Groups

By Stephanie Shane OTR/L

Pass the NBCOT

Group Development Stages:

  • Orientation: members learn what group is about, connect with members
  • Intermediate: members develop interpersonal bonds, group norms, roles
  • Conflict Phase: members challenge group structure, purpose, & process
  • Cohesion: involves members regrouping after conflict with clear purpose
  • Maturation: involves members using their energy to be productive for goals
  • Termination: dissolution of group due to lack of engagement, inability to resolve conflicts, goal attainment or task accomplishment.

Factors that contribute to group cohesion:

a. Extensive interaction between members

b. Similarity or complementariness in member characteristics

c. Perception of relevance of group to individual needs

d. Members’ expectation of goal attainment and successful group outcome

e. Democratic leadership and member cooperation.

Types of Groups:

  • Evaluation Group- to enable client and OT to assess client’s skills, assets, and limitations regarding group interaction. The OT must observe the person in a setting where the skills can be demonstrated. Understand that the purpose of an eval group is to evaluate group interaction skills, so an activity in an evaluation group must require the interaction of members for completion. The group’s focus is not intervention, so activities to increase members’ skill level would be incorrect.
  • Thematic Group-to assist members in acquiring the knowledge, skills, and/or attitudes needed to perform a specific activity. Recognize that the purpose of a thematic group is to acquire knowledge & skills to perform a specific occupational performance task, so this groups’ activity must involve active doing of the specific task in a real or simulated environment.
  • Topical Group-to discusses specific activities that members are engaged in outside of group to enable them to engage in activities in a more effective, need-satisfying manner. (Parenting skills group for parents of children with developmental disabilities. Realize that the purpose of a topical group is to discuss activities that members are engaged in outside of the group; task completion is not a primary focus.
  • Task oriented group- to increase client’s awareness of their needs, values, ideas, feelings, and behaviors as they engage in a group task. To improve intra- and interpsychic functioning by focusing on problems which emerge in the process of choosing, planning, and implementing a group activity. Understand that a task-oriented group uses a psychodynamic frame of reference to increase intra and inter-psychic functioning; activities are selected to help members examine their behaviors to increase self-understanding.
  • Developmental Group- A continuum of groups consisting of parallel, project, egocentric-cooperative, cooperative, and mature groups.
  • (A) Parallel groups- enable members to perform individual tasks in the presence of others.
  • (B) Project group- to develop the ability to perform a shared, short-term activity with another member in a comfortable, cooperative manner.
  • (C) Egocentric-cooperative- to enable members to select and implement a long-range activity which requires group interaction to complete.
  • (D) Cooperative- To enable members to engage in a group activity which facilitates free expression of ideas and feelings, and develop a sense of trust, love and belonging.
  • (E) Mature Group- to enable all members to assume all functional socio-emotional and task roles within a group.

-Understand that the purpose of primary prevention is to promote wellness and maintain health; therefore an exam item about primary prevention would not have a correct answer that contained information about the remediation of deficits.

-Be aware that collaboration with the individual, family, significant others, and/or caregivers is essential to ensure development of a relevant and meaningful intervention plan.

-Disadvantages to co-leadership: splitting by group members of one leader against the other, excessive competition among co-leaders. Unequal responsibilities resulting in unbalanced work load.

****Co-leadership advantages: each leader can assume different leadership roles, tasks & styles. Both leaders can provide mutual support. Observations & objectivity can increase. Co-leaders can share knowledge and skills, and co-leaders can model effective behaviors.

*****MUST KNOW: Mosey’s Taxonomy of groups: Mosey provided a standard classification to identify major types of activity groups.

Evaluation group: Purpose/focus: to enable client and OT to assess client’s skills, assets, and limitations regarding group interaction.

Assumption: The OT must observe the person in a setting where the skills can be demonstrated.

Type of client: all individuals who will be involved in groups or who lack group interaction skills.

Role of the therapist: selects and orients clients to group’s purpose, selects activities that require collaboration and interaction and provides needed supplies, Does not participate or intervene in group but observes and reports member’s interaction and functional skill level. Asks for clients’ input, validates assessment and establishes treatment goals with each individualclient.

Types of Activity Groups

  • Evaluation- enables assessment of skills, assets, and limitations regarding group interaction; (purpose is assessment)
  • Thematic- assists to acquire knowledge/skills/attitudes needed to perform specific activity (learning specific skills)
  • Topical- discuss members current activities & enable engagement in activities in a more effective, need-satisfying manner
  • Task-oriented- to increase awareness of needs/values/ideas/feelings/behaviors as they engage in a group task; to improve intra and inter psychic functioning by focusing on problems which emerge in process of planning and implementing group activity
  • Developmental- to teach and develop group interaction skills; continuum of 5 groups
  • Parallel- enables members to perform individual tasks in presence of others; encourage minimal interaction for the task; develop basic level of awareness, trust, and comfort (minimal interaction)
  • Project- to develop the ability to perform a shared, short-term activity with another member; develop increased interactions beyond the task; members give and seek assistance (some interaction and cooperation)
  • Egocentric-cooperative- enables members to select and implement a long-range activity which requires group interaction to complete; identify and meet needs of selves and others (joint interaction)
  • Cooperative- enable members to change in a group activity, facilitating free expression; develop trust, love, belonging, and cohesion; identify and meet socio-emotional needs (working cooperatively)
  • Mature- enables members to assume all functional socio-emotional and task roles within a group; reinforce behaviors resulting in need satisfaction and task completion (carrying out tasks while meeting needs of members)
  • Instrumental- to help members maintain function at highest possible level for as long as possible (meeting health needs)

