Group Leadership in
Occupational Therapy
Group leader functions fig 6-1
 Task – activity functions:
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Teach
Supply equipment
Organize
Give feedback
 Social-emotional functions:
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Give support and meet members needs
Enable communication and self-expression
Motivate and facilitate group cohesion
Leaders role – Activity Group
Mosey’s Group Interaction Skills
 1. Parallel group
 2. Project (Associative) group
 3. Egocentric (Basic) cooperative
 4. Cooperative group
 5. Mature group
Parallel Group
Each member:
 Engages in some activity, but acts as if
this is an individual task as opposed to a
group activity
 Is aware of others in the group
 Initiates some verbal or nonverbal
interaction with others
 Appears to be relatively comfortable in this
situation
Parallel Group, cont.
Leader role:
 Chooses and assists with task
 Meets all social-emotional needs of members
 Enforce inappropriate behavior such as
engaging in the task, Answering questions,
shape behavior by giving praise and ignoring
inappropriate behaviors
Project (Associative) Group
Each member:
 Occasionally engages in the group activity, moving in
and out according to his or her own wish
 Seeks some assistance from others
 Gives some assistance when directly asked to do so
 Competes, cooperates with therapist prompting
Leader:
 Assists group with task and meet members needs
 reinforces behaviors when two or more members work
together or interact
Egocentric-Cooperative Group
Member behaviors:
 Aware of group’s goal relative to the task
 Acts as if he belongs in the group
 Willing to participate
 Responsible for organizing their activity
 Not overly competitive
Leader
 Less of director role and more of a role model
 May make suggestions and give assistance
 Meet love and safety needs
Cooperative Group
 Meets needs of other members and express feelings
Leader
 Consultation
 Participant
 Makes own wishes, desires, and needs known
 Participates in group activity
 Both members and leader have mutual responsibility
for the group activities and reinforcing behavior
Mature Group
 Flexibly take on various roles
Leader
 Acts as group member
 Responsive to all group members
 Take a variety of task roles
 Take a variety of social-emotional roles
 Able to share leadership
 Promotes a good balance between task
accomplishment and satisfaction of group members’
needs
Leader roles- Support Groups
 Creation and maintenance of the group
 Culture building
 Activation and process illumination
 Dealing with transference
Group Leadership Styles
in OT
Leadership Theory: Kurt Lewin
 Leadership experiment at boys’ summer
camp (1939)
 Used 3 fundamental styles: Autocratic,
democratic, and laissez faire
 Autocratic: Complete control
 Democratic: Members make choices, share
leadership responsibilities
 Laissez faire: Lets group do what it wants
Lewin’s Conclusions
 Autocratic groups:
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Highly productive
Poor quality work
Created hostility and resentment in members
Dependency on leader
 Laissez faire groups:
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Independence from leader
Low productivity and low morale
Lewin’s Conclusions, cont.
 Democratic groups:
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Highest morale
Highest group cohesiveness
Lower productivity but higher quality work
Most resembles the “facilitator” role in OT
 Lewin’s three styles were a prototype of
group leadership for many years
 Not always a good fit for OTs
Group Leadership Styles
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Types of Political
Leadership
1. Autocratic
2. Democratic
3. Laissez-faire
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Types of Occupational
Therapy Group
Leadership
1. Directive
2. Facilitative
3. Advisory
Directive Leadership
 Therapist determines structure, activity, and
processing
 Therapist takes an active role in shaping
member participation
 Communication groups are an example
 Group goals are achieved through active
leadership
Directive Leadership is Appropriate
When:
 Members have cognitive impairment, poor capacity
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for insight, immaturity, poor verbal skills, or low
motivation
Specific goals and activities are desired
Topic is educational and requires therapist
expertise/demonstration
Most group roles are performed by the leader
Feedback to members given mostly by the leader
Facilitative Leadership
 Leader gathers support from members
 OT earns their support by giving them
choices and asking them to collaborate in
reaching goals
 Presumes a certain level of ability and
rational thought
 Allows group to experience advanced levels
of group development
Facilitative Leadership is Appropriate
When:
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Members have a middle-high level of cognition and capacity
