OT 852- Group Theory and Process

What is a group

gathering 2 or more people, common goal (need connection)

what is not a group

not a simply random mix of people

Why a group?

-The natural environment promotes social interaction

-achieve outcomes that rely on the group and process

-convenient in settings with homogeneous client populations

-opportunities offer services to multiple people simultaneously

-therapeutic effectivness

What are the therapeutic factors of groups know these

-universality

-catharsis

-imitative behaviour

-instillation of hope

-imparting information

-social learning

-interpersonal learning

-Group cohesiveness

-altruism

-corrective recapitulation of the primary family group

-existential factors

Evolution of groups in OT

promoting the moral treatment of patients

1920s and 30s

project era

1937-1953

socialization era

1954-1961

Group process era (group dynamics)

1962-1969

Psychodynamic era

1970s to 90s

adaptation era

1990 to present

Wellness era

Differentiating OT groups

-small groups (6-10 members)

-occupation-focused

-focus on increasing performance or specific skills for participation

-directed at increasing skills for daily living

OT's use of therapeutic groups

means of change, members can:

-experiencing feelings of belonging

-be with others who have common challenges that can be shared

-observe the problems, struggles, behaviours, interaction styles and coping techniques of others

-experience support for individual growth

Advantages of OT groups

-provide an occupation-based experience

-natural environment for social support, teaching and learning

-group can be empowered with shared leadership

-provides opportunities for group members to excel

-can be cost effective*

*requires therapist skill to ensure individual needs met

Transformative change and OT groups

person-> doing -> interpersonal connection-> here and now...this all leads to belonging, self-esteem, emotions, skills

Group formats

-Provide interventions in groups to the right clients at the right time

-Use activity analysis in the design of the group

-know the client's goals and current functional capacity

-consider the client's psychosocial needs relative to the benefits of the treatment group

-know about any impairments that may limit participation

-consider the number of participants

-consider the complexity of the individuals engaged in the group

-ensure group interventions are directed towards goals that meet individual needs

three types of leaderships

1. democratic (facilitative)

2. Authoritarian (directive)

3. Laissez-faire ("hands off:

client perceptions of important leadership functions:

-emotional activation

-caring

-meaning attribution

-executive function

What is a group norm

-shared expectancy of what is appropriate

-should be made explicit, particularly in groups that are long-term, involve risk or personal investment for members and/or deal with personal issues

Where do groups happen

-hospitals, schools, rehab centres and mental health facilities (exercise, cooking, ADLs, arts, feeling-oriented discussion groups, SI groups/sensorimotor and education)

-community programs and schools higher proportional use than hospitals

-most group activity-based vs. discussion-based

Stats in graph for practice area

OT is most in school

OTA is most in Long term care and skilled nursing facility

Stats in a graph for intervention types

most in exercise groups, task, and sensory

Barriers to this

-reimbursement is most

-then unsupported by setting

-lack of time

-then using 1:1 modality

-inadequate space

Benefits to this

-role modelling

-communication/participation

-then feedback

-time

-insight and learning

-self esteem

Statd for groups over time

50-60% usig

-decrease in physical health setting

-consistent use in mental health

-increased use in school and community

Group structure

influenced by:

-context

-climate

-composition

-purpose (and goals)

-size

Context

historical, environmental

climate

physical, interpersonal

composition

open vs closed (o: anyone can join at any point, c: 12 ppl signing up and continuing), number of sessions voluntary/involuntary

Purpose and goals

Group goals provide more "press" than individual goals (more incentive)

group size

# of people

Stages of group development-Forming

-Groups are difficult trying to form a group

-strength and resources of how can we bring this to our team

Stages of group development-Storming

-conflicts arise from group leadership

-conflicts are seen as normal in terms of group development

Stages of group development-Norming

-Team begins to function as a team, working without constant conflict

-learning trust

Stages of group development-Performing

-established as a cohesive unit

-comfy sharing information and discussing problems openly

Stages of group development-Adjourning

-added later

-The project worked on is completed

-achieved goals and objectives

-learn what works and doenst work

leadership and group stages

Forming(members need max direction and rely on group leader->Directing (high directive, low supportive behaviour)

