Week 2: Theories That Guide Group Development

Models and/or Frames of Reference for Groups

•Humanistic Approaches

•Developmental Approaches

•Psychodynamic

•Behavioral-Cognitive

•Allen’s Cognitive Disabilities

•Sensor motor Approaches

•Model of Human Occupation

•Functional Group Model: more a FOR

Developmental Approach

It is a paradigm (overarching concept that you are always considering)

The developmental stage is part of personal context and inherent in every group.

Cannot consider group activities without considering the developmental level of the group members.

Levels are defined by points of growth, crisis or conflicts that need resolving.

Several theorists – Levinson, Jung and Erikson

Considers motivation and a person’s natural desire for mastery

Includes group development.

Humanistic Approaches

Humanistic groups are about tapping into humanity and facilitating growth, self-development and healing through belonging and shared experience.

Concepts of humanistic groups include respect, understanding, genuineness, spirituality and self-actualization.

The Recovery Model would be considered a humanistic approach in groups.

ex: WRAP training

Psychodynamic Approach

Ground in psychoanalytic theory that focuses on ego development and insight into the underlying processes behind behavior and thought.

Relationship to OT Groups

Considered symbolic meaning of activity

Provision of activities that fit the person’s personality – or that help to alter the person’s personality if need be

Focused on the impact of unresolved childhood interpersonal issues the interfere with the person’s ability to derive pleasure from activity

Included concepts of transference and object relations.

Behavioral-Cognitive Approach

Emphasis is on learning, practice and cognitive restructuring

Relationship to OT Groups

Behavioral goals and objectives

Conditioning and development of habits

Shaping and chaining

Rehearsal and practice

Modeling and reinforcement

ex: lisa and her husband’s socks. her habit was knocking on the door. her alternate approach was cleaning the bathrooms when it happened again

Sensory Motor Approaches

Include a range of Frames of References that address motor, sensory, perceptual or cognitive changes that are a result of developmental or acquired conditions affecting the brain.

Incorporates concepts from many theorists including Trombly, Rood, the Bobaths, Ayres, and Dunn.

Stress the importance of sensation as well as practice and feedback in the approach – new FoRs incorporate a holistic approach (motor control, Co-Op). Experiencing your body doing

Encompasses motor-learning theory which emphasizes the relationship between neuroplasticity, movement and development of new patterns of movement to accomplish desired tasks.

These FoRs were not necessarily meant to be used in OT group context, but principles can be applied when planning activities.

Allen’s Cognitive Disabilities

Applied when there is need to measure and monitor problem-solving ability and safety during performance tasks.

Relationship to OT Groups

Designed to apply to daily function with a particular focus on available cognitive structure and process in daily tasks.

Used in acute and long-term settings with people who have cognitive changes due to illness or injury

Quantifies ability and disability into categories and helps direct intervention to support or compensate

ex: leather lace tool

Ecology of Human Performance

ecology definition

Defined as the transaction between people and their contexts/environments.

Four contexts = personal, cultural, temporal, and virtual

Two Environments = social and physical

basic assumptions of Ecology of Human Performance

Four constructs person, task, context, and performance work together.

There is a dynamic relationship between person and task and contexts

Environment is a factor in performance

OT promotes self-determination and Inclusion

Environment and person are constantly changing, requiring adaptation.

Independence is achieved when wants and needs are satisfied (adaptations included).

temporal contexts

refer to age, life stage and timing and availability of the tasks. Relationship to groups – groups are done within the preferred environments and in consideration of and within contexts when possible.

Person-Environment-Occupation-Performance

Begins with the PEO paradigm - assuming these are not separable.

Performance is defined a dynamic experience of a person engaged in purposeful activities and tasks – in the environment.

4-Step process -

Narrative (occupational profile),

Assessment of occupational performance,

Intervention – Addressing performance barriers

Determining outcomes

Environments are considered part of performance – cooking in the kitchen.

more narrow than the ecology of human performance

Kawa Model

Japanese Model of Occupational Engagement. Considers the aspects of Japanese culture (not held in western cultures).

• Occupation is embedded in nature

• Occupation is Collective - in Families, social groups, work groups

• Reason and reality are situational - problems can change depending on the situation

• Ideas and opinions are accepted or rejected based on the hierarchy of individuals

• River Metaphor exemplifies this – every changing and complex - intervention is multifactorial - with change being determined by the collective group, the environmental changes, not just individual needs.

All parts of the model are part of intervention – but also are determined by the collective in the group – family, etc. 

Model of Human Occupation

• Based on the assumption that people are open systems that interact with their environment

• That there are internal processes impacted by underlying anatomy and physiology as well as motivation, life experiences, and daily habits

• That there is a developmental process to create occupational identity and competence.

• Groups are a combination of education, engaging in processes and/or engaging in occupations of interest or value.

  For a truly occupation-based group approach, you will use this theory and incorporate other FoR into group process. COPM and PEOP don’t lend themselves to group processes well because they focus on impairment and illness.

Types of OT Groups

• growth

• social context

• activity

• functional groups

Growth Groups

Aimed at increasing an individual’s sensitivity to feelings or enhancing members’ ability to help themselves through the power of the group.

Support groups and self-help groups are examples

Encounter groups – very intense didactic and action-oriented groups are common growth groups.

