Final Exam Flashcards
Group definitions (4 points)
a gathering of two or more people based on a common goal
- a dynamic interaction among people
- group consciousness that exists among members
- NOT simply a random mix of people ….a group implies a connection between members
Therapeutic Group
formalized process where there is a gaol, and there is expected change in knowledge, skills or personal beliefs
Why Groups (4 points)
a natural environment to promote social interaction
- some outcomes can only be achieved in groups
- convenient in setting with homogeneous client populations
- Perceived as cost-effective by administrators
11 Therapeutic Factors
- Installation of hope
- Universality
- Imparting information
- Altruism
- Corrective recapitulation of the primary family group
- Development of socializing techniques
- Imitative behaviour
- Interpersonal learning
- Group cohesiveness
10 Catharsis - Existential factors
Historical evolution of OT groups 7 time periods
-Promoting moral treatment of patients
-1920’s and 30’s: Project era
-1937 - 1953: Socialization era
-1954 - 1961: Group dynamics-
1962-1969: Psychodynamic era
1970s to 90s: adaptive era
1990 to present : wellness era
What makes it an OT group?
common characteristics:
- Groups are one type of “client”
- The CPPF addresses individual or group clients
Common characteristics:
- small group (6-10members)
- Task oriented vs. verbal
- Focused at increasing performance or specific skills
- Directed at increasing skills for daily living
Why do OTs use therapeutic groups as a means of change?
-members can…… (4 points)
- Experience feeling of belonging
- be with others who have common problems that can be shared
- observe the problems, struggles, behaviours, interactions styles and coping mechanisms of the others
- Experience support to enable individual growth
Ot group Advantages
- Provide an occupational-based experience
- Natural environment for social support, teaching and learning
- Empower group with shared leadership and opportunities to excel
- Can be cost-effective ….
- -> BUT requires therapist skill to ensure individual attention
Leadership Functions
- Emotional activation
- Caring
- Meaning attributions
- Executive function
Group formats (4 main points)
- Less structure and more client choice:
- -> higher quality social interactions and increased personal meaning
- Need to tailor structure to functional levels of participants
- The occupational base of groups can have a positive effect on member wellness
- must balance activity with member interaction
Where do OT groups happen and why?
Duncombe and Howe (1985) survey (300 surveys with 40% response rate)
- 60 % of respondents used groups asa form of treatment
1. large general hospitals
2. Schools
3. rehabilitation centers and psychiatric hospitals - types of groups used included exercise, cooking activities of daily living, task, arts and crafts, self-expression, feeling-oriented discussion, sensorimotor and sensory integration, and education groups.
Duncombe and Howe (1993) survey (309 surveys with 62% response rate)
- 52% of respondents used group as a form of treatment
- Fewer therapists in hospitals and more in community programs and schools
- Most groups activity based and fewer were discussion based
Higgins, Schwartzberg, Bedell and Duncombe, 2014 ( 323 respondents with 273 complete online surveys (85%) using snowball sampling through state associations (8%% OTs and 14% OTAs)
-50% of OT respondents used groups in current practice
-69% of OT respondents had some kind of training or education on therapeutic groups
Settings:
1. School
2. Hospitals
3. Outpatient settings
-Exercise, including yoga and range of motion, was the most common group modality used, with task groups and sensory-based groups reported as high use
-groups use increases directly with years of experience for occupational therapists, with the highest group use by occupational therapists with more than 20 years of experience
Higgins, Schwartzberg, Bedell and Duncombe, 2014 (the reported benefits of group treatment seemed to fall with two categories)
a) environmental benefits, which include time and cost-effective forms of treatment
b) vclient factors, which include peer role modeling and support, improved communication and social performance and feedback and advice from peers
Figure 1. Practice area by role (OT and OTA )
Higgins, Schwartzberg, Bedell and Duncombe, 2014
OT: 1. School 2. OPT 3. Hospital 4. Other OTA: 1. LTC 2. School 3. Rehab 4. Hospital
Higgins, Schwartzberg, Bedell and Duncombe, 2014
Benefits of group treatment
Feedback cohesiveness communication/Participation Self-Esteem Instillation of hope Role Modeling Insight and Learning Skill Performance Goal Outcome Time
The changes over time from 1985–>1993–>2014 (4 points)
- Groups remain an important intervention for OTs
- 50-60% of respondents used groups as a therapeutic modality
- decreased use over time in physical health settings
- Consistent in mental health settings
- Increased in school and community settings
Group Norms
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
Group major characteristics (5) Of what a group is
- Dynamic interaction among members
- A common goal
- A proper relationship between size and function
- A dependence on volition and consent
- A capacity for self-determiniation
Group Structure is influenced by a number of elements including:
- Historical context and climate
- Composition of members
- Group purpose and member goals
- Leader and member interaction
- Group norms and size
Historical Context and climate
historical and environmental context
historical: elements of social and environmental context outside the group, is a unique factor influencing the structure of the group
environmental: the mission of the group
climate: physical and interpersonal or emotional environment
Group Composition
Open versus closed groups
number of sessions
Voluntary or involuntary membership
Two factors that have found to attract members to a group are:
- The group itself is viewed as desirable object, and
2. Group membership is viewed as a way to satisfy needs that exist outside the group
Group Purpose and goals
-composite of the goals of individual members
-groups fare better when members are clear about the group’s purpose and goals as well as their individual goals
might have more than one goal
might have individual goals
spend more time together on objectives agree on goal faster
Four steps that enable a group to increase its productivity are:
- A group should have at the outset a well-defined understanding of the goals it wants to reach.
