Step 1: Introduction
-this includes the therapist name, title, and the name of the group that is about the begin. Explain the purpose clearly, use the warm-up if needed to relax or prepare the group. Communicate expectations outline timeframe, structure of group, and any rule
Step 2: Activity
Must ab adequately prepared, utilizing time effectively. Directions should be clearly give and prepared to down grade if needed for those client that might require extra attention. Have appropriate materials ready and available and make sure the environme
Step 3: Sharing
in this step invite members to share their finished projects or assignments, use appropriate verbal and nonverbal communication and empathize and acknowledge feelings or group members. Make sure time is shared equally amongst all group members
Step 4: Processing
-in this step of "processing", leader are encouraged to elicit members feelings about the experience. Ask if they were able to relate to one another or asking the group to provide suggestions. If part of intervention is to assess leadership. Ask members h
step 5: generalizing
-during this point group leaders should point similar responses, contrasts or differences. If possible, identify principles learned during the group
step 6: Application
-the leader verabalizes the meaning of this experience, shows how the experience can relate to everyday life. If appropriate identifies the experience of group to everyday problems or issues.
-A questions to ask the group is "how would you apply what you
step 7: summary
-during this last step, identify important points that were emphasized, reinforce group learning acknowledge contributions of group members and thank them for attending. Try your best to end group on time
what is group?
an aggregated of people who share a common purpose which can be attained only by group members interacting and working together
primary group
face to face relationships
secondary group
more formal
benefits of groups
-non-textbook reasons
-instill hope
-universality
-gain/give information
-altruism
-recapture family dynamics
-develop socializing strategies
-imitative behavior
-catharsis
-existential factors
-cohesiveness
-interpersonal learning
Group Norms
-seen as rules/attitudes/behaviors that are accepted
-can be verbalized and specified by group leaders
Group non-verbalized norms
-unspoken rules, norms that develop over time, which can be implied by behaviors and interaction of group members
-eg. avoidance of conflict:
-eg, taboo topics (unspoken topics)
Group Verbalized Norms
-confidentiality, respecting others, no cross talking/ disrupting
Group Desirable Norms
-Active involvement in the group
-Extensive self disclosure (leader might share his or her feelings/experience)
-desire for self-understanding (push for them to explore themselves)
-eagerness of change
Role as the OT/Leader
-discourage norms that are defeating the goals of the group
-you the leader should serve as the role model to share feelings/experience
changing norms as OT/Leader
-don't want them to always focus on group leader for all the answers
-reinforce positive behaviors
-encourage to change undesirable behaviors
Content
-what happened or was said in the group
-pay attention to the demeanor during verbal interaction
process
-what is happening beyond what is said or done?
-What is implied by the content?
Process vs. Content: Therapist role
-need to identify the area of content that must be processed. If processed properly, this will help clients move forward and as a result through processing their needs will be addressed
Process vs Content: Group Development
Over time a group develops, relationships change and you (the OT) will see processing more often as time goes on
Schultz's Stage of Group Development: Stage 1
Inclusion stage- Beginning stage, general thought process of members "where do I fit in?" "Am I respected?
Schultz's Stage of Group Development: Stage 1 behaviors
-over talking
-territoriality
-individual self-centeredness
-listen but do not hear
-look at leader but not at others
-turn to leader for answers
-look for similarities, downplay difference
-depend on leader for structure
-only say what will be accepted
Schultz's Stage of Group Development: Stage 2
Control stage- Group members may think..."how do I stand in relationship to power?" "How much influence do I have?
Schultz's Stage of Group Development: Stage 2 behaviors
-leader is viewed with skepticism
-leadership struggle
-members disagree about leadership
-challenge leader
-disenchantment with the group
Schultz's Stage of Group Development: Stage 2: choice for leader
-back down
-subdue the rebellion
-encourage sharing the leadership
Schultz's Stage of Group Development: Stage 3
Affection Stage-Members thoughts..."how do others feel about me?" "How do we feel about each other?" (In this stage there is an observable group mentality)
Schultz's Stage of Group Development: Stage 3 behaviors
-now group is able to listen
-feel safe
-altruistic desire to help others
-can often regress from this stage
Why do we need Schultz's stages? How groups can reach maturity?