OT might engage in activities people fear, or feel they cannot do or explore alternatives – and process the experience. This includes changing narrative stories about the self.

Social Systems Groups

Designed to help participants learn about process and dynamics of “group” participation through a collective task experience.

Focused on relationships, patterns of behavior within those relationships and how parts fit together to form a whole.

Family therapy is one example used by social workers. OT can use work situations, friends. Roles groups take on a social context

Primarily addresses “here and now” experience

Activity Groups

Groups that center around an activity or task chosen to direct learning or maintain occupational performance

Important to keep in mind that we are not teaching the activity but using it to address functional skills or limitations.

Requires strong activity analysis

The activity, tools and supplies become the mode for therapy

Functional Groups

According to Schwartzberg, Howe and Barnes

Functional Groups were designed to include purposeful activity and meaningful occupation in the process and dynamics of group intervention

The Session Plans that you will do are based on this Functional Groups model.

OT Group Interventions

reminiscence

leisure

senorimotor

energy conservation

psychoeducational

social skills group or communication

ADL

Reminiscence Group

Focus: maintain, support, preserve past occupational interests and abilities by participating in past meaningful activities

example: Focus: establish, remediate, restore ADL fx/skills; group members gain awareness, knowledge, and skills necessary for ADL mastery                                                             

Leisure Group

Provides an opportunity to explore and participate in leisure activities in order to promote increased occupational balance

ex: an OT leads groups that parallel opportunities available at a local community recreation program for homeless teens to facilitate community reintegration and resource utilization

Sensorimotor Group

Focus: facilitate adaptive m/m and engagement (and behavior); common to address neurological or cognitive dysfunction

ex: An OT uses a parachute with adolescents who have had a mild TBI to facilitate movement to different rhythms, speed, and tempos

Energy Conservation Group

Focus: Health promotion to reduce incidence of disease or prevent secondary conditions when illness/disease already present

ex: An OT uses a parachute with adolescents who have had a mild TBI to facilitate movement to different rhythms, speed, and tempos

Psychoeducational Group

Focus: enhancing the client’s capacity for health mgmt through educating; sometimes has a CBT component to it

ex: Soldiers with PTSD attend a weekly group to learn stress management strategies and report back on the degree to which they were effectively incorporated into their daily routines/activities

Social Skills Group or Communication Group

Focus: social participation; creating a situation where members are socially connected allows members to develop social interaction skills and learn from one another

ex: Outpatient program for individuals with ETOH abuse that incorporates role-playing based on participants’ concerns. Members practice giving each other feedback on how they were perceived during the role play.

ADL group

Focus: establish, remediate, restore ADL fx/skills; group members gain awareness, knowledge, and skills necessary for ADL mastery

ex: An OT runs a group with seniors who have low vision that focuses on completing different ADLs with AE or low vision strategies.

Cole’s Seven Steps

•Introduction

•Activity

•Sharing

•Processing

•Generalizing

•Application

•Summary/Wrap up

Introduction

Leader Introduces the Group - Group name, purpose (goals) and general expectations with a brief outline.

Introductions as needed

Warm up activity – usually designed to prepare participants to participate in the activity of the day.

• These steps are repeated in every group, though they may change according to the kind of group, or the members.

• It is good to build in ways to help people remember names and each other.

• This sets the mood for the group

Activity and Sharing

These steps will be considered together for our groups:

The activity is the primary method, mode to meet the goals for that day’s group.

Activity Analysis - Plan for a just-right challenge.

Consider the amount of time allotted when planning

Sharing is the process of considering the end product. If each person is doing something on their own, they might display it to other group members, or everyone steps back to consider the work they did.

The process for sharing is largely dependent on the activity – so we will combine these in your session planning doc.

Processing –

Members are given the opportunity (encouraged to) speak about their experience with the group activity.

This is primarily feelings-based – and provides insight into some of the participant’s behaviors.

Often skipped by new group leaders, but very important

Generalizing –

The leader considers the participation and responses of the group members and pulls together some general takeaways.

If the group goes as planned, this will reflect the goals.

Application –

Takes the key concepts from the summary (generalizing), and helps the members apply them to their lives.

Can have participants speak individually, or think, pair, share. How you do this is planned.

Summary/Wrap up

How you finish the group is important and should be considered as part of your planning.

You can do the summary several ways – you do it, have them do it, or some combination, step-by-step review.

Review the goals – did they meet them, or did something else happen?

Closed groups - Might include telling them what they need to do before the next meeting (homework, try and apply what they learned, plan for the week, etc)

Announce the next meeting day and time

Adult learning principles

When planning groups, you must consider how you present your material. We will spend time on dynamics and leadership, but you also need to consider the development and presentation of content. I realize that not everyone will teach adults but many of you will, both in groups and inpatient care (patient and family) and there are some things to consider.

Adult learning principles:

Consider the motivation – what is the change people want to make? What is the motivation? What is getting in the way of motivation? (Don’t ever forget what you learned about volition – no one else learns that!!!). Consider the sources of motivation

Principles need to be relevant and practical

Adult learners often have a preferred learning style. In groups, provide content in multiple ways.

Be familiar with the barriers to learning (this could be part of your assessment) so that you can put things in place to decrease them.