- The group should be aware of its own process. It should continually evaluate the process and make necessary changes
- The group should be aware of and understand the skills, talents, and other resources within its membership
- The group should create new tasks as needed and discontinue tasks no longer compatible with the goals
Leader and member Interaction
interaction can be predominantly verbal or physical and activity-oriented
might be formal and highly structure or spontaneous and loosely structured
Group members are viewed as coping with and working though their tensions in three stages:
- Through fighting or fleeing
- Through dependence and counter-dependence on the leader
- Through a process of pairing
Dependence and power relations (groups proceed along a continuum development that reflects two stages, within which are subphases)
a) Dependence-flight
b. Counter-dependence-flight
c. Resolutions-catharsis
d. Enchantment-flight
- Group interdependence (groups proceed along a continuum development that reflects two stages, within which are subphases)
e. Disenchantment
f. Consensual validation
discipline of social work, which described five stages of group development
- Pre-affilation
- Power and Control
- Intimacy
- Differentiation
- Seperation
Small-group dynamics were investigated and described by Tuckman (1965), who identified five stages of group development:
- Forming
- Storming
- Norming
- Performing
- Adjourning
Johnston and johnston: groups will develop according to seven stages
- Defining and structuring procedures
- Conforming to procedures and getting acquainted
- Recognizing mutuality and building trust
- Rebelling and differentiating
- Committing to and taking ownership of the goals, procedures, and other members
- Functioning maturely and productively
- Terminating
Parallel
Members are involved in individual pursuits with little need for interaction sand caste example
Project
Members engage in short-term tasks that have a common theme and require some interaction, cooperation, or competition
-ex pre adolescents Pizza each have jobs parent provides encouragement and facilitating
Ego-Centric Cooperative
Group members are able to work together on long-term activity through cooperative interaction
task is primary focus but more capable of responding to social-emotional level
ex. adults with developmental disabilities
leadership are still needed doing art
Cooperative
Members are encouraged to address one another’s social and emotional needs in concert with activity goals of the group.
ex. leader is advisor or facilitator
lions club members are able to carry on without leader being present
Mature
Members balance meeting task and social-emotional roles as the leader is seen as coequal member of group
-long time co-workers or close-knit friends
these groups are not age specific
Activity Group
Group Purpose and Goals
activity groups are small, primary groups in which members are engaged in a common activity or task is directed toward learning and maintaining occupational performance
seven-step format is to allow for “maximum integration of learning by members” (Cole, 2005, p. 3) and consists of:
1 .Introduction
- Activity
- Sharing
- Processing
- Generalizing
- Applying
- Summary
Mosey’s Six Major Types of activity groups
- Evaluation groups
- Task-oriented groups
- Developmental groups
- Thematic groups
- Topical groups
- Instrumental groups
Intra-Psychic or Psychoanalytic Groups
achieve characterological and personality changes in each group member by “working through” the personal, intra-psychic and historical antecedents of present maladaptive personality patterns.
