Groups Final Semester 1

Cole's Seven Steps:

1. Introduction

2. Activity

3. Sharing

4. Processing

5. Generalizing

6. Application

7. Summary

Client Centered Therapy

provides guidelines that help occupational therapists develop skills for forming and maintaining therapeutic relationships

Yalom's Factor (12)

1. Instillation of hope

2. universality

3. imparting information

4. altruism

5. correct recapitulation of primary family group

6 social learning

7 imitative behaviors

8 interpersonal learning (interpersonal relationships, corrective emotional experiences, social microcosm)

9 group cohesiveness

10. catharsis

11. existential factors

12. self understanding

Installation of Hope (IOH)

As clients observe other members father along in the therapeutic process, they begin to feel a sense of hope for themselves

creates a feeling of optimism about one's future and the ability to cure that which need not be endured and endure that which cannot be cured.

Universality

helps group members realize that they are not alone in their suffering and the problems they face and that others are willing to support them

Imparting Information

educates and empowers group members with knowledge pertaining to their specific situation, whether it be information about a resource or someone's personal story of how they dealt with difficulties and experienced success.

Altruism

helping other group members. As one comes to recognize they have something of value to provide their fellow group members, they gain in self-worth and confidence.

The corrective recapitulation of the primary family group

allows for the rememberence of past family and childhood events

Clients learn functional patterns of communication, interaction, and behavior

Social Learning

encourages and advances relating and social skills such as tolerance, boundaries, empathy, and conflict resolution.

learning through observation

imitative behaviors

witnessing other members apply new and appropriate methods that disrupt their old, dysfunctional patterns.

Members and leader modeling their behavior for others

Interpersonal learning

learn about relationships and intimacy, members can openly share and communicate; in return, they receive support and respectful feedback, perhaps for the first time ever.

Members and leader modeling their behavior for others

Group cohesiveness

gives members a sense of belonging, acceptance, and value, providing both a nurturing and empowering experience.

When members feel a sense of belonging

catharsis

Clients learning to express their own feelings, speak openly about what bothers them and expressing strong feelings about others

Existential Factors

to find meaning in their life. Includes the process of understanding and accepting the reality of the human condition, with all its frustrations and limitations.

the group provides opportunities for clients to explore the meaning of their life and their place in the world

Yalom

Orientation:

hesitant participation, dependency and search for meaning

Conflict:

members start making personal comments/criticism

rebellion of group structure

leaders must promote awareness

cohesive maturity:

conflicts of previous stages are resolved

high morale and group spirit

sense of trust and nonjudgmental acceptance

Therapeutic Use of Self

calls for a dynamic, personal, and subjective investment in the client during which the therapist makes moment-to-moment decisions about how to initate and respond to the clients interpersonal characteristics

empathy and intentionality

requires therapist to strive toward a fundamental understanding of our clients as human beings at an interpersonal level

Therapeutic Relationship

"trusting connection established between therapist and client through collaboration, communication, therapist empathy, and mutual understanding"

Mosey's Developmental Theory

Repeats normal developmental sequence

How does a child learn to interact?

Primary group: Naturally occurring in life

Family is one type

Nonfamilial primary groups:

Peers, school, clubs, sports team

Moseys Group Interaction Skill

Parallel group (18 months to 2 years):

group interaction is not required

Project group (2-4 years):

interaction required to complete task

short term activity with 2 or more people

Ego-Centric Cooperative Group (5-7 years):

activity selected by members

long term activity with 5-10 people

Cooperative Group (9-12 years):

fufilling needs more important than the activity itself

Mature Group (15-18 years):

carry out all social-emotional components

Treatment of Group Interaction Skill Deficiency (Mosey)

group interaction skill defined, "ability to participate in aa variety of groups in a manner that is satisfying for oneself and for ones group members"

Parallel Groups (mosey)

Each Member:

engages in an individual task as opposed to a group activity

is aware of others in the group

initates some verbal and nonverbal interaction with others

Leader Role:

director, chooses and assists with task

meets all social-emotional needs of members

Key Example: Group members engage in activities side by side, such as drawing or watching a movie, with minimal interaction.

Project Group (mosey)

Members:

occasionally engage in group activity according to their own whim

seek some assistance from others

a little more peer activity

Leaders:

chose activity

assists group with task

Key Example: Completing a puzzle together while learning to cooperate and share responsibilities.

Egocentric Cooperative Group (mosey)

Members:

chose the task

aware of goal relative to the task

aware of group norms

Leaders:

support and guide

act as a role model

Key Example: Group members work together to make a meal, dividing tasks and communicating effectively.

Cooperative Group (mosey)

Members:

make their own wishes, needs, and desires known

participates in group activity but seems concerned primarily with their needs and the needs of others

Leaders:

advise

Key Example: A grief support group where participants openly share memories and feelings.

Mature Group (mosey)

Members:

responsive to all group members

takes a variety of task roles

able to share leadership

promotes a good balance over task and accomplishment

Leaders:

interacts as co-equal member

Key Example: A community group that plans and executes an event, prioritizing the group's needs over individual desires.

