Activity Groups in Family-Centered Treatment

Psychiatric Occupational Therapy Approaches for Parents and Children

Laurette Olson

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317786344
• Topic: Medicine
• Subtopic: Occupational Therapy

Get the tools for practical family-based interventions for children or adolescents with mental illness

Providing parent-child occupation-based interventions can be one of the most important therapeutic services offered to children or parents with mental illness and their families. Activity Groups in Family-Centered Treatment: Psychiatric Occupational Therapy Approaches for Parents and Children provides useful in depth how to strategies into the processes of providing family occupation-based group intervention when a child has a mental illness. Occupational therapists working with children or parents with mental illness can learn valuable practical interventions to apply in their own clinical work.

Cherished activities that strengthen parent-child bonds are many times lacking in families that include a child or parent with mental illness. Activity Groups in Family-Centered Treatment describes valuable parent-child occupation-based interventions with detailed examples of how they have been provided in therapy. This text provides an overview of the literature related to providing family-based psychiatric OT treatment for children and their families, a framework for providing services, rich descriptions of a parent-child activity group, a parent-adolescent activity group, and case studies of inpatient and home-based occupation based interventions.

Topics in Activity Groups in Family-Centered Treatment include:

• an overview of theory and research literature on the nature of the interaction between parents and children with emotional disorders
  
• detailed case studies of family challenges with mental illness
  
• a framework for parent-child activity groups
  
• a qualitative study of a parent-child activity group
  
• analysis of the barriers that can arise in a parent-child activity group
  
• clinical experiences leading a parent-adolescent activity group
  
• analysis of the influences of culture within a parent-child activity group
  
• a case study of the intervention for a depressed mother and her family
  
• issues between parents and professionals when children are psychiatrically hospitalized
  
  

Activity Groups in Family-Centered Treatment provides occupational therapists and other professionals who lead parent-child groups or who work with families that include a child or parent with mental illness with integral tools to effectively treat their clients.

Chapter 1

Introduction

SUMMARY. This chapter provides an overview of this volume as well as a description of the author’s experiences working with psychiatrically hospitalized children and their families that led her to develop the framework for parent-child occupation-based group and individual intervention that is described in this publication. doi: 10.1300/J004v22n03_01 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2006 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Occupational therapy, parent-child activity groups, child psychiatry

In the first seven chapters of this volume, I will describe my experiences as a researcher studying the experiences of a group of parents and their psychiatrically hospitalized children as they participated in a parent-child activity group on a child inpatient unit. In the following two chapters, I will share some of my other experiences adapting my parent-child activity group work for addressing the needs of parents and their psychiatrically hospitalized adolescent offspring and a mother diagnosed with depression and her baby–persons with mental illness within the context of their families that include children.

I began my career as an occupational therapist expecting to provide individual and group services for children. In my second year of practice, I began working as an occupational therapist with children on a child inpatient psychiatric unit. Most of the children were hospitalized because of severe behavior outbursts, including the destruction of property and physical violence or threats toward adults, other children, or themselves. Their relationships with their parents were typically tense; the parents spoke of being overwhelmed and unable to manage their children’s behavior prior to the hospitalization. Many of these children and their parents described little or no pleasurable parent-child interaction immediately prior to hospitalization.

On the child inpatient unit, I frequently worked with children who showed little enjoyment or investment in play or activity when they were alone, in groups, or with their parents. They quickly expressed feeling overwhelmed, frustrated, or bored when an activity presented a challenge to them. Over the course of their hospitalization, many of these children developed interests and began to enjoy play and activity on the unit, but their interactions with their parents did not substantially change.

I observed little playful interaction occurring between parents and children on the unit. Children expressed a longing each day for visits from their families. When visiting hours finally came, I observed distant and superficial interaction between some parents and children; others had tense visits that ended in children being reprimanded for misbehavior. It was anticlimactic for some of the children whose needs for positive contact and interaction with their families were not met. The following day, these children again longed for their next visit with their families.

When I spoke to other staff about my observations, I was frequently told that life for these children was not going to change. The sentiment of the staff was that children who had negative relationships with their parents would likely continue to have that type of relationship with them, and that their behavior would most likely deteriorate after discharge from the hospital.

Varied therapeutic approaches were used on the unit to assist families in providing greater structure so that children might be successfully reintegrated into their families. These methods included teaching behavior management techniques to parents and providing family therapy and individual parent counseling. In spite of these efforts, many of the professionals with whom I worked spoke of the strong resistance of these families toward making changes in parent-child interaction. I felt that as an occupational therapist, I could design a group that would complement the work of others and would add a different dimension to what was presently offered to these families.

I developed a parent-child activity group based on the premise that if children’s play behavior could change in a positive direction with the staff and other children on the inpatient unit, it could also change with their parents. I believed that an activity group that increased opportunities for positive interaction between parent and child might lessen the degree of negative interaction between some children and parents. A structured play group might change the expectations of both parents and children, and lead to pleasurable interactions. Over time, if families had multiple positive experiences, they might begin to expect pleasure in family activity and thus seek out opportunities for similar parent-child interaction outside of the group.

