (Markkanen et al., 2020). For example, the first step is a case description, where one offers facts about the event without further investigation into the deeper meaning behind each element. The following stages focus on emotions, outcomes, skills, and other factors contributing to the result (Steven et al., 2020). This model was chosen because its multiple steps require one to think about the critical incident from several viewpoints, providing much material for examination.
Stage One: Description
The following event happened when I was assisting as a community mental health worker. While I usually oversaw users and worked with them to perform medical and psychological assessments, I was asked to participate in a short set of group therapy sessions for intimate partner violence perpetrators. This type of session was relatively new for the center, as it did not previously have a group therapy offering for users with part experiences of violence perpetration. However, as one of the workers, I oversaw sessions and guided communication between the group members without interfering with their dialogue unless required.
My duties differed from a therapist invited to lead sessions, as I was tasked with collecting information on whether such a practice was appropriate for the facility and how it affected service users’ behavior. It should be noted that the users also attended individual therapy sessions with their own practitioners. Moreover, the group therapy initiative was created based on available scholarship covering the benefits of this approach for perpetrators (Black, 2017; Karakurt et al., 2019; Nesset et al., 2019; Stephens-Lewis et al., 2021). Thus, the group sessions were held in the community mental health center with the help of several professionals and myself.
During the beginning sessions, I encountered a combative individual who reacted aggressively to other group members and often engaged in verbal violence. While such emotions as anger and frustration are common in these settings, this person’s behavior differed from his peers’ significantly. It discouraged many participants from attending or voicing their opinions in the conversation. As a worker with limited experience observing such therapy sessions, I did not engage with this behavior. I did not question the leading phycologist’s choice not to interfere with the conflict. However, the outcome of one incident was that the aggressive service user and another attendant became physically violent toward one another and had to be stopped from escalating the conflict. This behavior was against the facility’s rules, and both men were removed from the session and excluded from further meetings. I believe that my actions could have prevented this incident and improved group therapy in that case.
Stage Two: Feelings
The experience was new to me, as I had never dealt with verbal violence in a group setting before. During the meetings, I felt confused as to why nothing was done to manage the users’ anger or to direct it in another direction. When the fight started, I was feeling scared for the health and safety of everyone involved, including myself. As the men became physically violent after several sessions of verbal abuse, I also felt a sense of relief as the tension between them finally escalated to a different level. However, this relief was based not on positive emotions of resolution but on an expectation of conflict worsening and stress related to these sessions.
After the fight was stopped, I felt guilty for not stepping in and discussing the therapist’s approach to interacting with the service users. I think he was unprepared for a physical altercation, was frustrated about the outcome, and was afraid for people’s safety. The service users also likely experienced fear, anger, and discouragement, as they were not protected from the risk of physical violence in group therapy. They may now assume that group therapy is ineffective in solving their issues. While I also engaged with that thought at the moment of the incident, I now believe that it was a missed opportunity for improving group therapy and taking action to prevent such escalation in the future.
Stage Three: Evaluation
The positive result of this incident was that the community mental health facility gained more experience leading group therapy sessions. The center established new guidelines against verbal and physical violence and paid more attention to research surrounding these practices. Some service users did not stop attending and reflected upon the fight to see how violence affected their lives. However, the two involved men stopped attending the mental health center, and their care was stopped abruptly, which put several individuals in danger of continuing violence and abuse.
My contribution to the event was minimal, as I did not speak out about the main therapist’s behavior in time to prevent this conflict. This behavior can be viewed as a negative influence because I did not engage in eliminating risks when they were potentially preventable. The same can be said about the therapist who chose not to stop or engage service users before they became physically violent. These men contributed by supporting the conflict and choosing to fight during the session. Some participants tried to de-escalate the verbal violence and stop the fight.
Stage Four: Analysis
Dealing with group therapy interactions and conflicts is challenging because participants have to express their feelings. Black (2017) explains that verbal abuse can be permitted in this treatment as it helps service users engage with their emotions and deal with anger that is often not released to the world. Therefore, it is recommended that some degree of using harmful and aggressive language is allowed. However, Marmarosh (2021), Novotney (2019), and Barrett-Ibarria (2019) also note that it is vital to establish clear boundaries for what is permissible in the therapy setting and what is considered verbal abuse to the point where it should be stopped. Furthermore, these works emphasize that therapy users should be aware of physical violence being forbidden during sessions.
