Group Leadership in Occupational Therapy

Group leader functions fig 6-1

Task – activity functions: Teach Supply equipment Organize Give feedback

Social-emotional functions: 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 promptingLeader: 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 competitiveLeader 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: Highly productive Poor quality work Created hostility and resentment in members Dependency on leader

Laissez faire groups: Independence from leader Low productivity and low morale

Lewin’s Conclusions, cont.

Democratic groups: 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

Types of Political Leadership

1. Autocratic

2. Democratic

3. Laissez-faire

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

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:

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

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 as-needed

basis Members lead their own group and experience

natural consequences from the environment

Role of OT Group Leader

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 rolesExamples: 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:Introductiona. 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 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

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

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 light- hearted?

Step 1, cont. D. Explaining the Purpose

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

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: ActivityA. 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

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, contF. 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 Example: Playing Bingo Modifications are made to compensate for

disability or need for added challenge

Step 2, cont. F. Giving Instructions

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

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: 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 Confidence in the leader Encouraging enthusiasm Encouraging interaction

Setting Limits Limiting inappropriate behavior Assuming appropriate authority Equal time Respectful limit setting

The End

Assignment: Practice group plan Leadership evaluation Sign-ups

Group Leadership

Group Leadership

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

The responsibilities of the leader varies, some of them are as follows:

1. Demonstrating by using examples

2. Putting rules, limits, boundaries to the group

3. Orienting the members

4. 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?