I based my parent-child activity group organization on what I heard about a similar group that occurred in another hospital, and on my knowledge of group theory (Cartwright & Zander, 1968; Yalom, 1995), occupational therapy theory (Fidler & Fidler, 1978; Reilly, 1974), and parent-child interaction research and theory (Heard, 1981; Lytton, 1980; Murphy, 1962; Murphy & Moriarty, 1976). I organized the parent-child activity group as a multifamily group in which everyday constructional activities, tabletop or gross motor games, or play were used as a concrete means to engage individual family members with each other in a manner that they would likely perceive as pleasurable and positive. Since other families were also present and participating in activities with their own members, there was an opportunity to learn from other families via observation, as well as through interaction. My co-leaders and I adapted activities to limit the impact of children or parents’ attentional difficulties, motor planning or coordination deficits in order to support the ability of parents and children to participate in everyday family leisure or activities of daily living that had the potential to draw parents and children closer and to be more in tune with each other. My goal was for children to expect warmth, positive attention and assistance from parents and for parents to expect warmth, cooperation, and compliance from their children.

As I led the parent-child activity group, I observed that some parents appeared to be walking on eggshells, afraid that their children might have a tantrum if they set limits. They seemed to do whatever their children demanded to get through the first groups that they attended. Other parents actively avoided interaction with their children in activity; they appeared angry and ready for trouble between themselves and their children. As they were helped to interact and participate in projects and activities with their children by the leaders and their observations of other families, they seemed to relax and interact with their children with increased pleasure. Some parents took over projects from their children when there was a display of the kind of misbehavior that the parents seemed to expect. As parents and children became comfortable in the group and began to use the support and assistance of the group leaders and other members, the children remained more consistently involved in activity with their parents and the activities were more often child-directed. Children were reprimanded less, and parents and children exhibited more pleasure in their interaction. I observed parents and children smiling at one another and talking about their days as they worked together to complete a project or to play a game. Some parents and children reported that they had not experienced the other in this way before and structured similar activities for their other time together during the week. Over time, parents exhibited more interest in participating in activities with their children on and off the inpatient unit. Some also appeared to develop a more optimistic view of interacting with their children.

In my informal conversations with some parent participants, they told me that they had not expected the experience of a parent-child activity group to be positive or productive. They said that it took a few sessions to be comfortable with the idea. They reported that watching other families participate in activities and listening to them discuss successes, as well as difficulties, were very helpful. Other professionals reported that after this group, some parents and children were more positively engaged with each other at other times on the ward and more open to other forms of therapy.

The following are excerpts from a taped interview with Susan, a mother who participated in parent-child activity group during a late spring and summer in the early 1990’s when I was a co-leader of the group. The interview took place midsummer prior to her discharge from the parent-child group. Though her situation was different from that of the other parent participants because Susan was an inpatient on an adult psychiatric unit at the same hospital, she reported feelings about herself as a parent similar to those I heard from other parents who were visiting their hospitalized children. She came to participate in the group because it seemed that she and her children had similar issues and would likely fit comfortably into the group. In the course of our retrospective discussion about her experiences in the parent-child activity group, Susan brought up some reactions to the group process that were similar to what I had heard from other parents who had participated in the group.

Susan’s children came to the hospital to participate in the group. Her sons, Tommy and David, were 11- and 7-years-old respectively. All names are pseudonyms.

Susan talked about her feelings about herself:

I felt inadequate. I’m not really that artistic and so it was important that I be able to think of all of the wonderful ideas and do a good job so that this will show that I’m a really good mom … that everything is perfect and that was very hard in the beginning. It seems like that was what I was concentrating on. Even more than interaction with the boys.

Susan shared some thoughts about working with her sons in parent-child group:

One of the things that were difficult in the beginning that changed was the feeling of walking on eggs with each other. I was afraid I was going to say the wrong thing and I think they were afraid that they would say the wrong thing … I remember, in the very beginning, I couldn’t think about how to put anything together, because I felt like I had to think of this all on my own and I had to think of the idea and I had to put this together. Later on, as the interaction between us became better and more relaxed, the idea came from all of us. I would throw something out, Tommy would say maybe we could add this, or my other son, David would say, “Mommy, what about this?” By the end of the project, everyone has put in an idea and no matter what it looks like, it’s really special, no matter what it is … We laughed at some of our projects, but we thought they were pretty terrific because we all helped. One time with the four of us-we still have it at home. We made a house and all of us had a different part. I made the curtains and the bedspreads; my husband made the roof; Tommy helped paint inside; David made our family–with clothespins. We all had a pillow. We all had a bed. It was the four of us and it was very special because we did it together.