1.An OT in a community mental health program has been approached by the consumers to lead a group on alternative treatment techniques. The OT has only a basic understanding of alternative treatment. What is the BEST response?

  1. The OT should discourage the idea because of the possible conflicts with the consumers’ current treatment.
  2. The OT should acknowledge the request but ask for time to research the topics.
  3. The OT should tell the consumers that she has no information or training in this area, and refer the consumers to an alternative treatment specialist.
  4. The OT should tell the consumers that she has no information or training in this area, and refer the consumers to their medical doctor.

Answer: C

2.An OTR is writing a job description for an aide position in the OT department. According to AOTA guidelines, which of the following is BEYOND the scope of practice of an aide?

  1. Cue an individual with schizophrenia to maintain attention to task during a group activity.
  2. Practice use of a sock aid and shoe horn with a patient who has had a hip replacement and is able to perform the task safely, but takes an excessive amount of time.
  3. Help place food on the spoon for a patient practicing the use of a universal cuff in the patient’s room at lunchtime, while the OT runs a lunch group in the dining room.
  4. Help a child maintaining correct positioning during paper and pencil activities next to the OTR who is working with another client.

Answer: B

3.An occupational therapists leads a group activity for adolescents with conduct disorders. The school fire alarm goes off five minutes before the group’s scheduled termination. There have been 6 false alarms during the past 3 days at the school. Several students laugh and say “there it goes again”. The OTR’s most appropriate response is to

  1. continue with the group’s planned wrap-up, adding a discussion about the implications of false alarms.
  2. call the school’s main office to determine the validity of this alarm.
  3. Escort the students back to their homeroom classrooms to await directions.
  4. Escort the students to the nearest fire exit.

Answer:d

  1. An individual is unable to read a standardized evaluation because he does not have his glasses with him. Which of the following options is MOST appropriate?
  1. Instruct the individual to bring his glasses to the next session and complete the evaluation then.
  2. Ask the OT aide to read the evaluation to the individual and check off his answers.
  3. Include the individual in the group session that is about to begin and remind the individual to bring his glasses to the next session.
  4. Read the questions to the individual and check off his responses.

Answer: D

  1. In a subjective section of a daily progress note in a mental health facility, an OT practitioner documents an individual’s initial refusal to participate in OT activities. Which of the following subjective statements would MOST likely cause the therapist to consider depression as a factor in the evaluation process?
  2. “I had an argument with another group member and I’m too angry.”
  3. “I do not want to participate because I do not know how to do the activity.”
  4. “I’m just too tired.”
  5. “I’m waiting for my visitor to come.”

Answer: C

  1. An OT practitioner needs to identify why an individual who attends a day program for adults with developmental disabilities has difficulty participating in group activities. The BEST way to determine whether the individual is experiencing anxiety during group sessions would be to:
  2. Observe the individual’s body language during group sessions.
  3. Ask the individual to complete a questionnaire rating her anxiety level after each session.
  4. Have group members provide feedback to the individual and OT about her anxiety.
  5. Allow the individual to select two other clients she feels she’d be comfortable with in a small group.

Answer: A

  1. Which of the following activities would MOST effectively evaluate group interaction skills during an OT session?
  2. The clients make individual collages, sharing a set of magazines to complete the activity.
  3. All group members construct one tower that incorporate all of the pieces provided in a set of constructional materials (e.g., Legos or Erector set).
  4. All group members work together to make pizza and salad for their lunch that day.
  5. Each client selects a short-term craft activity from four available samples.

Answer: B

  1. Which of the following is the best support group to recommend to a husband who describes having difficulty in coping with the ups and downs of his wife’s bipolar disorder?
  2. Al-anon
  3. Family therapy
  4. National alliance for the mentally ill
  5. Recovery inc.

Answer c: this support group is for clients and families that focus on education and support related to all mental illnesses. Al-anon-is for alcohol use among family members. Family therapy-Is not a support group. Recovery inc-is a self-help support group for clients with mental disorders.

  1. During a group community outing, one day program member complains of chest pain. The ot practitioner determines the individual’s resting heart rate is 120 bpm, and blood pressure is 220/180 mm hg. The most appropriate action for the OT to take is to
  2. Continue the community re-entry outing
  3. Immediately return the rest of the clients to the day program.
  4. Help the patient lie down and wait until his vital signs return to normal
  5. Call 911

Answer: d: both of these ranges are above safe and indicate that the pt is medically unstable. Therefore, immediate medical services are necessary.

