Group Process and Structure in Psychosocial Occupational Therapy

Diane Gibson

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780866568296
• eBook ISBN: 9781317773504
• Topic: Medicine
• Subtopic: Occupational Therapy

Effective group leadership techniques are the focus of this practical, sound volume. Dedicated to assisting occupational therapy practitioners and students in understanding current theory and state-of-the-art techniques in group treatment, this functional book fills the gap left by existing literature and educational programs that focus mainly on diagnoses and task analysis. Highly skilled professionals examine the important concepts of group therapy--structural elements, such as goals, norms, group size, physical environment, and instructions that can be varied depending on the purpose, needs, and functional level of the client; the ability to guide and control process elements, such as spontaneous feedback; and the ability to support clients and help build a cohesive, safe group. Fascinating examples of innovative new group techniques--social skills game, mime group, and the use of robots--demonstrate how creative content can effectively combine structure and process in group treatment.

Applying the Group Process to Psychiatric Occupational Therapy Part 1: Historical and Current Use

Franklin Stein, PhD, OTR, FAOTA

Franklin Stein, Director, Occupational Therapy Program, University of Wisconsin-Milwaukee.

Beverlea K. Tallant, MA, OT(C)

Beverlea K. Tallant, Occupational Therapy Program, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.

SUMMARY. The authors trace the current use of group activities in occupational therapy from an historical perspective. A pilot study of thirty-four psychiatric treatment programs located in Wisconsin, Quebec, and Alberta are described. The five most frequent groups used in these facilities include: social skills training, independent living skills, leisure time activities, stress management and exercise. The results are compared to a previous study by Duncombe and Howe, 1985.

Group therapies were first developed historically as a means to encourage patients to gain insight into their illnesses and to foster self-expression. In the present practice of group therapy a diversity of theories and methods have emerged that can be readily applied by the psychiatric occupational therapist. In this paper the authors trace the history of group therapy in psychiatry and in occupational therapy. The authors describe the most widely used group therapy methods and the current use of groups by psychiatric occupational therapists.

The authors raise the following questions in this paper:

• What are the historical precursors to the development of group treatment?
• Who are the major group theorists?
• What are the current frames of references and methods used in group occupational therapy?
• How are groups currently being used in psychiatric occupational therapy?

Historical Development of Group Therapy

Group therapy, a method of working with disabled patients, began during the 1920s. It coincided with the psychoanalytic movements of Freud, Adler and Jung and the introduction of psychotherapy as a treatment method. In the initial practice of group therapy, clinicians used lectures and discussion methods to encourage patients to gain insight into the psychodynamics of their illnesses and to foster mutual understanding from the members of the group. For example: J. H. Pratt (1922), working with tuberculosis patients in a Boston hospital, used educational lectures to inspire patients and to increase their motivation to regain their health. Lecture methods which encouraged patient discussion were also used by early practitioners of group therapy. Lazell (1921) lectured to schizophrenic patients as a method of increasing self-awareness. Alfred Adler (1930) used group methods in working with emotionally disturbed children and their parents as a way of providing mutual problem solving approaches, when he worked in child guidance clinics in Vienna. J. L. Moreno (1946) initiated psychodrama as a method to help psychiatric patients re-experience and act out traumatic events in their lives. Moreno experimented actively with psychotherapy during the 1920s in Vienna and later introduced these techniques into the United States. Moreno was the first group psychotherapist to develop a formal methodology in using group processes with psychiatric patients. He emphasized the importance of catharsis, i.e., the expression of emotional feelings that have been repressed, in the treatment of schizophrenic patients. Another important contributor to the development of group methods in treatment was S. L. Slavson (1964) a social worker who worked with emotionally disturbed children during the 1930s in New York City. Slavson used arts and crafts activities and play media to help the child to express conflicts and emotions without the interference of the group therapist. Slavson felt this approach was most useful with repressed and withdrawn children who needed to release their feelings without parental and adult censure and disapproval. Group therapy methods were used sparingly in mental hospitals before the 1930s. L. C. Marsh (1935) a minister and psychiatrist, used discussion groups in class settings for examining everyday issues such as the family, child development, job problems and social interactions. In these groups patients were encouraged to support each other. Paul Schilder (1939), a psychoanalytically trained psychiatrist, used group therapy methods to foster individual insight and self-confidence with others while he was at Bellevue Hospital in New York City in the 1930s.