The present incident ended poorly because these rules were not transparently stated and enforced during the meetings. The instigating man was not stopped by any responsible party, thus inciting aggression from the other participant or eliciting fear and negative responses from service users. I believe that I did not engage with this behavior in time, discussing this approach with the therapist and bringing this issue for further discussion, which led to the escalation of the conflict. The professional also did not foresee the fight as a possible outcome or minimize its negative impact on the group.
While the roles of the leading therapist and mine differed, we acted as medical professionals who exercised their authority and should have prevented the conflict from becoming physical. The theory suggests that such aggression is common in group therapy, which should have guided my analysis during the events. Furthermore, another risk factor was the problem being addressed – intimate partner violence. Studies show that perpetrators of violence in relationships experience a challenging relationship with authority and anger, comparing their urge to hurt someone to an addiction (Arvidsson & Caman, 2022). Furthermore, their aggressive responses are likely tied to their use of violence as a tool for establishing control (Bahji & Altomare, 2020). The scholarship should have been examined better to deal with the conflict.
The right decision could have been contacting the therapist about interfering with the discussion more actively and stopping the man from instigating conflict. Black (2017) provides an example where the therapist prevents escalation by interrupting a violent conversation and confronting the instigator about his language and emotional outburst. This technique puts harmful words into perspective and allows the group members to see the meaning behind such phrases. As a result, verbal abuse turns from a tactic that persecutors often use into a topic of discussion (Weinberg, 2019). By engaging more actively and stepping in, the therapist brought attention to reflection and analysis and lowered the risk of further harmful dialogue. The same approach could have been taken during the session. My reliance on the main professional as a source of authority stopped me from acting during the meeting or suggesting this method to the therapist. I also feared participating in such aggressive communication as I was unsure of the outcome.
During this situation, I used a delegation leadership style, giving the authority to the leading therapist and group members to resolve their incident independently. While this management approach may be effective in other circumstances, this conflict required additional interference and active interaction with other individuals (Pina et al., 2021; Scanlon & Piersol, 2021; Wuryani et al., 2021). Transformational leadership that emphasizes people’s strengths and encourages them to solve problems could be more appropriate in such cases because it statistically positively impacts one’s cooperation and performance (Nielsen & Taris, 2019; Purwanto et al., 2020).
In contrast, the selected leadership style impeded successful problem resolution and did not result in safe nursing practice. A factor that could have led to different results is participation – a different management strategy that requires one to take an active position in the process (Wuryani et al., 2021). This approach would be more beneficial for the situation as it would guide service users toward conflict resolution rather than uncontrolled escalation.
Stage Five: Conclusion
From this situation, I learned that not taking action in time can lead to negative consequences and endanger the safety of service users. As a result of the conflict, two potential group members stopped attending group sessions, which likely influenced their ability to face being the perpetrators of violence. I also understood that doubts and concerns should be voiced to prevent potential dangers. It is unknown whether the conflict could have been stopped if I discussed it with the therapist or brought it up during the meeting. Nevertheless, it is clear that the lack of interference from the staff, including myself, influenced the fight.
The event could end differently if I had taken steps to prevent escalation and encouraged the instigators to face their emotions through words and self-reflection rather than aggression. To handle such situations, I need to develop leadership and management skills. Furthermore, I must work on interpersonal communication and conflict resolution to understand how to diffuse tension and help service users express themselves safely (Black, 2017; Weinberg, 2019). I could have discussed this issue with the group members and other facility staff to assess the risks and consequences of this conflict (Arvidsson & Caman, 2022). In this case, communication with professionals and service users is vital to finding the roots of the problem and resolving the issue at its core.
Stage Six: Action Plan
Based on the reflection and the available theoretical and practical knowledge, I would approach similar situations differently in the future. If I had to participate in group therapy sessions again, I would consider the topics the participants wanted to discuss and pay attention to how they express their negative emotions. Then, I would develop and transparently explain the boundaries that separate language allowed during meetings. For example, the rules may permit service users to voice their anger freely and express their opinion openly but only through words, never engaging in physical violence. Furthermore, I will research literature and attend courses to develop my leadership and communication skills to ensure that I am more prepared to act in the future.
Conclusion
Reflecting on a critical incident in my practice has allowed me to see the issues leading to the conflict and how to avoid such situations in the future. The chosen model – Gibbs’ Reflective Cycle – has six stages, each offering a unique perspective on the case. The conflict that arose during two group therapy attendants could have been de-escalated if I had engaged with the therapist or service users directly, focusing on their emotional responses and inviting them to reflect on their behavior. To avoid such problems in the future, I will pay more attention to preparation, review practice standards, and improve my communication skills.