for insight
Members have at least a medium level of maturity, verbal
skills and motivation
Members are capable of making choices of activity, topic,
structure
Members can learn from experience
Therapist can delegate some leadership roles to members
Members are encouraged to give each other feedback
Therapist/leader does not do anything for the group that they
can do for themselves
Advisory Leadership
 Assumes high level of functioning
 Appropriate for more informal activities
 Assumes motivation of members
 OT leader acts as resource
 OT imparts information as needed
Advisory Leadership is Appropriate
When:
 OT’s role is consulting, wellness, or care-giver
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education
Members have high cognition, verbal skills, insight
capacity, and motivation
Members have selected a specific activity or topic
area
Members can seek advice from leader on asneeded basis
Members lead their own group and experience
natural consequences from the environment
Role of OT Group Leader
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Select members
Design group based on client needs
Set goals, write group protocol
Determine best leadership style based on client
needs and preferences and purpose of the group
 Oversee group roles, maintain therapeutic norms,
support positive efforts of members
 Process group according to member needs
 Evaluate progress and determine group outcomes
Co-Leadership
 Advantages:
 Offers mutual support
 Increases objectivity
 Uses collective knowledge
 Modeling for each other
 Taking on different roles
Examples:
 Male and female
 COTA /OTR
Disadvantages
 Splitting – Member subgroups ally
themselves with one or the other
 Competition – Need to downplay and
recognize one another’s assets as leader
 Unequal contribution – Use supervision to
discuss how to redistribute responsibilities
 Need to meet on a regular basis to coordinate
leadership and support one another
Lessler, Dick, and Whiteside (1979)
 Studied the development of the co-therapy
relationship. They identified four developmental
stages that parallel the group’s development
 A. Formative Stage. In this stage, co-leaders are
pre-occupied with their feelings of self-worth as a
leader, and plagued by fears of inadequacy. These
feelings naturally lead co-leaders to compete with
one another. By trying too hard to be “good” leaders,
they could end up in a power struggle with one
another, or a popularity contest with the group
members
Stages of Co-Leadership
 B. Development Stage. This stage requires
much interpersonal discussion and the
recognition of differences. This stage must be
resolved if the co-therapy team is to work
effectively together
Stages, cont.
 C. Stabilization. After having their fights and
talking it out, co-therapists view each other as
individuals and recognize each other’s
strengths and weaknesses as well as their
own. They are able to capitalize on their
differences by taking on different leadership
roles, and discussing their perceptions openly
during the group as well as afterwards
Stages, cont.
 D. Refreshment. From the process of the first three
stages, a relationship between co-leaders forms that
allows each to grow in their role as leader. Their
interaction results in renewed enthusiasm for the
group experience and it’s potential to help others.
They may experiment with new ideas, do research
together, or present their group experiences at
professional meetings. They take pride and
enjoyment from working with each other, and this
energizes the group members with a sense of hope
and anticipation
Group Leadership in
Occupational Therapy:
Cole’s 7 Steps
7 Steps: Overview
1. Introduction
2. Activity
3. Sharing
4. Processing
5. Generalizing
6. Application
7. Summary
Step 1:Introduction
a. Names
 Acknowledge each member by name
 Self as OT leader, title of the group activity
 Ask members to greet each other by saying
their names in turn
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Important even if members know each other
Shows recognition of each individual as
important
Reinforces inclusion in the group
Creates a friendly atmosphere
Step 1, cont.
b. Warm up
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How alert are members?
Are they ready to begin a new experience?
Need to be “warmed up”
Provide a short introductory activity
Captures attention of members
Refocuses member thoughts
May be informal or imaginative
Prepares group for activity to follow
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Examples
Step 1, cont.
C. Setting the Mood
 Warm-up can facilitate
 Environmental features:
 Lighting
 Seating: Correct number of chairs
 Getting rid of clutter and distractions
 Having needed supplies ready
 Therapist facial expression, gestures, and
tone
 Expectations of group: Serious or lighthearted?
Step 1, cont.