Storming(members finding their way in a group need max support to navigate new environment->coaching (high directive and high supported behaviour)

Norming (members developing their own norms for group behaviour, less reliant on the leader)->Supporting (low directive and high supportive)

Performing (members able to maintain productivity and process with minimal input from the leader->delegating (low directive and low supportive)

Stages of group development (described in terms of member function)

Parallel

project

ego-centric cooperative

cooperative

mature

Parallel

Purpose: provide an environment where individuals work or engage in activities independently, but within the same space, helps participants develop basic social skills and awareness of others in a non-interactive way

participants: these groups are typically used with people who have limited social skills, such as children or ppl with cog impairments or low functioning

Key features: low interaction between members, focus on individual tasks

ex/ yoga class, workoit class

Project

Purpose: to promote interaction between members in the context of completing a simple task. allows for some degree of cooperation and sharing of materials

, participants: often used with individuals who have a slightly higher level of functioning than those in parallel groups, but still need structure and guidance in interaction

Key features: members can work together on a short-term, cooperative task. Interaction is facilitated but not required

ex/ cooking group

Ego-centric cooperative

purpose: help individuals develop and express their own needs while also learning to meet the needs of others in a group context. this type of group encourages more complex interactions and group problem-solving

participants: used with ppl who are able to engage in more complex social interactions such as adolescents or adults with developmental delays or mental health conditions

Key features: greater emphasis on collab, sharing responsibiluty, and group decision making. members encourages to develop sense of group identity and work toward shared goals

ex/ younger kids sports, labs, planting community garden

Cooperative

Purpose: helps ppl work together more maturely and reciprocally. The primary goal is for members to develop a sense of mutual respect, empathy, and teamwork while fulfilling individual needs and group goals

Participants: type of group often used for individuals who are capable of more mature social interactions and group participation

Key features: members work cooperatively to solve problems and achieve common goals. more autonomy is given to members and therapists role shfts to providing guidance as needed

ex/ peer support group

Mature

purpose: provide a group setting where ppl can fully engage in fully developed group processes, including self-regulation, group roles, leadership, and collaboration. focus on supporting individuals in achieving personal growth and improving group dynamics

participants: typically used with individuals who are fully capable of complex social interactions and independent functioning

Key features: high level of interdependence with members taking on various roles and leadership responsibilities. Problem solving, group decision making and conflict resolution are integral

ex/ charity tourneys no coach

Types of groups

activity

psychodynamic

social systems

growth

Activity groups

small task directed groups

activity is vehicle of cohesion

shared process of doing

6 types described in literature:

-evaluation (assess occupational performance, cooking)

-task orientation (increase member awareness -yoga)

-developmental (leader teachers interactive skills)

-thematic (accomplishing set of activities)

-topical (have goals theyre learning and want to learn)

-instrumental (maintain levels of function and health)

psychoanalytic

achieve perosnality changes in members y working through individual conflicts

ex/eating disorder groups, DBT

social systems group

participation in group experiences guides exploration of group dynamics

ex/ sports teams, group work in school settings

Growth groups

-personal enhancement through the power of the group

-may be peer support or self help focussed

-may include educational components, chronic disease group

ex/ AA

Group models

-Colles' 7-step model (intro, activity, sharing, processing, generalizing, application, summary)

-functional group model (FoR-assumptions, Concepts -expected results, Assessment-intervention strat, Logical deductions-intervention principles)

Group and theory

Group theory: theory of how groups should be constructed based upon theories of group development

OT theory: groups are developed using basic and OT models of practice

Colles 7-step model- intro

-warm up introduce people

-open or closed

-where you may set group rules purpose

-overview of the session

Colles 7-step model- activity

-pick activity most important for skills were trying to work on

-need to be age and developmental stage appropriate

-make ut to not single people out

-have goals, leader skill, participant capacity, timing, adaptation

Colles 7-step model- sharing

ackowledgment and share experiences

Colles 7-step model- processing

we are expressing how we felt about the activity and dynamics

-feelings, group process, addressing dynamics

Colles 7-step model- generalizing

therapist reviews what happens in a group and tries to summarize members and generalize it, identify patterns present, responses