-have a focus
-pay attention to feelings
-be an active participant
-give feedback
-be open to feedback
-take responsibility for what you accomplish
Group roles: initiator-contributor
suggests ways or ideas for addressing
group roles: information seeker
asks for clarification or facts relating to problems
group roles: opinion seeker
not facts, but clarification of values and attitudes
group roles: information giver
offer facts or info or generalization w/out being asked. They do it automatically
group roles: opinion giver
states beliefs or opinions, maybe w/out being asked
group roles: elaborator
spells out suggestions and gives examples
group roles: coodinator
clarifies relationships among various ideas
group roles: orienteer
defines position of group with respect to its goals
group roles: energizer
prods group into actions
group roles: procedural technician
gets group going by doing things
group roles: recorder
group memory, writes everything down or remembers everything
group roles: evaluator/critic
asses accomplishments in-group
group building & maintenance roles: encourager
praises members and exudes warmth toward members
group building & maintenance roles: harmonizer
someone that helps keep the peace smooth out differences between group members
group building & maintenance roles: compromiser
person that will change opinion or compromise in order to keep group in harmony
group building & maintenance roles: gatekeeper & expediter
tries to keep communication going by encouraging participation, equally sharing
group building & maintenance roles: standard setter
-presents standard that will help group move forward
group building & maintenance roles: group observer commentator
someone that pays attention to group process & gives info & interpretation/ good evaluation of process
group building & maintenance roles: follower
acts more passively, goes along with the flow, builds group cohesiveness
individual roles: aggressor
someone that expresses disagreement (in unpositive way), of the way group is going. May attack feelings of others, or group as a whole. Might joke aggressively, right see them taking credit for what they'v done
individual role: blocker
-someone negative/stubborn trying to prevent progress, bring up old issues which prevents moving forward
individual roles: recognition seeker
someone that calls attention to themselves, by boasting, being over talkative
individual roles: self-confessor
expresses non-group feelings or only slightly related. takes opportunity to dump
individual roles: play boy
-cynical, lack of interest in group, may do horseplay, flirting, and little emotional investments
individual roles: dominator
person that tries to be authority, this type of person moves into leadership role. However; not really listening, talks over others and interrupts
individual roles: help seeker
always looking for sympathy, might be insecure, self-depreciative, can be teary eye in sessions
individual roles: special interest pleader
will always be trying to stand up for a political/special interests
Group roles
-initiator
-information seeker
-opinion seeker
-information giver
-opinion giver
-elaborator
-coordinator
-orienteer
-energizer
-procedural technician
-recorder
-evaluator/critic
group building and maintenance roles
-encourager
-harmonizer
-compromiser
-gatekeeper and expediter
-standard setter
-group observer commentator
-follower
individual roles:
-aggressor
-blocker
-recognition seeker
-self-confessor
-playboy
-dominator
-help seeker
-special interest pleader
What is communication?
a sensory modality: visual, auditory, and kinesthetic/body language
non-verbal communication: eye contact
direct=assertive
none= passive
stare= aggression
non-verbal communication: body posture
good stance= assertive
slumped= passive
forward= aggressive
non-verbal communication: hand movements
natural= assertive
tentative= passive
pronounced=aggressive
non-verbal communication: facial expression
friendly=assertive
downcast= passive
contorted= aggressive
OT as a communicator
your right are to speak up, you're allowed to have problems, to be confronted, to work, to make mistakes, to be rewarded, to be independent, to find solutions, to confront others, to correct mistakes, to reward others, to be dependent on colleagues
non-therapeutic use of questions
-don't make judgments
-don't use multiple questions
-"why" questions can become offensive
-be careful of self-disclosure
common communication problems & strategies
-break eye contact
-redirect questions to other members of the group & encourage interactions
-don't give advice/ suggestions right away
-validate client's perceptions/ beliefs
-think about your body language as a role model
-encourage patient to share th
communication response to avoid
-moralizing
-don't probe too much
-do not be too socialized with patient
-avoid giving false reassurance
-don't be too giving (could equal dependency)
-no "why" questions
-avoid interrupting patient
-don't summarize right away
-do not belittle the patient
Traits of a good leader
-honest
-consistent
-patient
-in control
-empathetic
-assertive
-good-listener
-respectful
-responsible
-objective
-creative
-flexible
good leaders born or made?
