Names: acknowledge each member by name, self as leader, title of group, ask members to greet each other, reinforces inclusion in group, creates friendly atmosphere
Warm up: How alert are the members? Are they ready to begin a new experience? Provide a short introductory activity, captures attention, refocuses member thoughts, may be informal or imaginative, prepares group for activity to follow
Setting the mood: warm up can facilitate, environmental features (lighting, seating, getting rid of clutter and distractions, having needed supplies ready), therapist facial expression, gestures, and tone
Expectations of the group: light hearted or serious? Closed group?
Explanation of 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, goals should be outlined in first session
Brief outline of the session: include time frame, media and procedures, what is important, focus is on discussion and learning, don't reveal anything you don't want to share
Selection: very complex process, includes activity analysis and synthesis, based in OT theory and evidence, simplified, focus on personal growth and meaning for students
Timing: 45 minute sessions, activities should be short and simple, activity portion should last no longer than one-third of total session, must be challenging and complex enough to produce meaningful discussion and learning
Therapeutic goals: desired outcomes, individually set before group begins, based on client preferences and therapist evaluation, clients and therapist collaborate to accomplish, once goals are defined-activity is chosen
Capacities of the members: activity should match capacity of members, choose activity challenging enough to hold interest but not beyond capacity, cognitive limitations require simplified instructions, physical limitations require adaptations, focus on learning something new and meaningful
Knowledge and skill of the leader: students should choose activity with which they are comfortable, capitalize on individual talents and skills, go with strengths and experience, select a growth facilitating activity, use self as barometer of what is meaningful
Adaptation of the activity: all potential activities need to be adapted, use knowledge of peers to create a match, activity analysis-break down activity, match each component with the human functions required to accomplish it, modifications are made to compensate for disability or need for added challenge, activity presented in systematic way, simple/direct language, instructions sequenced, get feedback from members to check understanding, keep materials hidden until needed and removed when activity ends, choose to participate as leader or not, give warning when time is up (1 minute), stop even if some members are not finished
after completing activity, each member is invited to share, ask for volunteer to start, once begun go around group in order, acknowledge each member's contribution (verbal and nonverbal, PAE or feeling statement), for some activities sharing is incorporated into activity, requires opinion giving, discussion, and group decision making, leader must make sure everyone participates in discussion Formation (6 months): therapists own experiences, concerns over incompetence, self-worth, jealousy, energy focused internally, atmosphere complicated, must have regular exchange or supervision, goal: decrease intrapersonal to focus attention on clients
Development (4-12 months): energy shifts to interpersonal, deal with difference between therapists, distinct qualities, focus-acknowledge differences, concerns, power, goal-recognize differences and encourage use of both styles
Stabilization (6-18 months): recognizes individuality, positive stroking of each other, difference are treated as enriching, focus-role models for group, acceptance, increase in communication, increase in enjoyment, goal-allow resistances to be confronted and positive dealing with transference
Refreshment (mature stage): peak experience, creative interaction leads to new theory, new practice, increased growth, significantly positive for clients and therapists, fun discussions-less energy on processing, few teams stay together this long
standards of group behavior, participation, and interaction-must be established by the leader right from the first group session. Once established norms (culture) are exceedingly difficult to change (ex: no interrupting, active listening, eye contact, active participation, no swearing, body language, etc.). Leader shapes norms by initial instruction of group members and setting ground rules, contract, model-setting participation. Example of therapeutic norms: self-monitoring group, self-disclosure, procedural norms, importance of group to its members, members as agents of help, support help group get its work done (initiator-contributor, information seeker, opinion seeker, information giver, opinion giver, elaborator, coordinator, orienter, evaluator-critic, procedural technician, recorder) Level 1: Self, internal stimuli, might not even be responding to outside
Level 2: Body, respond to body sensations, look at body
Level 3: Arm's reach, not very far out, only arm's reach
Level 4: Visual field, what is in their visual field, not going to scan the environment particularly well
Level 5: Task environment, entire task environment, ex: the entire classroom
Level 6: Potential task environment, being able to discern what might be coming in/going out, knowing a whole lot more, knowing where you will find things, ex: bowls in cupboard, silverware in drawer
The human open system: Input, throughput, output, and feedback
Throughput divided into three subsystems: Volitional, Habituation, Performance capacity
Concepts from Mary Reilly's occupational behavior:
Adaptation—Requires occupational skills, including motor, social, time use, self-care, work, and play
Motivation: Intrinsic urge to explore and master the environment (White, competency)
Temporal adaptation—Balance and habits
Occupational roles—Socialization and occupational choice
The environment: Occupational forms, socially defined tasks, and performance requirements (David Nelson); Social groups; Objects; Spaces
Occupational behavior settings: Home, workplace, school, stores, etc.
Occupational performance is "output"
Feedback about performance results in "occupational identity"
Experience (repeated occupational performance with specific contexts) results in "occupational competence"
Overall goal is finding meaningful roles for individuals within the larger systems: Family, community, work or school, etc.
Includes: Goals and objectives, training, shaping, chaining, modeling, external reinforcement, rehearsal and practice, role playing, systematic desensitization, biofeedback
OT examples: Assertiveness training, social skills training, graded tasks, relaxation, time management, stress management
Strength, ROM, endurance, positioning, prevention, restoration, compensation, adaptation, skill training, biofeedback, context of ADL
OT Examples: Group exercise, group games involving graded movements, learning prevention strategies, ergonomics in the workplace, work hardening, training in use of adaptive equipment, energy conservation
Skill training (remediation) for orientation, attention, visual processing, motor planning, memory, cognition, problem solving; multicontextual use of strategies, metacognition; functional approach; quadraphonic approach (Abreu)
OT Examples: Group orientation, labels and reminders, cancellation sheets, computer programs, group multicontextual strategy practice
Social learning, modeling, self-regulation, disputing irrational beliefs, thought stopping, interruption, cognitive reframing or restructuring, dialectical strategies
OT Examples: psychoeducational modules, group learning, role playing, worksheets for self-awareness and understanding, interpersonal effectiveness, emotion regulation, distress tolerance, mindfulness