This document outlines the seven steps of the group intervention process used in occupational therapy: introduction, activity, sharing, processing, generalizing, application, and summary. The introduction step involves welcoming group members, setting expectations, and outlining goals. The activity step requires selecting a therapeutic activity matched to members' capacities. Sharing and processing involve discussing members' experiences. Generalizing identifies lessons learned. Application relates lessons to real life. The summary reviews key points and acknowledges participation. Additional factors for effective group leadership include motivation, role modeling, communication skills, limit setting, and personal qualities like courage and willingness.

1. Occupational Therapy the Group Process part 2

2. Group Intervention Process
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

3. Group Intervention Process
Step 1:Introduction
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

4. Group Intervention Process
Step 1:Introduction
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?

5. Group Intervention Process
Step 1:Introduction
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)

6. Group Intervention Process
Step 1:Introduction
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

7. Group Intervention Process
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

8. Group Intervention Process
Step 2: Activity
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

9. Group Intervention Process
Step 2: Activity
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
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

10. Group Intervention Process
Step 2: Activity
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

11. Group Intervention Process
Step 2: Activity
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
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

12. Group Intervention Process
Step 2: Activity
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

13. Group Intervention Process
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
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

14. Group Intervention Process
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
Very revealing when done effectively

15. 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

16. Group Intervention 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
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

17. Group Intervention Process
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

18. Group Intervention Process
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)

19. 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

20. 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

21. 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

22. The organizer:
Sets and maintains boundaries, limits and rules
Establishes a tone
Sets a feeling of safety and security
Role Model :
Demonstrates by giving examples to ease the understanding
of a certain idea
Provides orientation on how the group is supposed to go
Role Model :
Demonstrates by giving examples to ease the understanding
of a certain idea
Provides orientation on how the group is supposed to go
Facilitator:
Determines and directs, enables the group activity and
participant interaction among each other

23. Communication skills
Active Listening:
Absorbing the content
Noting the persons gestures and changes of expression
Sense underlying messages
Have to be in the moment for each interaction
Reflection
Communicating back to a person, given a sense of what
he/she has communicated to you
Clarification:
Recounting what one of the members has said
Blocking
Prohibiting either directly or by your interpretation, types of
communication that are destructive to the group, gossiping,
and invading other members privacy

24. Facilitating
Inviting others to participate, to express their thoughts and
feelings, or to work on the activity of the group.
To work with others and make comments and suggestions
about what other members are doing/saying
Empathizing
Provide a response to show that you understand what the
member wished to communicate to the group
“putting yourself in their shoes” Personhood skills
Courage
The ability to admit mistakes, express fear, act according to
hunches.
To be direct and honest with members
Be genuine and not defensive in the face of criticism
To do what the leader expects others to do in that group
situation

25. Willingness
The model behavior that one expects from group members
Being Present
Fully experiencing the groups activity and interactions and
not being distracted from the purpose of the group
Belief in the group
Believing in the value of what is being done or is happening
in the group
Ability to cope nondefensively
Not personalizing or withdrawing from comments or actions
that you perceive as critical of you or your performance
Self awareness
Awareness of your personal goals, identity, motivations,
needs, strengths and limitations, values and feelings
Sense of Humor
The ability to laugh at yourself, and to see and understand
the imperfection of the human condition

26. Inventiveness
The capacity to be spontaneous and creative, often combined with the
ability to learn from every experience in your life
Group Intervention Structure of Process
› Forming
› Discussing tasks and roles.
› Setting out expectations.
› Goal setting.
› Brainstorming ideas.
› Discussing alternatives.
› Completing tasks and duties.
› Making a decision.
› Implementing the solution.
› Evaluating performance

27. Determine which roles are most suitable and helpful for the
current stage/function.
- When first forming your group, you will not necessarily need
anyone in the Evaluator/Critic or Orienter roles.
- You will, however, need Energizers, Procedural, Technicians, and a
Recorder.
- When discussing alternatives, it is important to have representation
in as many maintenance roles as possible.

28. Recruit and/or develop the missing roles within your group.
- Where are the gaps? Filling these roles will promote group success.
- With a flexible group structure members each use a wide range of
talents, and provide maximum contribution to the team
Identify any dysfunctional roles being played within the group.
- Eliminate dysfunctional behavior either through increased
awareness, coaching, or feedback.
- Self-serving roles must be minimized or eliminated for effective
group work to emerge.
- Make the whole group aware of the maladaptive behaviors.
- This alone should decrease much of the disruptive behavior

29. Limit Setting
How the facilitator exerts authority over the group
Assume appropriate authority
Don’t dominate, facilitate
Equal time
Limiting inappropriate behavior
Respectful limit setting
Re-evaluate regularly.
Groups are constantly changing their function and purpose.
Make sure you continuously evaluate what is going on within the
group and take action to maximize effectiveness.
A learning experience
Consider analyzing the roles you take on as well as the roles taken
on by your group members.
This will help in your reflection

30. Self Role Analysis
What roles did you see yourself playing in the group?
Were these the same or different as you saw others playing?
How does your role in the group compare to the roles you
play in other groups?
What other roles would you like to try?
What might help you take on these roles?