D. Explaining the Purpose
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Primary task of introduction: Never leave out
Include main therapeutic goals
Use language members will understand
Clients need to know how proposed activity can help
them
Encourages member cooperation
Facilitates client collaboration
In first session of a series, goals for whole series of
activities should be outlined in first session
Example: Money Management (budgeting, record
keeping, banking, balancing checkbook, saving for
emergencies)
Step 1 cont.
E. Brief Outline of Session
 Include time frame, media, & procedures
 Example: 45 min. session
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Draw yourself – 15 minutes
Sharing & discussion 25 minutes
I will be keeping your drawings after we finish
Artistic talent isn’t important
 What is important in above example?
 Focus is on discussion and learning
 Don’t reveal anything you don’t want to share
Step 2: Activity
A. Selection
 A very complex process
 Includes activity analysis
 Based in OT theory and research evidence
 Activities designed for peers (students) now
 Later you will learn to design activities for
clients with disabilities or wellness
 Focus on personal growth and meaning for
students
Step 2, cont.
B. Timing
 45 minute sessions
 5 more steps to go
 Activities should be short & simple
 Activity portion should last no longer than 1/3
of total session (15 minutes)
 Must be challenging and complex enough to
produce meaningful discussion and learning
Step 2, cont.
C. Therapeutic Goals
 Goals are desired outcomes
 May be individually set before group begins
 Based on client preferences and therapist evaluation
(knowledge of theory and disability)
 Clients and therapist collaborate to accomplish
 In planning practice groups, think about what might
be useful for yourselves as students
 Managing time, managing stress, improving study
habits, enhancing communication, expression of
emotions, clarifying values, etc
Goals, cont.
 Once goals are defined, an activity is chosen
to help meet the goals
 Example: personal growth may best be
accomplished through creative activities,
such as drawing, drama, or storytelling
 Example: social goals may best be worked on
through activities involving interaction of
members, such as communication exercises
or group problem-solving
Step 2, cont. D. Physical and Mental
Capacities of Members
 Activity should match capacities of members
 College students without physical or mental
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disabilities, possibilities are unlimited
Choose an activity challenging enough to hold their
interest, but not beyond their capacity
Persons with cognitive limitations require simplified
instructions and discussion topics
Persons with physical limitations require adaptations
in materials and environment
Focus on learning something new and meaningful
Step 2, cont.
E. Knowledge & Skill of Leader
 Students should choose an activity with which
they are comfortable
 Capitalize on individual talents and skills
 Go with strengths and experience
 Select a growth facilitating activity
Step 2, cont
F. Adaptation of Activity
 All potential activities need to be adapted
 Use knowledge of peers to create a match
 Activity analysis: Breaking down activity into
components or steps
 Match each component with the human
functions required to accomplish it
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Example: Playing Bingo
Modifications are made to compensate for
disability or need for added challenge
Step 2, cont. F. Giving Instructions
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Activity should be presented in a systematic way
Simple and direct language
Instructions sequenced step by step
Get feedback from members to check understanding
(repeat back instructions)
 Keep materials hidden until needed and removed
when activity phase ends. Why?
 Choose to participate as leader (encourages trust) or
not (if it distracts you from giving needed assistance
or making observations)
 Give warning when time is up (1 minute); stop even if
some members are not finished
Step 3: Sharing
 After completing activity, each member is
invited to share his or her own work or
experience with the group
 Ask for volunteer to start (OT can role model)
 Once begun, go around group in order (so no
one is forgotten)
 Acknowledge each member’s contribution
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Verbal and non-verbal responses
Step 3, cont.
 For some activities, sharing is not a separate
step, but incorporated into the activity
 Discussion is involved as part of the activity
 Requires opinion giving, discussion and
group decision-making
 Leader must make sure everyone participates
in discussion
Step 4: Processing
 Most difficult step to learn
 Involves how members feel about the
experience, the leader, and each other
 Ask questions to facilitate expression of both
positive and negative feelings
 Include recognition of non-verbal
communications and their meaning
Step 4: Processing, cont.
 Very revealing when done effectively
 Examples: (What behaviors are likely?)
