Groups in Occupational
Therapy
Lec. 1
September 19, 2012
Groups in Society
Family/ Classroom/ Sport teams/ Clubs
and societies
Groups is more than just a collection of
individuals
Members are bonded together both by
their group identity and shared purpose
We learn who we are as we interact with
others
Sense of identity forms
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Groups in Therapy
Special qualities of Groups: (fig 1.1)
 Groups as learning environment - Interaction
occurs
 Multiple layers of relationships, rather than
working with just one therapist
 Sharing and support
 Dynamic source of energy and creativity
 Social learning
 Heighten emotions
 Powerful shapers of behavior (positively or
negatively)
 Group norms and pressures
WHY OTs TREAT IN GROUPS
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Common goal—More practical (e.g., teach
communication skills)
Multiple feedback and support (consensual
validation), encouragement for self-value,
identity
Promote independence (from leader) and
developmental progression (Mosey)
Groups support growth and change in
members (e.g., assertiveness)
Groups have capacity for self-direction can
create own tasks (task oriented group)
Satisfy individual needs and social demands
helping one another also helps self
Yalom’s 11 Curative Factors
Overview
1.
2.
3.
4.
5.
6.
Instillation of Hope
Universality
Imparting
Information
Altruism
Corrective
Recapitulation of
Primary Family
Group
Social Learning
7.
8.
Imitative Behaviors
Interpersonal
Learning
• Interpersonal
Relationships
• Corrective Emotional
Experiences
9.
10.
11.
Group Cohesiveness
Catharsis
Existential Factors
1. Instillation of Hope
Therapist capitalizes by reinforcing belief in
healing power of group therapy
 Discuss expectations and evidence during
pre-group orientation
• Elevate positive expectation
• Downplay negative
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Members of groups acts as inspiration for
each other
Hope, cont.
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Clients vary along recovery-collapse
continuum
Clients share success stories
Therapist belief in healing power of
groups conveyed both verbally and
non-verbally
Belief that clients have much to offer
one another—convey as group norm
2. Universality
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Clichés
• Welcome to the human race
• We’re all in the same boat
• Misery loves company
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Addresses fear all clients have that
their own misery is unique (too awful
to be shared)
Basis of therapist empathy (nonjudgmental acceptance)
Universality, cont.
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In life, many troubled persons are
isolated
In groups, members naturally seek to
find their similarities
Yalom’s group research, “Top Secret”
3. Imparting Information
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Formal and informal info
Includes: Didactic Instruction and Advice,
Suggestions and Guidance
Maxwell Jones, 1940s, lectured to
psychiatric patients about the function of
nervous system
Current practice includes psychoeducational groups (e.g., how medications
work)
Specialized problem elucidation (e.g.,
what causes obesity, or the addictive
cycle)
4. Altruism
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Therapy for troubled individuals is often
some type of service to others
People need to feel needed and useful
Doing for others takes clients outside their
own morbid self-absorption
Victor Frankl: Meaning in life often
emerges when we have forgotten
ourselves and become absorbed in
someone else
Altruism, cont.
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Clients often resist the idea of receiving
help from other members
“Blind leading blind”
Acceptance of help from other members
comes with experience
Requires a basic level of trust which
develops over several sessions
Leader models, reinforces, and
encourages mutual helpfulness
5. The Corrective Recapitulation of
the Primary Family Group
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Often the source of anxiety comes from
highly unsatisfactory experiences with
one’s own family
How are groups similar to families?
• Authority/parental figures
• Peers = siblings, competition for attention and
love
• Deep personal revelations, strong emotions
• Especially true of heterogeneous groups
Corrective Family, cont.
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Group members eventually interact with
others in modes that resemble those
learned with parents and siblings early in
life
Look for variety of patterns: Dependency,
defiance, hostility, attempts to control
others
6. Development of Socializing
Techniques (Social Learning)
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Explicit social skill learning:
• Preparation for living in community
• Ground rules (respect for others, taking
turns)
• Expectation of accurate interpersonal
feedback
• Discussion of explicit changes in social
behavior
Social Learning, cont.
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Implicit methods:
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Fine tuning expression of emotions
Heightened sensitivity to non-verbal cues
Observing and practicing conflict resolution
Recognizing emotions of others
Experiencing and expressing accurate empathy
Observational learning:
• spectator therapy
7. Imitative Behaviors
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Clients imitate therapist behaviors and
modes of communication
Clients imitate other members whom they
perceive to be favored or successful in
some way
Bandura has demonstrated effectiveness
of imitation as a therapeutic force
Therapist encourages:
• Role Playing and trying out new behaviors
8. Interpersonal Learning
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Importance of interpersonal
relationships
Human bonds are essential to
survival (mother-infant bond)
Humans crave contact with others
(Goldschmidt)
8. Interpersonal Learning, cont.
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Humans need to be noticed by others
(William James)
• Research demonstrates the pain and adverse
consequences of loneliness (mortality risk higher
for single, divorced, widowed,…)
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“The self made up of reflected appraisals…”
(Harry Stack Sullivan)
• We learn who we are from how others see us
and respond to us
• For example, in adolescents, satisfying peer
relationships and self-esteem are inseparable
concepts
Interpersonal Learning, cont.
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Evidence abounds that people in all
categories have a deep concern about
opinion of others
Examples:
• Heart surgery group: Fear of embarrassment
• Cancer group: Don’t want to upset their
families
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Many research studies confirm importance
of interpersonal relationships in life
9. Group Cohesiveness
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Definition: attraction of group for its
members
Evidence abounds that cohesiveness exists
and works to facilitate therapeutic change
The group equivalent to a good therapeutic
relationship is GROUP COHESIVENESS
Group Cohesiveness, cont.
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Characteristics of Cohesiveness
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“we” ness
Sense of solidarity as a group
Members highly value their group
Members feel warmth & comfort with other
members
• Feeling of belonging
• Members feel valued, unconditionally accepted
& supported
10. Catharsis
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Freud theorized that the best treatment
for hysteria was helping clients rid
themselves of suppressed affect.
Evidence shows that he was wrong
Catharsis (the venting of emotion) alone,
is not enough to produce therapeutic
change. It must be accompanied by some
form of cognitive learning
Catharsis, cont.
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Studies show that expression of strong positive
affect is highly correlated with cohesiveness and
positive change for members
Expression of negative affect was therapeutic
only when accompanied by genuine attempts to
understand oneself or fellow group members
Expression of emotion in groups creates bonds
between members, and is vital to the
meaningfulness of the group experience
But… catharsis is only a part of the process
11. Existential Factors
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Yalom’s “leftover” category: 5 items
1. Recognizing that life is at times unfair
2. Recognizing that ultimately there is no
escape from some of life’s pain (or from
death)
3. Recognizing that no matter how close we get
to other people, we must each face life alone
4. Facing the basic issues of life and death
makes living more meaningful, and less
caught up with trivia
5. Learning that “I” must take ultimate
responsibility for the way I live my life, no
matter how much guidance and support I get
from others
Existential, cont.
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Despite Yalom’s “afterthought,” research shows
that clients often rank existential factors near the
top of their list in importance to them
According to a survey, many psychotherapists
are existentially oriented in their view of life
Represents a dynamic approach addressing a
person’s ultimate concern’s of existence: Death,
isolation, freedom, and meaning seeking
Christiansen would add the “occupation”
represents the human attempt at coherence, that
is, to understand one’s purpose in life.
Summary
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Why is group therapy so important for individuals
with mental or physical disabilities?
• Participation in life requires interaction with
others
• Problems in relating to others create barriers
to participation in many life activities
• Activities of daily living are defined by the
roles people play in families, communities, and
society
Therapeutic goals need to be redefined
• Not “relief of suffering” (pain, anxiety)
• Learning how to better communicate, to trust,
and to love (more related to satisfaction and
well-being)
Summary, cont.
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Therapeutic factors help to explain why
groups are therapeutic
All OT groups include these factors to
some degree
Share the overwhelming evidence of the
value of groups with clients when
discussing possible intervention strategies
Use your knowledge of therapeutic factors
to better design and facilitate group
process.
The End
Types of Groups in OT
Continuum:
 Activity base groups
 Support based groups
 Both
Types of Groups in OT
Task
Activity
 Social
 Communication
Support
 Psychotherapy
(Fig 1.2, p.8)
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Examples
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Activity Groups:
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Developmental groups
Directive group
Functional group
Cognitive Dysfunction
Support Groups:
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Psychodrama
Social skills training
Psychodynamic communication group
Creative therapy