RN Nursing · Therapeutic Milieu · Practice question
The mental health nurse is leading a group about anxiety and anticipates that some clients may become disruptive and talk with each other during the group. To deter such behavior, which action is best for the nurse to implement?
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Describe the expectations for group behaviors at the beginning of the first group session.
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Explain that those with anxiety tend to talk more than others, but it is important to allow all to speak.
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If a client becomes disruptive, ask that client to leave and return when the anxiety is lessened.
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Arrange seating so that there is less opportunity for the clients to talk among themselves.
Answer & explanation
Correct: Describe the expectations for group behaviors at the beginning of the first group session.
Establishing group norms and behavioral expectations at the very beginning of the first session is the most effective preventive strategy a group leader can use. When clients know from the outset what conduct is expected — such as one person speaking at a time, refraining from side conversations, and respecting others — they are far less likely to engage in disruptive behaviors later. This proactive approach gives every member a shared framework and promotes accountability within the group. Explaining that anxious clients tend to talk more normalizes disruptive behavior and essentially gives permission for it to continue, which undermines the therapeutic environment. Asking a disruptive client to leave mid-session is a reactive, punitive response that can increase the client's anxiety and shame and damage the therapeutic alliance. Arranging seating to limit conversation is a physical manipulation that does not address the behavioral issue directly; anxious clients will still find ways to interact, and it may feel controlling rather than therapeutic. Therefore, clearly communicating behavioral expectations at the start of the group is the single best preventive measure, as it empowers clients to regulate their own behavior within an understood structure while fostering a safe and respectful therapeutic milieu.
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