both: depends on your strengths and weaknesses
primary functions of the leader
develop group goals/objectives
-how to meet goals
-group building and maintaining: facilitates processing and goes beyond the group activity
roles of OT group leader
-select members to join group
-write group protocol
-choose the best leadership style for the group
-support positive efforts of group members
-maintain therapeutic norms
-evaluate progress and determine group outcomes
group leadership styles
-directive
-facilitative
-advisory
-co-leadership
group leadership styles: directive leadership
-feedback is give by the leader.
-determine structure, activity, and processing
-takes active role in shaping member participation
-group goals achieve through active leadership
-this type of leadership is appropriate when there is cognitive impairment, p
group leadership styles: facilitative leadership
-is a democratic system where leader gathers support from members by communication and through showing concern for the group's best interest and allows choices
-a level of ability and rational thought is presumed
-the group can experience advanced levels
advisory leadership
-a passive type of leadership, which assumes a higher level of functioning
-members are more motivated and activities tend to be more informal (such as community and professional activities)
-the leader acts as a resource, provides information on more spe
co-leadership disadvantages:
-splitting
-take sides against each other
-power struggles
-competition
-unequal contribution
-takes more time meeting
-each individual has a different pace
co-leadership tips
-choose good partner for you (compatible)
-interview clients together
-plan to be organized together
-time to process afterwards
-remember co-therapy has both positive and negative effects
sharing group leadership with a COTA:
-OTR needs to understand the skill level of a COTA
-There's no need for a power struggle, COTAs can work with all groups at all levels
-As co-leader, COTAs may have more knowledge of the client than the OTR because of prior contact
COTA Group leaders
-collaborative relationship must be established first
-COTA and OTR share or alternate responsibility
-COTA can lead groups alone
-OTR has education with regard to theory, but the COTA may have more experience
problem behavior types
-the silent one
-the monopolizer
-the hostile and aggressive one
-the abusive language and swearing one
-the late one
-"I want to leave group"
-breakdown/crying
-dishonestly
-the skeptic
-self-depracator
-the narcissistic member "attention seeker"
-psycho
problem behavior: the silent one
-makes frequent eye contact, break the ice, speak to person outside of the group
-ask "you seem quiet today"
-encourage don't force to participate
-recognize and appreciate small efforts
-ask for their opinion
problem behaviors: the monopolizer
-takes over the group
-OT should redirect the topic to others, summarize/ re-focus group goals
-ask other members to give feedback of how they feel when group conversation is taken over
problem behaviors: the hostile & aggressive one
-provide person with cool-off time
problem behaviors: the abusive language and swearing one
-as long as no one is being offended, know how group members feel
problem behavior: the late one
-figure out why they are late, depending on setting, ask them to listen and sit quietly when they arrive, and talk with them after group
problem behaviors: "I want to leave group
-ask yourself why
-ask them why
-show you care
-let them know it's their choice
problem behaviors: breakdown/crying
-as long as not disruptive of an act of attention-seeking, it's okay
-be supportive, discourage other group members from overreacting
problem solving: dishonesty
-ask why
-discuss privately with person
-be conscious to decrease embarrassment
-have group confront the individual depending on the situation
problem behaviors: the skeptic
-ask why
-what are they really saying
-leader should not become defensive
-remember group process
-let group members respond
-meet with the patient individually
problem behaviors: self-deprecator
-ask why
-ask group to identify behaviors
-encourage the patient to accept group support and encouragement
problem behaviors: the narcissistic member: "attention seeker
-demands attention and has a fragile sense of self worth
-can be very disruptive
-in a caring manner have members tell how the individual's actions make them feel
problem behaviors: psychotic behavior
-pay attention to it
-if destructive in group, ask the individual to leave.
-action is better versus discussion in this case