31. Dealing with problem behaviors in a group
- OT’s need to develop skills in handling group problems
- Problem behaviors can block the group from progressing
Solutions
Understand what this person client needs?
Develop strategies for preserving group cohesion
Try and meet the needs of the person/client and the group

33. AVOIDING
- Taking no action & disregarding
- Low assertion and cooperation
- Sometimes appropriate
Overuse of this style results in
negative evaluations from others and
doesn’t contribute to productive outcome

34. ACCOMMODATING
Cooperative but unassertive
Appropriate when
you are wrong or
when you want to let the other party have his or her way or
when the relationship is important
Over-reliance may lead to
loss of respect for you or
you may become frustrated as your needs are never met

35. COMPETING
- Very assertive and uncooperative
- Satisfaction of own interests at other party’s expense
- Appropriate when emergency and you are right
Overuse may result in putting others offside or having a team that
is not prepared to disagree with you

36. COMPROMISING
- Intermediate between assertiveness and cooperativeness
- Each party gives something up
- An effective backup style when efforts to collaborate fail
- Compromise is not an optimal solution
- Solutions reached may be temporary and often do nothing to
improve relationship between parties

37. COLLABORATING
- Win-Win
- High on assertiveness and cooperativeness
- Open and thorough discussion
- Solution satisfactory to both parties
- Works when both parties need to be committed to final solution
- Requires openness, trust and sharing of information
- Improved relationships and effective performance long term

38. WHAT IS REFLECTIVE PRACTICE
Enables us to explore an experience
Identify what happened
Consider your role (behavior/thinking and related emotions
WHAT IS REFLECTIVE WRITING?
Personal style of writing.
Reflect on and think critically about ideas and practice related to
you personally
analyze and judge in relation to the theory
Purpose is to
help you to understand your course material
to help you create links between your past and present learning
and
clarify the relationship between theory and practice.

39. MODELS OF REFLECTION
There are many different models of reflection
Share common features
1. Usually start with a description of what happened (why is this
incident worth reflecting on)
2. Relate what you already know
How is theory relevant
Awareness of your personal feelings
Making sense of the situation
3. Change
how you see yourself,
how you see others,
your beliefs/values/views and/or opinions.

42. Formulating questions (step 1)
M= Member relevant
questions must help group members
A =Answerable
questions should be clear (what do I really want to learn),
specific (relate to that particular group),
parsimonious (don’t include too many variables),
answered relatively quickly
P =Practical
Concerned with practice rather than theory

43. Searching for Evidence (step 2)
Meta analyses are systematic reviews of high quality research
published in reputable peer reviewed journals
These reviews are written by experts who have already
reviewed the methodology used in the articles
There are less sources available as we move up the pyramid
Too few results? Widen the types of publications (move
down the pyramid).

44. Searching for Evidence (step 2) COMPASS
Co= Concepts
Concepts/keyword for the search
Me= Methodology
Intervention technique/survey/assessment
P= Publication
Sources e.g. Cochrane library, ERIC (education), CINAHL
(nursing and allied health).
ASS And Search String
Maximizes the effectiveness of searches e.g. group dynamics
(group dynamic/s, group process/es, group structure/s

45. Critically reviewing the evidence (step 3): RCT
1. Rigor
Research merit of the evidence, trustworthiness or Validity
e.g. randomization, number of participants, instruments
used to measure, statistical analysis
2. Evaluate the impact of the research
How powerful are the findings
e.g. statistical and clinical significance
3. Applicability
Practice relevance and appropriateness
e.g. is the intervention used relevant to my clinical setting

46. Applying the evidence step 4
Can you apply the exact intervention technique found in the
literature to your group?
Do you need to make adaptions?
Alter the intervention?
Use the technique with a different population?
Use it for a different problem?

47. Applying the evidence step 4
How are you going to evaluate the results of your group?
1. Goal setting
e.g. reducing depression (individualized goal) or improved
cohesion/group interaction (group work goal)
2. Monitoring/tracking progress
e.g. using research tools for tracking progress and
outcomes/measures with good psychometric properties suitable
for clinical practice e.g. GAS (Goal Attainment Scale)
We need to remember to document what intervention was used, how it
was adapted and the results/outcomes.

48. Evaluating Group Outcomes
Did the group progress the way we planned?
1. Data from each session
Who attended
Level of participation
Topics covered
What stage of development is group at?
Were the activities matched to this stage or did the activities help
to develop to the stage?

49. 2. At the end of the group program
Was cohesion achieved?
What stage was achieved by the end of the group program
What content/ activities should be modified?
Empirical support/evidence for maintaining or changing?
Participant feedback
Facilitator consensus
Self reflection on leadership/ facilitation
Reflection on co-facilitation

50. How did the client respond?
Attendance, participation, contribution
Observations, session notes, behavior in activities
Client feedback
Disclosures during sessions
Overall reporting and feedback
Formal assessment
Standardized assessment (interview, survey, questionnaire)
Structured or unstructured interview

51. Assessing Whole Group Outcomes
Process AND Behavioral Change outcomes.
In what way was the group satisfying to the members?
Why was it attractive?
Self monitoring strategies
Development of measures or consultation or use of
standardized measures
Evolution of content over time
Facilitator experience of Group
Compare perceptions to participant feedback
Review in professional supervision or peer supervision

52. Individual Outcomes
Did the group have desired effect on individual?
Base line measure
After group measure
Degree and direction of change
Statistical significance of change
Post group measure
Maintenance of change over time (e.g. 1 month, 6 month
and 1 year)

53. Evaluating Group differences
Are two groups statistically different from each other?
across time or compared to control wait list?
Mean score on measure
Compared statistically (t tests commonly)
Determination of statistically significant difference.
Must consider
Variability between groups
Variability within groups
We have to judge the difference between group means relative to
the spread or variability of their scores.
The t-test does just this

54. All scientific work is incomplete— whether it be observational or
experimental.
All scientific work is liable to be upset or modified by advancing
knowledge.
This does not confer upon us the freedom to ignore the knowledge we
already have, or to postpone the action that it appears to demand at a
given time