-look at summary, responses, patterns, energy

Colles 7-step model- application

we did this activity. Now, look at how youre applying outside the room, making it practical and the transferring of skills, encouraging members to try this outside, give something to talk about next session

-talk about everyday life, using new knowledge/skill

Colles 7-step model- Summary

summarizing sensing everyone off and tying things up with a bow

-ask others to summarize to make it more interactive

-look at goals, content, process

Group planning considerations

-structure-> long term care, rehab, community

-goals-> group goals, not individual client, what all members are gonna get

-assessment-> will they be a good fit? chronological age, cognition

-FoR-> helps us figure out the focus, what is the approach

-evidence->research, peer reviewed, published article

Group structure

-climate/environment (context)

-size (how many)

-timing (how long will it run)

-composition (who will partake inclusion/exclusion)

How to set goals

-individual vs group

-SMART goals (specific, measure, attain, realistic, timely)

-RUMBA (relevant, understand, measure, behavioural, achieve)

-client-centred/relationship focused intervention within a group

Assessing needs/gathering info

-identify client population and context of group (group by age, diagnosis, functional ability, goals/topics, look at who is NOT eligible)

-identify common occupational performance issues

To assess clients

-health status/ history, behaviour, cognition/motovation, goals, performance/participation restrictions, occupational performance issues, age/demographics

Frames of reference

set of interrelated internally consistent concepts, defiinitions, and assumptions that provide systematic description and prescirption for a practitioner's interation within a particular aspect of a profession's domain of concern

importance of FoR

-narrows issue down

-identifies which members most benefit

-suggests a leadership style

-determines approach

leadership style with For

-single: autocratic/authoritarian

-team/shared: democratic/ participant driven

-delegative/hands off/ laissex faire

Types of FoR

biomechanical, rehab, cog-behavioural, psycho-dynamic, neuro-developmental, humanistic, developmental, health promotion, acquisitional

What is a group protocol in OT

structure that informs ones reasoning and techniques used in onteractions within the group

Reasoning process

1. gather client info

2. chose FoR

3. Develop protocol

4. plan session

5. implement group

6. evaluate group process and outcome

see if successful (if not return to step 1 or 3)

Leadership Theories-Trait

individiuals do or do not possess "natural" leadership trait

Leadership theories-Situational

Individual leadership style suitable to a situation or type of group

-four categories of leader behaviour (telling, selling, participating, delegating)

-styles emerged (autocratic,democratic, laissez faire

Leadership theories-Functional

leaders emerge in naturally occuring groups out of necessity, usually based on these needs

leadership can be distributed so that the right skills are matched with specific tasks

Leader styles -OT context

Directive (autocratic)-> facilitatve (democratic)-> advisor (laissez faire)

goes from Leader centred<------> group centered

Directive/autocratic

Member characteristic->

Cognitive level: Low

Insight capacity: minimal

Group maturity: immature

verbal skills: poor

motivation: low

Activity Characteristics->

Structure: therapist selects activity

Goals: accomplish task

Instruction: therapist demonstrates/teachers

Group maintenance roles: mostlt done by therapist

feedback: given mostly by therapist

Facilitative/democratic

Member characteristic->

Cognitive level: medium/high

Insight capacity: fair-good

Group maturity: medium-high

verbal skills: average

motivation: medium

Activity Characteristics->

Structure: therapist and members select

Goals: learn skill from experience

Instruction: therapist and members teach process

Group maintenance roles: members share in leadership

feedback: members encourages to give feedback to each other

Advisory/ Laissez-faire

Member characteristic->

Cognitive level: high

Insight capacity: very good

Group maturity: mature

verbal skills: high

motivation: high

Activity Characteristics->

Structure: members select activity

Goals: understand the process

Instruction: members seek advice as needed

Group maintenance roles: members lead themselves

feedback: natural consequences from the environment

Leader focus and action

Task: action(s)- keeping info flowing, organizing, directing, ensuring others understand the role

role(s)-gatekeeper, organizer

Maintenance: Action(s) -encouraging participation, relieving tension and disputes, reinforcing members for contribution

role(s)-interpersonal support

A leader role-Before group

-planning, scheduling, selecting members, prep of site or location, materials and equipment