References
Arvidsson, M., & Caman, S. (2022). Treatment experiences among intimate partner violence perpetrators: A qualitative analysis. International Journal of Offender Therapy and Comparative Criminology, 1-18. Web.
Aziz, A., Mahboob, U., & Saleem, T. (2020). Benefits of reflective writing in health care through the vivid lens of house officers. MedEdPublish, 9(60), 1-11. Web.
Bahji, A., & Altomare, J. (2020). Prevalence of intimidation, harassment, and discrimination among resident physicians: a systematic review and meta-analysis. Canadian Medical Education Journal, 11(1), e97-e123. Web.
Barrett-Ibarria, S. (2019). The problem with group therapy. The Outline. Web.
Black, A. E. (2017). On attacking and being attacked in group psychotherapy. International Journal of Group Psychotherapy, 67(3), 291-313. Web.
Karakurt, G., Koç, E., Çetinsaya, E. E., Ayluçtarhan, Z., & Bolen, S. (2019). Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence. Neuroscience & Biobehavioral Reviews, 105, 220-230. Web.
Markkanen, P., Välimäki, M., Anttila, M., & Kuuskorpi, M. (2020). A reflective cycle: Understanding challenging situations in a school setting. Educational Research, 62(1), 46-62. Web.
Marmarosh, C. L. (2021). Ruptures and repairs in group psychotherapy: Introduction to the special issue. Group Dynamics: Theory, Research, and Practice, 25(1), 1–12. Web.
Nesset, M. B., Lara-Cabrera, M. L., Dalsbø, T. K., Pedersen, S. A., Bjørngaard, J. H., & Palmstierna, T. (2019). Cognitive behavioural group therapy for male perpetrators of intimate partner violence: a systematic review. BMC Psychiatry, 19(1), 1-13. Web.
Nielsen, K., & Taris, T. W. (2019). Leading well: Challenges to researching leadership in occupational health psychology – and some ways forward. Work & Stress, 33(2), 107-118. Web.
Novotney, A. (2019). Keys to great group therapy. Monitor on Psychology, 50(4), 66. Web.
Pina, D., López-Ros, P., Luna-Maldonado, A., Luna Ruiz-Caballero, A., Llor-Esteban, B., Ruiz-Hernández, J. A., García-Jiménez, J. J., Puente-López, E., & Martínez-Jarreta, B. (2021). Users’ perception of violence and conflicts with professionals in Primary Care centers before and during COVID-19. A qualitative study. Frontiers in Public Health, 9. Web.
Purwanto, A., Bernarto, I., Asbari, M., Wijayanti, L. M., & Hyun, C. C. (2020). Effect of transformational and transactional leadership style on public health centre performance. Journal of Research in Business, Economics, and Education, 2(1), 304-314.
Scanlon, E., & Piersol, C. V. (2021). Workplace aggression: Exploring experiences of occupational therapy practitioners in healthcare settings. Occupational Therapy in Health Care, 35(1), 105-121. Web.
Stephens-Lewis, D., Johnson, A., Huntley, A., Gilchrist, E., McMurran, M., Henderson, J., Feder, G., Howard, L. M., & Gilchrist, G. (2021). Interventions to reduce intimate partner violence perpetration by men who use substances: A systematic review and meta-analysis of efficacy. Trauma, Violence, & Abuse, 22(5), 1262-1278. Web.
Steven, A., Wilson, G., Turunen, H., Vizcaya-Moreno, M. F., Azimirad, M., Kakurel, J., Porras, J., Tella, S., Pérez-Cañaveras, R., Sasso., L., Aleo, G., Myhre, K., Ringstad, Ø., Sara-Aho, A., Scott, M., & Pearson, P. (2020). Critical incident techniques and reflection in nursing and health professions education: Systematic narrative review. Nurse Educator, 45(6), E57-E61. Web.
University of Edinburgh. (2020). Gibbs’ reflective cycle. Web.
Vuckovic, V., Carlson, E., & Sunnqvist, C. (2021). ‘Working as a real nurse’: Nursing students’ experiences of a clinical education ward in psychiatric care. Issues in Mental Health Nursing, 42(11), 1038-1047. Web.
Weinberg, H. (2019). Discussion of “Taking the sting out: Manifesting aggression and containing difficult states in a relational group psychotherapy.” Psychoanalytic Dialogues, 29(2), 226-232. Web.
Wuryani, E., Rodlib, A., Sutarsib, S., Dewib, N., & Arifb, D. (2021). Analysis of decision support system on situational leadership styles on work motivation and employee performance. Management Science Letters, 11(2), 365-372. Web.