-transference
Examples: eating disorder groups, DBT groups
Social system Groups
Participation in a group experience guides exploration of group dynamics
ex. sports teams, group work in school settings, families
Growth Groups
Personal enhancement through the power of the group
- may be peer support or self-help focused
- may also include educational components, such as chronic disease groups
Group Theory
Theories of how group should be constructed, based on the theories of group development
OT theory
groups are developed using basic and occupational therapy models of practice
Cole’s 7-step model
- Introduction
- Activity
- Sharing
- Processing
- Generalizing
- Application
- Summary
Cole’s 7-step model : assumptions
Adaptive occupational functioning can promoted within a group setting
- The group setting provides a safe and rich learning environment
- The group leader is an active agent in helping members build skills, and transfer learning to the world outside of the group setting
- the role of the leader is determined by the theoretical approach used in groups
Relevance of theory
Each group is based on a pertinent practice theory (frame of reference)
–> e.g. humanistic, cognitive-behavioural, developmental, sensory motor
Depending on the theory used, the stages may look different
-Example: Introduction stage
–> using a humanist philosophy should instil trust, respect, and caring and activities that model self disclosure
–> Not always used in C-B and psychoanalytic groups
-Always used in MOHO-based groups
Step 1: Introduction
- During initial sessions, the therapist ensures all members know one another, and are oriented to the purpose of the group
- In later sessions, introductions are orientation may not be necessary in closed groups, depending on cognitive status of members
- This stage sets the mood and tone for the group: group rules can be introduced
- A warm-up activity can be used to break the ice
- End with an overview of the session plan for today
Step 2: Activity
- Activities are chosen based on client therapeutic needs, and are consistent with the theory base in use
- Activity synthesis is used to build activities that will be suitable for skill or knowledge development
- Leader presents the activity clearly at the level appropriate to the clients
- One activity may last over several sessions
Step 3- Sharing
Each member shares his/her experiences of the activity with other group members
- Could involve showing what they have completed during the activity
- In some cases, sharing may be combined with the processing and/or generalizing steps
Step 4- Processing
Members express how they felt about the activity, their interactions with other group members, and the experience as a whole
-Group dynamics can be brought to the table for airing
Step 5 - Generalizing
Therapist reviews what happened in the group, and tries to summarize members’ ideas, and the overall learning that occurred
Step 6: Application
- therapist helps group members understand how the ideas pulled out during the generalization step can apply outside of the group
- Group members may be challenged to try new skills outside of the group
- Group members may help one another problem solve around issues they will encounter in real-world setting
Step 7: summary
- Review of the overall group goals and outcomes
- can include the points raised in Generalization step
- Emotional content of the group should be recognized
- Group members may contribute
- Therapist can thank members for their participation and sharing
- Can take up to 5 minutes of group time
Pros and Cons to Coles 7-Step Model
Pros: structure, consistency between leaders and group members, easy for facilitating, really makes sure they walk away with the feeling of achievement
Cons: not very flexible, things might take longer than planned
Functional Group Model
Schwartzberg, Howe and Barnes
Designed for clients with a wide range of impairments:
- Physical injury or illness
- emotional disorders
- Congenital and intellectual disabilities
- aging
Functional group model Assumptions:
- Individuals are self motivated to explore their environment and achieve mastery over it
- Adaptation occurs through occupation
Functional group model Assumptions about group setting:
- provides opportunities for social, emotional and skill development through dynamic interaction and opportunity for feedback and support
- can address individual needs
- Can be a powerful setting for engaging individuals in a change process
- Allows for member change and progression over time
Functional group Model approach:
Group leader
- Plans the group and individual sessions
- Facilitates group process
- Can also foster control and shared responsibility in the members
- may be less involved over time
Functional Group Model - The group experience:
- objects guide action
- Action enhances members’ sense of control and well-being
- Talking is use to clarify doing
- The leader encourages members to take ownership of the group in whatever capacity they can
- Action is used enhance members’ sense of internal control and to promote adaptation
- Focus is on behaviours, not changing pathology
Functional group model steps: (6 steps)
Steps are not as defined as Cole’s model:
Follows general Group Theory:
1. Plan
-Have clear goals for the group and individuals
2. Begin
-Create a warm and inviting climate
-Use introductions/ice breakers as necessary
3. Orient Clients to the sessions agenda
4. Facilitate task or activity
5. Ensure that processing of the experience occurs
6. Close the session
-Summarize learning/experience
-Discuss next session
Pros and Cons of Functional Group Model
Pros: less reflecting could be better for people with cognitive impairment
- Allows for flow and spontaneity and flexibility
- Possibility for grow
- Leader can step away
Cons:
expecting a certain level of function
-might be more challenging for someone to run it
Functional model vs Cole model
Cole: more prescriptive-has lots of ideas and models
-frames filed in bible
Functional: a lot more discretion to the person running it
-someone inexperienced may have trouble with this
Look at the two examples (cole and functional model) and compare
Talk about it
Group Structure: How will you consider: (4 categories)
Climate
Size
Timing
Composition