 Embarrassed by activity (feel stupid)
 Angry with other members
 Intimidated by leader
 Activity too hard, too easy
 Underlying dynamics may never be
expressed, but will have a powerful influence
on the group
 Leaders must be keen observers of group
process
Step 5: Generalizing
 Addresses cognitive learning aspects of
group
 Verbalize a few general principles learned
from activity
 Leader asks open questions to generate
learning issues
 Principles often resemble original goals
Step 5: Generalizing, cont.
 Some ways to facilitate generalizing:
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What are similarities or areas of agreement?
What are areas of difference/disagreement?
What issues energized the group?
Follow up on areas that generate spontaneous
conversation
Ask open questions that reveal the meaning of
the activity for members
Step 6: Application
 Helps group apply learning to everyday life
 Each member explains how this group
experience applies to real life situations or
has meaning for him or herself
 Ask open questions to facilitate application of
specific aspects of this activity
 Answers may be different for each member
 Relates back to individual as well as group
goals
 Encourages members to interact
Step 7: Summary
 Verbally emphasize most important aspects
of the group (Can ask members to help)
 Summarize learning
 Summarize emotional responses
 Acknowledge member participation (thank
them for participating, sharing, trusting,
disclosing, taking risks, etc)
 Leader shares own feeling responses
 End on a positive note. (Also, end on time)
Additional Leadership Factors
 Group Motivation
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Confidence in the leader
Encouraging enthusiasm
Encouraging interaction
 Setting Limits
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Limiting inappropriate behavior
Assuming appropriate authority
Equal time
Respectful limit setting
The End
 Assignment:
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Practice group plan
Leadership evaluation
Sign-ups
Group Leadership
Group Leadership
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Leading a group changes according to the
type of group
 Regardless of the type of group, there are
“personhood/leadership skills”
 Three important points in leadership:
1. Role/style of leadership
2. Communication skills
3. Personhood skills
Roles and styles of leadership
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3.
4.
The responsibilities of the leader varies,
some of them are as follows:
Demonstrating by using examples
Putting rules, limits, boundaries to the group
Orienting the members
Being tuned into the mood of the group
Roles and styles of leadership
The organiser:
 Sets and maintains boundaries, limits and
rules
 Establishes a tone
 Sets a feeling of safety and security
Roles and styles of leadership
Role Model :
 Demonstrates by giving examples to ease the
understanding of a certain idea
 Provides orientation on how the group is
supposed to go
Roles and styles of leadership
Facilitator:
 Determines and directs, enables the group
activity and participant interaction among
each other
Communication skills
Active Listening:
 Absorbing the content
 Noting the persons gestures and changes of
expression
 Sense underlying messages
 Have to be in the moment for each interaction
Communication skills
Reflection
 Communicating back to a person, given a
sense of what he/she has communicated to
you
Communication skills
Clarification:
 Recounting what one of the members has
said
Communication skills
Blocking
 Prohibiting either directly or by your
interpretation, types of communication that
are destructive to the group, gossiping, and
invading other members privacy
Communication skills
Facilitating
 Inviting others to participate, to express their
thoughts and feelings, or to work on the
activity of the group.
 To work with others and make comments and
suggestions about what other members are
doing/saying
Communication skills
Empathising
 Provide a response to show that you
understand what the member wished to
communicate to the group
 “putting yourself in their shoes”
Personhood skills
Courage
 The ability to admit mistakes, express fear,
act according to hunches.
 To be direct and honest with members
 Be genuine and not defensive in the face of
criticism
 To do what the leader expects others to do in
that group situation
Personhood skills
Willingness
 The model behaviour that one expects from
group members
Personhood skills
Being Present
 Fully experiencing the groups activity and
interactions and not being distracted from the
purpose of the group
Personhood skills
Belief in the group
 Believing in the value of what is being done
or is happening in the group
Personhood skills
Ability to cope nondefensively
 Not personalising or withdrawing from
comments or actions that you perceive as
critical of you or your performance
Personhood skills
Self awareness
 Awareness of your personal goals, identity,
motivations, needs, strengths and limitations,
values and feelings
Personhood skills
Sense of Humour
 The ability to laugh at yourself, and to see
and understand the imperfection of the
human condition
Personhood skills
Inventiveness
 The capacity to be spontaneous and creative,
often combined with the ability to learn from
every experience in your life
Questions?