After the Second World War group therapy was increasingly used in psychiatric hospitals and clinics throughout the United States. During this time group methods developed from theoretical frameworks such as nondirective therapy (Rogers, 1968), behavior therapy (Wolpe, 1969), transactional analysis (Berne, 1966), gestalt therapy (Peris, Hefferline, & Goodman, 1951) and the therapeutic community (Jones, 1953).

Activity Group Therapy

This method, developed initially by Slavson (1964), has been incorporated into group occupational therapy and can be applied most effectively with hyperactive children who must develop the inner controls for self-regulation (Cermak, Stein, & Abelson, 1973).

In Slavson’s approach the children are encouraged to act out conflicts and emotions without the intervention of the therapist. The group meets for approximately an hour and a half using creative media such as finger paints, watercolors, modeling clay or paper crafts. The therapist establishes an emotional climate of unconditional acceptance and trust. The group is composed of about eight children of the same age or sex. An emotional balance in the group is fostered by the therapist by placing very aggressive children in with passively withdrawn children. At the end of the activity session, the therapist and children share a neutral activity such as having a “snack.”

Slavson’s model is very much influenced by psychoanalytic theory and it is primarily designed to provide emotionally disturbed children a permissive environment in which to encourage unrestrained expression of feelings (Rosenbaum & Snadowsky, 1976).

Directive-Didactic Approach

This group experience relies upon the therapist to guide discussions and activities of specific areas of importance in patient treatment and rehabilitation. The therapist uses educational methods, such as lectures, film, slides, video-tapes and seminar discussions. Content areas include prevocational exploration, family dynamics, understanding yourself, sexual adjustment, health maintenance, nutrition, exercise or other areas of interest and importance. In this approach the therapist designs the group experience as similar to a college course syllabus. The behavioral objectives of the group are defined, the specific content areas are described, and audiovisual programs are listed (Klapman, 1963).

Client-Centered Rogerian Group

The core of Rogerian therapy is the concept that man has the potential for self-actualization. In Client-Centered approaches the therapist emphasizes the healthy aspect of the individual rather than the disability or illness. The therapist is a democratic treatment agent in the group fostering an atmosphere of positive self-regard. The therapist attempts to facilitate personal growth in the individual by eliciting statements describing the client. One of the most important concepts in this approach is self-ideal congruence. In this concept the therapist works toward helping the client develop self-awareness and to compare how the client perceives his/her self with how the client would ideally like to be. Progress is assessed by how the client narrows the perceptual discrepancy between present self and ideal self (Meador, 1975).

T-Group

The T-Group methodology developed in 1947. The sponsor of this methodology was the National Training Laboratory for Group Development which held the first formal program for sensitivity training (Golembiewski & Blumberg, 1977). The T-Group has three distinguishing features, i.e., it is a learning laboratory simulating a miniature society, it focuses on learning how to learn, and there is strong emphasis on the here and now in relation to ideas, feelings and reactions. The prime task of the trainer (group leader) is to establish a psychologically safe atmosphere that facilitates learning. The task of the group members is to examine their behavior in interpersonal relationships. For example, if an individual obtains insight into his behavioral characteristics, then it is felt that the person will be able to express himself consistent with his inner feelings and ideas. The main goals of T-Groups are to improve an individual’s quality of cognition, clarify his identity, increase his self-esteem, self-acceptance, and acceptance of others. The philosophy of a T-Group is similar to Roger’s theory, however, the methodologies are much more formal. For example, the leader of a group undergoes a formal period of observation before becoming certified. In addition to Roger’s theory, T-Groups rely heavily on the theories of Lewin (1951), a psychologist who analyzed social forces in the environment that affect individual behavior.