Moseys Leadership style based on group

Parallel: directive leadership

Project: Directive leadership

Egocentric: facilitative

cooperative: facilitative

mature: advisory/participation

S in Soap Note

Subjective

clients report of their own needs, limitations

their perception of treatment & progress

EX: "I had a bad night last night"

O in SOAP Note

Objective

measurable & quantifiable

length of time, location, therapeutic reason for treatment

start with client engaged in __ minute session to work on ___

A in SOAP note

Assessment

analysis and interpretation of events

clinical reasoning

end with client will benefit from ____

P in SOAP note

plan

whats the OT's next plan

ex. continue direct OT services 40 minute session 1/week to support ___ with re eval in ___ weeks. Next session to utilize __

The Intentional Relationship Model (IRM)

should help you make the process of establishing a successful relationship with clients easier and clearer

should complement the usual concepts and strategies of OT

4 central elements of IRM

1. clients interpersonal characteristics

2. inevitable interpersonal events that occur during therapy

3. therapeutic use of self

4. occupational engagement (mechanism of change)

Enduring Interpersonal characteristics

•Knowing the client at a baseline level

•Identifying the interpersonal characteristics that are stable through time and across people and contexts

consistent patterns of emotions, behaviors, and reactions

Situational Interpersonal Characteristics

Emotions, behaviors, and reactions that are context-specific and INCONSISTENT with how the client typically interacts.

14 categories of client interpersonal characteristics

1. communication style

2. tone of voice

3. body language

4. facial/postural expression

5. response to change and challenge

6. level of trust

7. need for control

8. approach to asserting needs

9. predisposition to giving feedback

10. response to feedback

11. response to human diversity

12. orientation toward relating

13. preference for touch

14. interpersonal reciprocity

12 categories of interpersonal events

1. Expression of strong emotion

2. Intimate self-disclosures

3. Power dilemmas

4. Nonverbal cues

5. Verbal innuendos

6. Crisis points

7. Resistance and reluctance

8. Boundary testing

9. Empathic breaks

10. Emotionally charged therapy tasks and situations

11. Limitations of therapy

12. Contextual inconsistencies

The therapist role in IRM (3)

1. interpersonal knowledge and skill base

2. use of therapeutic modes

3. interpersonal reasoning

The 6 therapeutic modes

1. Advocating

2. Collaborating

3. Empathizing

4. Encouraging

5. Instructing

6. Problem Solving

Advocating Mode

Ensuring that the client's rights are enforced and resources are secured.

May require the therapist to serve as a mediator, facilitator, negotiator, enforcer, or other type of advocate with external persons and agencies

Collaborating Mode

Expecting the client to be an active and equal participant in therapy.

Ensuring choice, freedom, and autonomy to the greatest extent possible.

Empathizing Mode

Ongoing striving to understand the client's thoughts, feelings, and behaviors while suspending any judgment.

Ensuring that the client verifies and experiences the therapist's understanding as truthful and validating.

Encouraging Mode

Seizing the opportunity to instill hope in a client. Celebrating a client's thinking or behavior through positive reinforcement. Conveying an attitude of joyfulness, playfulness, and confidence.

Instructing Mode

Carefully structuring therapy activities and being explicit with clients about the plan, sequence, and events of therapy.

Providing clear instruction and feedback about performance. Setting limits on a client's requests or behavior.

Problem-Solving Mode

Facilitating pragmatic thinking and solving dilemmas by outlining choices, posing strategic questions, and providing opportunities for comparative or analytical thinking

Therapeutic Relationship at the macro-level

occurs outside of the interpersonal events that occur during therapy

Therapeutic Relationship at the micro-level

is influenced by the interpersonal events of therapy

Therapeutic Relationship Functions

support to occupational engagement

a place where the emotions and coping processes associated with the client's impairment and its implications for occupational participation

Underlying principles of IRM

1.Critical self-awareness

2.interpersonal discipline

3.head before heart

4. mindful empathy

5. grow your interpersonal knowledge

6. wide range of therapeutic modes can work and be used interchangeably

7. client defines successful relationship

8.activity focusing balanced with interpersonal focusing

9.application of IRM applied with core values and ethics

10.Cultural competency is central to practice

COAST goals

C: client

O: occupation

A: assistance level

S: specific condition

T: time

C in COAST goals

the who

ex. client will

O in COAST goals

essential focus on the goal

ex. participate in a circle

A in COAST goals

level of independence

ex. with a visual sequence model

S in COAST goals

condition which the client is expected to perform the action

location, adaptive equiptment, modified technique

ex. from w/c level in a rehab kitchen

T in COAST goals

ex. within 4 weeks

MOHO Volition

Motivation

MOHO Habituation

roles and routines

MOHO performance capacity

mental and physical skills

Dunn's 4 sensory processing patterns:

sensation seeking (hypo responsive)

sensation avoiding (hyper responsive)

sensory sensitivity (hyper responsive)

low registration (hypo responsive)

Ross's 5 Stage of groups

Stage I: acknoledgement of group members

Stage II: gross motor movement

Stage III: (30 mins) focus on attaining goal calming

Stage IV: cognitive stimulation

Stage V: resolution and termination

Directive Leadership Style

defines the group, activity, and structure

sets goals, structure, and in charge of activity

works with: peds, neurodevelopment, developmental delays

Facilitative Leadership Style

decisions are made by group, taking on roles allowing choice

Advisory Leadership

serves as a consultant

higher functioning groups

not necessarily goals and structure

Open Groups

Members may join and leave at any time

Closed Groups

Members join at one time

Runs for a set period

Tuckman

Forming

Storming

Norming

Performing

Reforming

Bion

Flight

Fight

Unite

Schutz

Inclusion

Control

Affection