Occupational Therapy Groups for Adults

1. Occupational Therapy Groups for Adults

2. Why service adults in a group
Adulthood 21-65 years (65+ late adulthood)
Social participation
Role models for each other
Both group and individual goals may be targeted
Therapist can observe client in group environment
Efficiency

3. Adulthood
Early Adulthood
• Finding work
• Intimate relationships
• Living independently
Middle Adulthood
• Productive at work
• Family
• Caring for self and others
Late Adulthood
• Contribute to society
• Decreasing work
• Declining physical performance

4. The role of OT
Occupational performance difficulties related to:
Trauma
Illness
Disease
May be physical, cognitive or psychosocial

5. Demand for a group
Identify staff, material resources
- Decide on type of group (consider wider context demands of setting)
- Define aims (Formulate goals---Consider Individual needs and group
compatibility)
- Sell the group and gain referrals
- Select Members
- Prepare members
- Plan group sessions
- Evaluate group sessions

6. Approaches to help with planning
Teaching and learning
Task Analysis
Role play
Reflection

7. How do we choose the activity?
What is functional level of members?
1• Psychological, Physical & Intellectual strengths and limitations
2• Consider all performance components; cognitive, communication
skills, emotional needs and perceptual motor skills
3• Group skills ability to interact and understand the needs of others
4• Optimal arousal level -Optimal match of individuals
capabilities and environmental demands = activity is neither too
taxing or under stimulating.
5• Mix of clients- Heterogeneous v’s homogenous, personalities
6• Group cohesion-This will impact on trust and willingness of group
members to share.
7• Setting-Consider the setting e.g. hospital ward v’s community

8. How do we grade and adapt activities?
Grade activity by:
1. Level of difficulty
2. Breaking activity into component parts
3. Individually graded programs
4. Increase the type and number of roles
5. Series of groups operating at different levels

9. How do we grade and adapt activities?
Adapting treatment
Skill levels may be different
Unexpected events may occur
Need a degree of choice
Need to meet the values/cultural requirements of group

10. Task or skill orientated Emotion oriented
Educational
- Developing task and functional skills (e.g. concentration work
ability)
Activity
-Experiencing social interaction and developing leisure interests
Support
-Mutual support and sharing
Expressive
-Expressing and exploring feelings
Therapy
-Therapeutic focus

11. Support Groups
Encourage members to explore feelings
Give each other support
Gain confidence
Develop trust
Share ideas
Activity is used as way of increasing interaction e.g. discussions,
social skills, psychotherapy

12. What is a support group?
Connect people sharing similar experience
Can be formal or informal
Not always treatment focused
May be non professional but may be overseen, facilitated by
professional
May be beneficial to have support outside of immediate social/
family group

13. Support Groups
May be formed by people affected by a condition, or circumstance
NGO’s, advocacy organizations, mental health clinics
May be in face to face or virtual format (internet)
Sessions may be structured (e.g. educational session from a doctor)
or focus on emotional support and sharing

14. Benefits of support groups
Feeling less lonely, isolated or judged
Gaining a sense of empowerment and control
Improved coping skills and adjustment
An opportunity to talk openly and honestly about your feelings

15. Education groups
Focus on learning new information, a new task or skill
Used in a variety of settings
Typically include
Presentation of information and knowledge by experts
Group discussion to foster learning
Group members are bonded by common interest or characteristic
Leader considers needs of group members when planning group
Knowledge of group members may vary
A low level of self-disclosure is expected

16. Education groups
Typically structure around a presentation of educational material or
a guest speaker
May emphasize
Learning as a social experience (use of group discussion and
groups activities) or
Didactic methods e.g. lecture

17. Adult education groups
Educators and participants are equal
e.g. Health Promotion Groups
• Benefits of healthy lifestyle
• Information about a condition and management of this
• Using hobbies in leisure time
• Advice on retirement
• Education groups are not therapeutic groups.
• Need boundaries around reasonable disclosure

18. Conducting an Adult education group
Selection of participants
Providing the right environment
Group Teaching techniques
Evaluation
Select members using clear set of criteria
Members need to understand
Purpose of the sessions
Practical requirements
Commitment needed
Need to adapt teaching techniques to meet the needs of all members
e.g. ESL, poor literacy, hearing or vision loss

19. Conducting an Adult education group:
Providing the right environment
Quiet room, free of distraction
Physical comfort (e.g. heating, lighting, seating)
Access to toilet, refreshments
Educational equipment (e.g. whiteboard, video etc.)
Therapist part of the group (e.g. circular seating v’s rows)

20. Conducting an Adult education group:
Group teaching techniques
Typically a “course” run for a small group over a number of
sessions
Should be curriculum and learning objectives
Learners should understand why they are attending
Format to
Maintain attention
Course program but need flexibility
Selection of participants

21. Conducting an Adult education group:
Group teaching techniques
Teacher a resource person who facilitates learning
Structure the content for the audience
Consider language used
Ice breakers/get to know you activities are needed
Workshop style activities e.g. small groups
Varied teaching techniques, helps maintain interest

22. Conducting an Adult education group:
Group teaching techniques
Conducting an Adult education group: Evaluation
Assessment- can be formal/informal
Pre and post questionnaire
Multiple choice test
Group members prepare a small summary of a topic and present to
the group
Evaluation Forms (can be anonymous)
Group Discussion
What was useful?
What has changed since course began?