Psychodrama

The application of a creative art form as a therapeutic methodology is consistent with occupational therapy. Moreno, a psychiatrist living in Vienna during the early nineteen-hundreds, established the theatre of spontaneity (Moreno, 1946). “The objective of psychodrama was from its inception to construct a therapeutic setting that uses life as a model, to integrate into the setting all the modalities of living—beginning with the universals of time, space, reality and the cosmos—and moving down to all the details and nuances of life” (Moreno, 1983, p. 158). The important components of psychodrama are the stage where the life dramas are re-enacted; the protagonist who is the center of the drama; the auxiliary egos are the other individuals, e.g., patients or staff, who act out the protagonist’s family or significant individuals in the protagonist’s life; the director or therapist, who guides the drama and is critically aware of the significance of what is happening in the patient’s behavior; and the audience who can take an active part in the action by reacting, responding and evaluating the action. The audience can also serve in the role of consensual validator relating objectively to the protagonist’s working through of emotional issues. Psychodrama has been used with all types of diagnostic categories in psychiatric hospitals and in community mental health facilities. It is a formal method that has been adapted and modified by psychiatric occupational therapists to accommodate for special needs. Role playing, simulated life dramas and behavioral rehearsal are techniques inspired from psychodrama.

Transactional Analysis (TA)

Eric Berne, a psychiatrist and psychoanalyst, developed the technique of Transactional Analysis during the 1950s. Transactional Analysis is a method of therapy based on examining the interpersonal exchanges that occur in social encounters. Berne identifies basically three roles that individuals assume in social interactions, i.e., the child, parent and adult. These three ego states are similar to but not the same as Freud’s concept of id, superego and ego (Berne, 1966). The child ego state is characterized by unrestrained emotional expression, play-like behavior and a need to be nurtured and protected. The parent ego state is characterized by a judgmental and critical attitude toward others. The parent is ready to overprotect others and to make decisions in an authoritarian manner. The adult ego state is the healthiest and most democratic transaction. The adult shares decisions with others and is a responsible self-accepting individual. Every individual assumes these three ego states, during his or her daily interactions with others. Some environments, such as a spectator at a sports event, encourage child-like behavior, while leading discussions may elicit an adult ego state and disciplining a child will elicit a parent ego state. In group therapy situations using transactional analysis, the therapist can act as a parent interpreting behavior and providing insight for the patient. The occupational therapist in working with patients can also function as a parent authority figure, or adult sharing responsibility or as a child participating with the patients in group activities.

Gestalt Therapy

This humanistic approach to treatment was created primarily from the work of Fredrick Peris (1969). Applying the concepts of Gestalt Psychology to treatment, Peris emphasized the wholeness of the individual and the awareness of the here and now. The gestalt therapist tries to help the individual discover who he or she is and to fully experience these feelings. Individual growth is equated with the indivi...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• Foreword
• Structure and Process in Designing a Functional Group
• Applying the Group Process to Psychiatric Occupational Therapy Part 1: Historical and Current Use
• Applying the Group Process to Psychiatric Occupational Therapy Part 2: A Model for a Therapeutic Group in Psychiatric Occupational Therapy
• A Preference for Activity: A Comparative Study of Psychotherapy Groups vs. Occupational Therapy Groups for Psychotic and Borderline Inpatients
• The Effect of Three Group Formats on Group Interaction Patterns
• The Process of Group Treatment with the Chronically Mentally Ill
• Structured Craft Group Activities for Adolescent Delinquent Girls
• Concept and Use of The Social Skills Game to Facilitate Group Interaction: A Case Study
• The Effect of a Mime Group on Chronic Adult Psychiatric Clients’ Body-Image, Self-Esteem, and Movement-Concept
• Using Robots in a Group with the Neuropsychologically Impaired: Achieving a Sense of Control Over the Environment