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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
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 prompting
Leader:
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 competitive
Leader
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 Types of Occupational
Leadership Therapy Group
1. Autocratic Leadership
2. Democratic 1. Directive
3. Laissez-faire 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 roles
Examples:
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:Introduction
a. 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: Activity
A. 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, cont
F. 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: