Neurobehavior Lab Exam 1

Group Process vs. Group Content

Content: the topic discussed, what happened?

Process: the here-and-now experience & “processing” of what just happened; self reflective loop

Activity analysis

process of examining an activity to distinguish its component parts

Activity synthesis

Putting those parts together in a way that matches client needs; Process of combining components of the human & nonhuman environment to design an activity suitable relative to an individual’s performance

Cole's 7 Steps of Group Leadership

Introduction, Activity, Sharing, Processing, Generalizing, Application, and Summary

Cole's 7 Steps of Group Leadership - introduction

Therapist introduces self, group members, purpose/goals, & outline; Includes warm-up

Cole's 7 Steps of Group Leadership - activity

1/3 of the time, about 15-20 mins

Consider goals + physical, mental, & social capacity

Adapt activity to goals and client ability

Cole's 7 Steps of Group Leadership - sharing

Each member shares work/experience

Leader acknowledges all & manages time across members

Cole's 7 Steps of Group Leadership - processing

Explore feelings about the activity, underlying issues & group dynamics

Cole's 7 Steps of Group Leadership - generalizing

Leader identifies common themes/patterns.

Cole's 7 Steps of Group Leadership - Application

Connect group learning to real life situations.

Cole's 7 Steps of Group Leadership - Summary

Review key points and emotions. End on positive note.

Motivation

1. Confidence

2. Encourage enthusiasm

3. Encourage interaction

4. Setting limits

5. Appropriate authority (do not dominate or intimidate)

6. Equal time

7. Limiting inappropriate behavior

8. Set limits (respect)

Confidence

Therapist shows leadership and empathy to build trust, so group feels safe

Enthusiasm

Model energy & encourage participation

Interaction

Share leadership, involve members, not just therapist talking.

Do not work too hard

Lewin’s 3 Types of Group Leadership

Autocratic, democratic, & laissez-faire

Autocratic Group Leadership

complete control of the group with little to no input from members

Democratic Group Leadership

allows members to make choices & have a say in what the group does/becomes

Laissez-faire Group Leadership

french expression meaning “to let do” or to let the people do as they choose

3 types of OT leadership styles

directive, facilitative, & advisory

Directive Leadership Style (Benevolent Autocratic)

Therapist defines goals and structure; best for clients with low cognitive insight.

Ex: homeless people who are hearing voices in a local shelter

Facilitative Leadership Style (Democratic)

Therapist shares decision-making; best for clients with fair insight and collaboration ability.

Advisory Leadership Style (Laissez-faire)

Therapist acts as a consultant; best for high-functioning, self-directed client groups.

Conflict Resolution Methods

Arguing, Avoiding, Compromising, & Collaboratively

Conflict Resolution: Arguing

defending one’s position in a non-conciliatory way; geared to winning through power & dominance

power struggle. not helpful.

Conflict Resolution: Avoiding

people who do not like conflict often hope it will just go away

ignoring conflict, often makes it worse

Conflict Resolution: Compromise

1. Agree to engage in dialogue

2. Each side acknowledges validity of the other side

3. Communicates most important point on each side & acknowledges concessions being made on each side

Conflict Resolution: Collaboration

Best option. Work together for win-win solution.

Both sides have diff views but put them aside to work out the best solution in the partnership

Yalom’s Therapeutic Factors of a Group

1. Interpersonal learning (input)

2. Catharsis

3. Group cohesiveness

4. Self-understanding

5. Interpersonal learning (output)

6. Existential factors

7. Universality

8. Instillation of hope

9. Altruism

10. Family reenactment (corrective emotional exp)

11. Imparting information (guidance)

12. Imitative behaviors (identification)

Yalom's Therapeutic Factor: Interpersonal Learning (input/output)

Input: Learn how others see you through feedback or compared to self-concept

Output: Learn to better express feelings, resolve differences & develop social skills; how to interact better.

Yalom's Therapeutic Factor: Catharsis

Emotional unburdening; the release and relief of emotional tension through sharing within the group.

Yalom's Therapeutic Factor: Cohesiveness

Group bonds, feels like a team; group solidarity

Yalom's Therapeutic Factor: Self-Understanding

Learn new things about yourself.

Yalom's Therapeutic Factor: Existential Factors

Realize life isn't always fair, but you can take responsibility.

Yalom's Therapeutic Factor: Universality

The realization that one is not alone and others share similar struggles in finding one’s own.

Yalom's Therapeutic Factor: Hope

Coming to group believing it will make a difference

Yalom's Therapeutic Factor: Altruism

Group gives a way to benefit others

Yalom's Therapeutic Factor: Family Reenactment

Group may feel like a family, allowing new healthier experiences.

Yalom's Therapeutic Factor: Guidance & Modeling

Learning from advice and observing others.

Yalom's Therapeutic Factor: Imitative Behaviors

Social learning through modeling (new)

Tuckerman's Group Development Model Stages

1. Forming (getting to know each other)

2. Storming (conflict, testing rules)

3. Norming (finding balance, harmony)

4. Performing (productive teamwork, beyond cohesiveness)

5. Reforming (reflect & adjust)

Bion's Group Development Model

1. Flight (avoidance)

2. Fight (challenge leader)

3. Unite (stabilize)

Schultz’s Group Development Model

1. Inclusion: an individual is concerned about being accepted

2. Control: “Where do I stand in relation to power & authority? How much influence do I have"?”

3. Affection: stage of group cohesiveness on “how do others feel about me? how do we feel about each other?”

Focuses on individual needs

Yalom’s Group Development Model

1. Orientation: hesitant, search of maturity, dependency, acceptance

2. Conflict: issues of power & control, dominance + rebellion

3. Cohesive maturity: can express negative & positive work through it; teamwork

Culture of Groups

Each group develops its own unique culture, with all members influencing it; becomes more stable over time

Norms are present & incorporate certain attitudes/standards of behavior

Explicit rules

Clear expectations (ex: be on time, respect others’ opinions, confidentiality)

Implicit Norms

Unspoken behaviors that develop (e.g., how members talk to each other)

Therapeutic norms

Encourage safety, self-reflection & disclosure, encouraging interaction, reinforcing group importance, members as agents of change, & risk-taking

Client Problem Behaviors

• Unequal participation

• Monopolist

• Silent member

Group Session Problem: Unequal Participation

Some too dominant, others too quiet

Group Session Problem: Monopolist

One member talks too much, takes over

Group Session Problem: Silent Member

Avoids speaking, may feel anxious or excluded

Mosey’s 5 Levels of Group Development

1. Parallel

2. Project

3. Egocentric/cooperative

4. Cooperative

5. Mature

Group members no more than 1 level above group interaction skills

Donohue’s social profile/Mosey’s 5 levels

Used for grading social interactions

Use no more than one level above the client’s current group skills

Donohue’s social profile/Mosey’s 5 levels Measures

Group membership, interaction, & activity behavior

Mosey's Parallel Group Level

Members complete individual tasks side-by-side with minimal interaction required; OT most directive

Ex: Adults standing in rows exercising

Mosey's Project (Associative) Group Level

Members collaborate on short-term shared tasks requiring basic interaction and cooperation; task is paramount! No social interaction outside task

Ex: Adults passing the ball and identifying the names of 10 members

Mosey's Egocentric-Cooperative Group Level

Members select & implement long-term tasks while taking on roles and recognizing peers' needs; social interaction expected

OT leader provides choices & facilitation

Ex: Adults in the ADL group are preparing and eating a fruit salad.

Mosey's Cooperative Group Level

Focus centers on mutually sharing feelings and support; task is not the primary focus; OT leader as advisor

Ex: 16-year-olds discussing and sharing their feelings about lyrics while making decorations for a parade float

Mosey's Mature Group Level

Members independently balance task productivity with social-emotional needs without direct OT leadership; leader is a co-equal member

Ex: Parents with children with disabilities coach each other on methods of intervention, needs, and task analysis

Group Membership

who is in the group

Group Interaction

how members relate to each other

Group Activity Behavior

how they engage with the activity itself

Cole’s Group Intervention Outline Requirements

• Group title

• Author/group leaders

• FoR or model

• Purpose

• Description of members & setting

• Group goals & rationale

• Outcome criteria

• Methods/activity

• Supplies & cost

• References

Stages of therapeutic communication for groups

1. Problem definition

2. Self-understanding

3. Behavior change

Therapeutic Use of Self Skills

• Immediacy

• Primary accurate empathy

• Advanced accurate empathy

• Confrontation

• Assertive communication

Crisis Stage of Care

Immediate safety, stabilization

Struggling Stage of Care

Symptom management, basic coping

Surviving Stage of Care

Maintaining stability, daily functioning

Thriving Stage of Care

Building skills, increasing independence

Excelling Stage of Care

Personal growth, meaningful roles, flourishing

Intrapersonal

Self-awareness, personal habits

Interpersonal

Family, friends, relationships

Community / Organizational / Institutional

School, work, local institutions

Policy / Socioenvironmental

Laws, policies, societal norms

Advocating (IRM)

Raise awareness, provide access to resources, normalize experiences

Collaborating (IRM)

Empower clients, follow client's lead, ask about preferences

Empathizing (IRM)

Understand client perspective via summary & clarifying questions

Encouraging (IRM)

Instill hope, provide positive reinforcement

Instructing (IRM)

Teach, guide, correct as needed

Problem-Solving (IRM)

Socratic questioning, weigh pros/cons of situations

Empathy vs. Sympathy vs. Pity

Empathy shares feelings; sympathy feels concern for another; pity looks down conditionally.

Communities

Provide a sense of stability, unity, and belonging

Community needs assessment: Identify needs & gaps

Look for areas where OT groups can fill service gaps, complement existing community programs, and address unmet health, wellness, or participation needs

Community needs assessment: Engage partners & stakeholders

Explore collaboration with local organizations and involve stakeholders (community members, providers, funders) early to ensure relevance and shared goals

Community needs assessment: Honor community voice

Respect autonomy by inviting input, supporting choice, and involving the community in decisions that affect their health and well-being

Focus groups

Engage potential clients, identify needs & goals, obtain feedback from the group regarding proposed interventions

Political Competence

Dynamic set of critical knowledge, skills & attitudes to effectively engage in situations of conflict & cooperation to people's needs & demonstrating the relevance of the profession

Wellness

Conscious & deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle

8 Dimensions of Wellness

Physical, Spiritual, Social, Intellectual, Emotional, Occupational, Environmental, and Financial.

Occupational Balance

Having the right mix and variation of daily occupations

"Yellow flags" on well-being and emotional distress

Worry, fear, avoidance, vigilance & catastrophizing are associated with interference with daily life and time off work

Social determinant of mental illness

violence and maltreatment, adverse life experiences, racism and discrimination, structural inequalities, and financial burden.

Four Dimensions of Occupation

Doing (participation), Being (identity), Becoming (growth/adaptation), and Belonging (community connection)

Doing (participation)

Perceived participation competence

Being (identity)

Values, motivations, and roles associated with the occupation

Becoming (growth/adaptation)

Process of occupational adaptation and the influence of context on capacity to engage in valued well-being occupations

Belonging (community connection)

Connectedness to family, friends, and the wider community through well-being occupations

Three Tiers of Public Mental Health Intervention

Tier 1: Universal promotion; Tier 2: Targeted at-risk; Tier 3: Intensive individualized care

Tier 1: Universal promotion

Promotion & prevention strategies for everyone