I did get relaxed. You know, it’s not just playing with them. It’s learning, learning how to sit down and learn how to enjoy being together and I’ve always had a hard time with that because I always thought things had to be perfect. Or, you know, I shouldn’t be a mother if anything not going to be perfect, but that’s not true … If the project came out perfect that would show that I’m doing what I’m supposed to be doing. It was not what I wanted and it was not what they wanted …

Susan shared her thoughts about being in a group with other families:

I learned a lot by watching and hearing what was going on with other people and mostly I think as far as that goes, that I learned that I was not the only one having a difficult time. I always thought that I was one of very few people that had a hard time with knowing how to sit down with my kids and that was hard. I didn’t think I was going to learn much of that, but I did. I’m not the only parent who has a hard time and it’s not like you have to have a hard time for the rest of your life. You can work on it …

The literature that I read at the time of initiating my first parent-child activity group and the subsequent literature that I have read support engaging families as I have done through group or individual parent-child activity intervention. Unfortunately, psychiatric services are often splintered into services for children and services for the adults in their lives. In many settings, only a small portion of resources is directed toward engaging family members with each other. Consistent with this, many occupational therapists typically see their roles as supporting the function of individual family members and consulting with family members as a supplement to reinforce intervention goals in children’s everyday lives outside of therapy. Over eight years of leading and supervising parent-child activity groups as an occupational therapist at a psychiatric facility, I came to believe that my most profound influence on my clients was through my work engaging parents and children in the actual doing of meaningful play and leisure activities. For the parents and children with mental illness that I will describe in this book, it was critical that parents were key figures in their children’s occupation-based treatment and experienced themselves as competent in supporting their children’s successful participation in everyday play and leisure activities. Many of these parents and children struggled with each other in their co-occupations for years prior to their children’s hospitalization and had come to believe that it is not possible to succeed at and enjoy co-occupations. Consultation was not enough in supporting improved family function in the interest of child development. Actual experience over time may positively shift parents’ beliefs about their skills as parents, children’s beliefs that their parents will be able to support them in their activities and children’s capacity to be cooperative and engage with parents in joint activity.

As my work and that of my colleagues whom I engaged as co-leaders in the parent-child activity group became an important part of the psychiatric services offered on the child inpatient unit, my colleagues and I were asked to work with other groups of patients at the hospital. I developed and co-led a parent-adolescent activity group on the adolescent inpatient unit, a parent-child activity group for preschool children at risk for developing behavior disorders at a local preschool (Olson, Heaney, & Soppas, 1989), and began providing individual and group parent-child intervention for parents hospitalized with mental illness and their children.

Within this volume, I will first share my research on parent child activity group intervention on a child inpatient psychiatric unit. In Chapter 2, I will present the theory and research literature that describes the nature of the interaction between parents and children with emotional disorders. I will then present professional writings about the issues arising between parents and children around a child’s psychiatric hospitalization and the nature of family involvement in psychiatric settings. Jumping off from this literature, I will describe then the framework that I developed for parent-child activity groups and for individual parent-child occupational therapy intervention.

In Chapter 3, I introduce readers to some of the families who participated in the parent-child activity group that I studied. By providing readers with a rich description of the challenges faced by some of the families that I’ve met in a parent-child activity group, as well as the strengths that these families exhibited, I hope to engage them thinking more deeply about whom the members of these families are. Readers may find that something that resonates with their own experiences with parents and children with mental illness.

I present my framework for parent-child activity groups in Chapter 4. In addition, I developed snapshots of a parent-child activity group to help readers visualize the parent-child activity group that I studied for my dissertation research. In Chapter 5, readers learn about my research methods and some of the results of my qualitative study including what I came to understand about what families appeared to gain through their participation in parent-child group. I explore the barriers that seemed to interfere with parents and children exploring how to engage in the co-occupation of parent-child play and leisure activity in the parent-child activity group that I studied, as well as my reflections on how to remove those barriers in similar parent-child activity groups. My research is a first step in examining what may happen in such a group and what clinicians can learn from those experiences to better provide services that support families that include a child with mental illness in having positive experiences in their co-occupations. Therefore in Chapter 7, I reconsider my thinking about parent-child activity groups and how my framework might be refined.

In Chapter 8, I share some of my clinical experiences leading a parent-adolescent activity group on an adolescent inpatient unit. I present case descriptions developed from logs that my co-leaders and I wrote as we worked with the families described and refined our group approach. I found that leading groups for adolescents and their parents required adapting the approach that I used for school age children and their parents. My experience was that in spite of adolescents...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ABOUT THE AUTHOR
• Foreword
• Preface
• Acknowledgements
• Chapter 1. Introduction
• Chapter 2. What Do We Know About the Daily Interactions Between Children with Mental Illness and Their Parents?
• Chapter 3. Introducing Parents and Children Participating in One Parent-Child Group on a Child Inpatient Psychiatric Unit
• Chapter 4. One Parent Child Activity Group: A Framework and Snapshots
• Chapter 5. A Qualitative Research Study of One Parent-Child Activity Group
• Chapter 6. Exploring What Was Missing in One Parent-Child Activity Group
• Chapter 7. Parent-Child Activity Groups Reconsidered
• Chapter 8. Engaging Psychiatrically Hospitalized Teens with Their Parents Through a Parent-Adolescent Activity Group
• Chapter 9. When a Mother Is Depressed: Supporting Her Capacity to Participate in Co-Occupation with Her Baby–A Case Study
• Chapter 10. Closing Thoughts About Promoting Parent-Child Co-Occupation Through Parent-Child Activity Intervention
• Index