A leader role-during group (early stages)

-orienting, guiding, setting the climate and norms, clarifying goals and rules, engaging members

A leader role-during group (middle stages)

-adapting/modifying tasks, modeling, encouraging, harmonizing, giving and recieving feedback, summarizing, managing resistance

A leader role-during group (late stages)

-ensure preparation for closure

A leader role-throughout all stages

-reinforcing norms, time keeping, encouraging participation from ALL members, observing participation and roles

A leader role-after group

-Evaluating, record keeping, individual follow up, future planning

Co-leadership (advantages)

-mutual support

-increased objectivity

-increased knowledge

-learning from partner

-different roles

Co-leadership (disadvantages)

-splitting of group allegiance

-competition

-confusion for group members

-unequal contribution

methors of Co-leadership

shared

leader/observer

split responsibility

The big 5 personality test (OCEAN)

O: Openness to Experience: Measures your imagination, curiosity, and willingness to try new things.

C:Conscientiousness: Reflects your level of organization, goal-orientation, self-discipline, and dependability.

E:Extraversion: Gauges your sociability, assertiveness, and how much you draw energy from social interaction.

A:Agreeableness: Measures your compassion, cooperativeness, and tendency to get along with others.

N:Neuroticism: Assesses your emotional stability and tendency to experience negative emotions like anxiety, mood swings, and stress

The TP3 Communiction Styles Questionnaire

The Action-Oriented (or Driver/Controller) Communicator:

Characteristics: Direct, fast-paced, and focused on results and deadlines.

The People-Oriented (or Connector/Associator) Communicator:

Characteristics: Friendly, empathetic, and focused on team harmony and relationships.

The Idea-Oriented (or Innovator) Communicator:

Characteristics: Highly creative, visionary, and interested in big-picture concepts and future possibilities.

The Process-Oriented (or Analytical) Communicator:

Characteristics: Systematic, logical, and focused on step-by-step procedures, facts, and past data

Group termination

-group termination usually means the end of something

-individuals may experience a feeling of loss and/or anxiety

reasons for termination

-withdrawl

-denial or avoidance

-devaluing the importance of group

-silence/inactivity

-expression of frustration/anger or sadness

-early departure

-raising new issues

Premature termination can include:

-dropping out early

-being unable to make a commitment to the group

-ending session early

-having made a commitment to the group but leaving before the work is complete

Healthy termination-Leadership responsibilities

-Review group experience

-review group/individual concerns related to separation/loss

-counselling skills

-finish unfinished business

-feedback on skill learned

-generalizing the learning

-Address closure throughout

-encourage emotional expression

-compare early experiences to later

-provide a structured end (token of completion)

-help members make a transition plan after if needed

-refer on if needed

factors that affect termination

-resolution of issues

-sociocultural background

-group structure and culture

Three main privacy laws

personal health ifnormation protection act (PHIPA)

personal information protection and electronic documents act (PIPEDA)

privacy act

*remind participants to keep group confidential

Making group goals

Who: Who are the clients

why: Why will the group make a difference to members

What: purpose of the group

action: what are the observable results of the intervention

condition: under what circumstances will the members complete the action

criteria: how will success be measured

Group evaluation-formative

informs group process and progress

-throughout session, identified gaps to improve goals, through informal approaches

*group member feedback, flexible and adaptive

group evaluation-summative

to assess overall outcomes/goals

-at the end of the group, collect evidence of outcomes/goals, do it through measures

*through qualitative or quantitative measures

Model for improvement

Plan, do, study, act

Occupational performance issues amongst children

socil skills, emotional regulation, fine motor skills, gross motor skills

Group setting Youth

school, naturally occuring groups (friends), inpatient/outpatient programs (kidsinclusive), mental health hospitals, community based settings

benefit of Youth groups

-increases opportunity to socialize, play, communicate (enhances developmental skills)

-increased oppertunities to learn (negotiation, compromise, sharing, turn taking, and problem solving, and assertivenes)