23. Culturally appropriate health education for
diabetes (type 2), Cochrane review
Culturally appropriate health education can result in
Improved glycemic control (as measured by HbA1c levels) and
improved cholesterol levels
Improvements in knowledge about diabetes and its management
Culturally appropriate health education is better than “normal”
practice for minority communities
Health education should be learner-centered and respect religious,
social and cultural values in order to have the most impact.

24. Features of expressive art groups
Requires more preparation than talking therapy groups
Group leader is responsible for
Planning the session topic
Materials
Structuring the session (allow time for art and discussion)
Need 1 ½- 2 hours
Features of expressive art groups Typical Session
15-20 minutes warm up
20-45 minutes art activity
Discussion where members can
- Share creations
- Discuss feelings and the activity
- Re-center

25. Features of expressive art groups
Expressive arts groups allow members to participate at their own
level rather than forcing them to “catch up” with other group
members
Structured groups- revolving around a theme e.g.
Painting your depression
Creating a personal portrait with a piece of string
Unstructured groups
Allow members to create random art
Not suitable for all groups.

26. Features of expressive art groups
Important Considerations
Logistics of the room
Level of mess
Time to clean up
Additional features e.g. music.
Art materials
Paints, brushed, brush cleaner, plates to mix
Dry Media: wax crayons, felt tip pes, oils, pastels, charcoal, colored
pencils, markers
Paper: construction paper, white paper, tracing paper, brightly
colored paper, cardstock (white and colored), newspaper, art paper
of various sizes.
Cutting material: scissors, circle cutters, hole punches (with
different designs), edge punches

27. Art Materials
Collage materials: old magazines, fabrics, textured materials
Miscellaneous: bits of thread, embroidery floss, beads, hemp
rope, stickers, ribbon, buttons
Adhesives: collage glue, craft glue, fabric glue, rubber cement,
glue sticks, spray adhesive, tape,
Clean up supplies: rags, paper towels, newspaper to cover
surfaces, plastic bags, windex etc

28. ART AS THERAPY
• Non-verbal productions of inner self
• Evaluate internal processes such as self-image emotions and
relationships with others
• Clients to interpret their artistic productions
• Promoting discussion and to build trust among group members
DRAMA AS THERAPY
• Psychodrama developed in the mid 20th century
• Specialist training required techniques are complex
Roleplaying easier to use e.g.
• assertiveness skills,
• conflict resolution,
• job interviews,
• interpersonal relationship problems

29. PET THERAPY
Benefits of pet ownership as an occupation with older adults
experiencing
• attachment,
• increased self worth,
• social integration and
• opportunities for nurturance and guidance
• Pet ownership can facilitate social relationships with others and
can help people with serious mental illness

30. Therapeutic Groups
Members come together to solve their problems
Group leader considered expert/authority figure/change agent
Problems are assessed
Treatment goals/objectives are set (with the help of the worker)
Post group assessment
The group has a common purpose however each member may have
a different problem with different symptoms

31. Therapeutic Groups
Facilitators provide opportunities for
sharing within the group,
encouraging risk taking and
openly talking with others about one’s experiences.
Facilitators encourage feedback and participation of members in
providing support to each other.
Group therapy is based on the premise of confidentiality
so that what is shared in the g

32. Therapeutic groups
The development/etiology of each persons problem is unique
To achieve individual goals the leader/worker may focus on 1
individual at a time.
Members of the therapy group may be expected to help out
/support others within the group
Self-disclosure is usually high (dependent on the problem of the
group members)

33. Therapeutic groups - Benefits
Relief from symptoms
Loss of emotional pain
Resolution of a problem
Therapeutic groups run by OTs
Avenue for self awareness and expression of feelings
Help clients with self-control
e.g. allow those who are confused or fearful to increase internal
organization and strengthen or re-establishing self-control
Enhance performance and improve functional skills
Examine priorities and try out new roles or gain confidence within
established roles

34. Therapeutic groups run by Occupational Therapist
Vehicle for learning about relationships with others and
enhancing social skills
Means towards greater self-acceptance
Avenue for improving quality of life – experiencing enjoyment,
feeling

35. Case study: Eating Disorders
Group for Women with Eating disorders
5-10 women with eating disorders in an inpatient facility
Inpatient treatment will last 1-2 weeks
Goal in that time is to medically stable before discharge to
outpatient services
Goal of OT group is
For women to confront the feelings they have about themselves
Including perceptions and feelings about bodies
Articulating and expressing values and beliefs relating to self
image, body weight, effectiveness in one’s life and control

36. Case study: Eating Disorders
Art media and drawing often a good therapeutic tool
Drawing activity
Each person draws picture of self as they are
Therapist pays attention to
what each person draws and
the relative amount of time they spend on various body parts
Participants encouraged to
look at their own drawings and
notice how they depicted themselves and
what body part they spent most of their time drawing

37. Group dialogue might be around
the drawings,
feelings,
societal values and expectations,
what the participant has learnt in their family about food, eating
or the importance of physical appearance
Group members support each other’s efforts towards
enhanced self-awareness,
self-acceptance and
healthier lifestyle.

38. What is the evidence?
Use of therapeutic groups remains a core part of occupational
therapy practice in the acute mental health setting.
Type of groups influenced by;
the environment,
resources,
relationships with members of the multidisciplinary team,
individual experience/skills of the therapist and
the service user needs.

39. What is the evidence?
Evaluation of group programs is essential
Hawkes et al (2008) stated that occupational therapists should
evaluate both the process and outcome of the intervention.
This can be achieved through the use of
Effective reflective practice,
supervision,
outcome measures or
service user enquiry (Hawkes et al, 2008).