  1. An individual is participating in an assertiveness training group within a psychiatric rehabilitation program. The expected outcome of this intervention is that the individual will most likely improve the ability to:
  2. Engage in relevant conversations with coworkers
  3. Use appropriate facial expressions when disagreeing with coworkers
  4. Express disagreements with coworkers in a productive manner.
  5. Use courteous behavior when disagreeing.

Answer: c: assertiveness training focuses on developing the ability to articulate and express feelings in an appropriate and productive manner. A,B,D are examples of additional social interaction skills and do not address an assertiveness component.

  1. An individual in an ot group has a history of monopolizing the group without giving others an opportunity to participate in the group process. What is the most effective approach for working on the individual’s social conduct and group skills during a gardening activity?
  2. Give the individual a specific task such as filling up the water containers
  3. Have the individuals assign tasks to various group members
  4. Have the individual observe the group
  5. Pair the individual with another group member for a specific task.

Answer: A. assigning a specific and concrete task allows the individual to focus on the task at hand while sending the message that the individual is a valued member of the group.

  1. An extremely withdrawn individual has developed the ability to tolerate interaction with one other group member while glazing slip molds in an ongoing ceramics group. Which of the following steps should be taken next in order to develop this individuals ability to interact with others?
  2. Involve the indiv in a 3 member task group.
  3. Progess the indiv from glazing slip molds to building coil pots
  4. Instruct the indiv in how to pour the molds in addition to glazing them.
  5. Encourage the indiv to choose his own project and glazes.

Answer a: adding an additional group member to the experience is the most appropriate way to upgrade this activity when addressing the goal of social interaction.

  1. An OT is using a sensory integration approach with a group of residents of a mental health setting who display very low energy level, hyposensitivity to stimuli, and poor visual and tactile perception. The activity that would be best for beginning a session with these indiv who can tolerate no more than a half hour session would be to
  2. Go around the circle and ask each patient to introduce themselves.
  3. Pass around a scent box and ask each patient to smell the contents.
  4. Ask each patient to select a favorite poem and read it.
  5. Discuss the lunch menu and healthy eating habits.

Answer: b: SI: indiv can learn by receiving, processing, and responding to sensory stimulation. Touch and smell can arouse interest.

  1. An indiv with mental illness attends group on a regular basis, but interrupts others, grabs tools and supplies, and bosses others around at almost every group session. What is the best way to respond to this disruptive behavior?
  2. Have the indiv contribute to a discussion identifying the rules for the group
  3. Tell the indiv he may not return to the group until he is able to treat others with respect.
  4. Ignore the behavior during the group and speak to him about it afterwards.
  5. Explain to him that this type of behavior is unacceptable.

Answer a: this approach elicits cooperation and it heightens the indiv’s awareness regarding his behavior.

  1. An ot in a residential community mental health setting is developing a psychoeducational program to promote healthier eating habits among the residents of the setting. To accomplish the group’s goals using this approach, the practitioner would be most likely to:
  2. Have each client make a healthy food collage
  3. Have the group plan and shop for a meal
  4. Designate 1 day a week for the residents to be responsible for cooking dinner
  5. Show a video about nutrition and keep a meal diary for a week.

Answer: d: the psychoeducational model utilizes a teacher student format as opposed to a learning by doing approach. It often includes a homework approach.

  1. An ot conducts assessments of indiv with MR living in a supervised community environment and finds that most can perform work tasks involving repetitive processes and social interaction. The most appropriate service delivery model for the ot to recommend would be:
  2. An adult activity center
  3. Supported employment
  4. Volunteer work
  5. A sheltered workshop

Answer: b: supportive employment provides a structure for persons with developmental disabilities to work in actual job sites .

  1. anindiv was unable to achieve the goal “the client will initate two requests to other group members for sharing materials within 1 week period.” The best revised goal is:
  2. the client will initiate two requests to other grop members for sharing group materials within a 2 week period
  3. the client will initiate one request to one other group member for sharing group materials within 1 week period.
  4. The client will initiate two requests to each of the 5 group members for sharing one group tool within 2 weeks.
  5. The client will say hello to the group leader at the start of each group session

Answer: b: reducing the number of requests and the variety of number of indvs the client is expected to interact with is the best way to simplify the initial goal.

An OTR®in a short-term acute care psychiatric hospital is leading a psychodynamic group. Which of the following activities would be the MOST appropriate for this group?

  1. Paint by number
  2. Crossword puzzles
  3. Free-form clay building
  4. Decorating gingerbread cookies

Incorrect.You answered A.

The right answer is C

An extremely agitated patient is admitted to an inpatient psychiatric hospital late on a Friday afternoon. Because nursing is short staffed, the nurse on the unit requests that the patient attend an occupational therapy group being led by a COTA®that evening. The COTA®calls the OTR®, who is working at a location far from the unit, for guidance. The OTR®is unable to return to the unit in time to evaluate the client before the session. What is the BEST course of action the OTR®should direct the COTA®to take?