Group Process

Occupational Therapy Tool of Practice

Group Process
The combination of structured, adapted group process
and tasks or activities aimed at fostering change and
adaptation in people with acute or chronic illness,
impairment, or disability.
Group Process
Occupational Verbal
Group Properties Peer Supp0rt
Therapy Psychotherapy

Leader
Leader involvement
involvement Very central Not central Not central
Purposeful
Purposeful activity
activity Very central Not central Not central
Structure
Structure and
and format
format Very central Not central Somewhat
Somewhat central
central

Practice Very central Somewhat

Somewhat central
central Not central
Teaching
Teaching and
and learning
learning Very central Somewhat
Somewhat central
central Very central
Socialization
Socialization and
and outside
action
action
outside Somewhat
Somewhat central
central Not central Very central
There and then Not central Very central Somewhat
Somewhat central
central

Here and now Very central Very central Very central

Historical Overview
Occupational therapy’s unique perspective of the
group as a format for service delivery is further
understood with descriptions of past and current
practices

Focus of
Era Group
Involvement
Project Era (1922-1936)
●
Project completion
●

Socialization Era (1937-1953)

●
Social activity
●

Group Dynamics – Process Era (1954-1961)

●
Interpersonal dynamics
●

Ego Building – Psychodynamic Era (1962-1969)

●
Ego reconstitution
●

Adaptation Era (1970-present)

●
Social adaptation
●
Definitions and Types of OT groups
In a survey of group practice, Howe and Schwartzberg
identified 10 types of groups commonly used in OT
1. Exercise
2. Cooking
3. Tasks
4. Activities of Daily Living
5. Arts and crafts
6. Self-expression
7. Feelings-oriented discussion
8. Reality-oriented discussion
9. Sensorimotor or sensory integration
10. Educational
Definitions and Types of OT groups
Occupational Therapy Group Variables
1. Setting
2. Therapeutic factors
3. Goals: short-term and long-term
4. Duration of group
5. Composition of group
6. Time frame and format
7. Population
8. Group size
9. Frame of reference
10. Open versus closed membership
11. Member selection and preparation
12. Contraindications
Definitions and Types of OT groups
Occupational Therapy Group Settings, Goals, and
Techniques
Group Orientation or Inpatient Goals and Outpatient Goals and
Format Techniques Techniques
Interpersonal and dynamically Support; containment Social change; insight
oriented

Behaviorally and educationally New skills and attitudes; structure; New skills and attitudes; structure;
oriented here-and-now experiences here-and-now experiences

Support Groups Acceptance Legitimization; information;

decreased isolation

Maintenance and rehabilitation safety; reevaluation; discharge adaptation; resources; minimization

groups planning of stress
Models in OT: roles of leader, group
member, and activity
Several different group approaches are used in OT and
to varying degrees, each has its own articulated
theoretical perspective.
Group Approaches Theoretical Considerations
Task-Oriented Group Theoretical Base

Functional Group Model Function-Dysfunction Continuum

Directive Group Therapy Behaviors Indicative of function or dysfunction

Activity Group Postulates of change

Developmental Group

Psychoeducational Group
Integrative Group Therapy Structured Five-Stage
Approach

Peer Support Group

Models in OT: roles of leader, group
member, and activity
Sample roles and phases of Group Development
Roles Formation Development Termination
Leader Set climate Grade actions Aid separation
Provide structure Facilitate Reinforce gains
Offer support

Member Identify purpose Collaborate Evaluate

Initiate Express reactions

Activity Form goals Purposeful action Review

Establish trust
Theory and Practice

Procedures of
assessing, designing,
planning and
Observation Interaction evaluating, analyzing
and responding, and
documenting
Observation
The leader looks for information about the group’s
process in several areas. All aspects of the group are
considered dynamic and therefore are constantly
changing, which makes observation difficult and
challenging
Observation
Group as system: group process, phase and dynamics
 In observing the group’s development, leaders look at the
group’s phase in relation to decision-making patterns,
membership and leadership roles, and the level and type of
participation patterns, such as who initiates communication,
who talks to whom, and the tone of voice members and
leaders use
Observation
Individual member in system
 The leader observes the group member in relation to other
members, the leader, and group task. These observations of
group dynamics may be informal or structured around a task
designed to demonstrate certain skills and behaviors, such as
cooperativeness, mobility, attention span, memory,
concentration, and assertiveness.
 Depending on the setting and length of treatment, when

possible, the therapist may also conduct pregroup intervews

as a means to observe, establish rapport, and gain
information about a potential group member
Observation
Leader and co-leader self-awareness
 It is common practice for group leaders to write group process
notes after each group meeting. Therapists describe their
personal reactions, thoughts and the critical events in the
group.
 It is beneficial to share observations of the group and of each

other with a co-leader. These observations are helpful in

clinical supervision and in analysis of countertransference.
Observation
Group, member and leader observations
 The observation of group process is conducted at the levels of
1. The group
2. The individual members in relation to the group
3. The individual members and the group in relation to the
leader or co-leaders
4. All in relation to a task or activity
Interaction
An important aspect of group therapy practice as well
as individual therapy practice is the therapist’s use of
self in the group. Leaders serve particular roles and use
techniques that they are continually attempting to
perfect to achieve therapeutic goals.
Interaction
Leader
 Primary roles: observer, group designer, role model, climate-
setter (supporting and substituting actions as needed in the
group)
 Techniques commonly used by the leader:
 Therapeutic use of self

 Attending and listening

 Self-disclosure

 Empathy

 Feedback

 Confrontation

 Activity analysis and adaptation

Interaction
Group members
 The therapist and members of a group have work to accomplish in a group.
Some problems commonly surface in group work include:
 Dependency on the leader

 Difficulty setting goals

 Misdirected anger

 Competition among group members

 Subgrouping

 Withdrawal from the group meeting

 Premature termination from the group

 External conflicts and pressure (eg, from family)

 Interference outside the group (eg, interruptions from other services, such as

laboratory)
 When one of these problems arises, it must be examined separately and

interpreted differently depending on the clinician’s theoretical framework.

Interaction
Co-leaders
 Co-leaders assist in the physical and emotional management
of the group.
 Co-leaders are model participants in the group,

demonstrating healthy interaction and ways of resolving

conflict with others.
 When possible, a more experienced therapist co-leads with a

beginning therapist. The experienced therapist serves as a

model and can also provide peer supervision
Procedures
Group leadership in OT requires time in designing the
overall group plan and individual session plans. The
leader also evaluates individual sessions and member
progress and overall group progress
Procedures
Assessing individual members and the group
 Usually begins with meeting the patient before the first
session
 May have a formal referral or see a group member as part of a

larger program
 Groups may also be used for the sole purpose of evaluation
Procedures
Designing
 The design is usually written in the form of a group protocol
that includes:
1. Group and, if possible, individual member short- and long-
term goals
2. Selection criteria for membership
3. Group size and composition
4. Group methods, techniques, and activity modalities
5. Time and location of the group meeting and group leaders’
names
6. Referral procedures
Procedures
Planning and evaluating
 Evaluation is continuous throughout the group’s existence.
 After evaluating each session, the leaders create detailed

individual group session plans with categories similar to the

overall, more generalized plan.
Procedures
Analyzing and responding
 Each group situation is analyzed separately and continuously
if the group is ongoing
 To respond, the therapist uses the group’s history as well as

individual members’ histories of strategies that were

successful or unsuccessful
Procedures
Documenting
 Therapists usually document each patient’s progress
separately after group sessions as well as keep records of the
group’s progress as a whole