The Functional Group Model
In a center that provides services to clients with sensory processing disorders, children often play together in small groups, with guidance from the therapist as needed. At times the groups are planned and other times they form informally as children ask to join an activity that looks fun to them. They might en-ter an imaginative play scenario, such as go-ing on a safari, cooperatively plan an obsta-cle course, play a board game, or participate in a competitive game of bumper tires.
Within these groups children work on turn-taking, sharing, working together, and being a good friend. They build valuable skills that will help them become successful outside of the therapy session.
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Maya Tuchner runs a hemiplegia group de-signed for clients following cerebrovascu-lar accident (CVA) who are in daycare or inpatient rehabilitation. The group is led every day by an occupational therapist for about half an hour. The group focuses on motor and cognitive functioning. The group starts with basic orientation in time and place and mention of special events like holidays. Then, there are several exer-cises that include bilateral and symmetric movements along with balance exercises.
Participation in the group requires the ability to imitate movements but does not require comprehension, so that clients with aphasia can also participate. The group also provides basic social stimulation.
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s demonstrated in these examples, occupa-tional therapists frequently use groups of clients interacting together as a means of providing ther-apy. The use of groups has always been part of occupational therapy, as Chapters 3 and 4 illus-trated. There are distinct advantages to addressing some client problems or needs and to providing some kinds of services in groups. For instance, groups are a natural context for addressing clients’interpersonal problems and groups can be a source of social support and feedback needed by clients. Moreover, certain kinds of services, such as those that are designed to impart information, improve understanding, or teach skills, can be enhanced by being delivered in groups where clients can share relevant knowledge and experience. Finally, services offered in groups are less expensive than those offered on a one-to-one basis. For these and other reasons, groups are increasingly used in occupational therapy (Duncombe & Howe, 1985; Howe &
Schwartzberg, 1986), creating the need for knowledge on how to conduct therapeutic groups.
Groups are often used to achieve goals related to other conceptual practice models dis-cussed in this text. For instance, as seen in Chapter 8, some cognitive interventions are pro-vided in groups. A variety of groups based on the model of human occupation have been devel-oped (Baron, 1987; Braveman, 2001; Gusich &
Silverman, 1991; Kaplan, 1986; Knis-Matthews, Richard, Marquez, & Mevawala, 2005). Exercise and range of motion groups also are used to achieve biomechanical goals of increasing range of motion or endurance. In these instances the content of the group is guided by these models.
However, the effectiveness of such groups can be either hindered or enhanced depending on how group dynamics and processes are managed to influence the individual members. It is to these aspects of groups that the functional group model is addressed.
The functional group model was first intro-duced in 1986 (Howe & Schwartzberg) as an approach to guide occupational therapy group intervention. Functional groups, in which mem-bers participate in occupation, are distinguished from group psychotherapy and related activity
groups, which focus on using discussion and group dynamics to resolve intrapersonal and interpersonal difficulties by achieving insight and working through issues. A func-tional group seeks to enhance occupation (Schwartzberg, Howe, & Barnes, 2008). Func-tional groups are considered appropriate for clients who need to:
•Evaluate their own ability to carry out life roles
• Acquire skills and role behaviors
• Develop communication and interaction skills to enhance occupational performance
• Prevent loss or deterioration of skills and behaviors
• Improve health, wellness, or quality of life (Schwartzberg et al., 2008)
Theory
Concepts Related to Groups
Schwartzberg et al. (2008) first discuss fea-tures that are common to all groups. These concepts address the definition, characteris-tics, and features of groups and serve as a context for thinking about the more specific, functional group.
Definition of Groups
Schwartzberg et al. (2008) note that the term group refers to a collection of people interacting together in order to achieve a common aim or purpose. They note, however, that true groups include:
• Interaction among their members
• A common goal
• A relationship between size and function (the size of the group is related to what the group is supposed to accomplish)
• Members’ desire or consent to participate in a group
• A democratic capacity for self-determination When these features are present, a true group exists. Thus, five people waiting in line at the grocery store do not constitute a group. On the other hand, five high-school students working together to decorate the gym for a dance do con-stitute a group.
Characteristics of Groups
All groups are characterized by structure, cohe-sion, and stages of development. Group struc-ture refers to “the combination of mutually connected and dependent parts of the group that form its existence” (Schwartzberg et al., 2008, p. 7). Group structure includes the organization and procedures of the group. It is influenced by its context, climate, composition of members, purpose, and goals. Group structure is also influenced by how the leader and members interact and the size and norms of the group.
Group cohesion refers to the intensity of feeling for and identification with the group among its members; it is reflected in a sense of group solidarity in how much the members value and care about the group. Cohesion is af-fected by how members mutually understand, accept, and support each other and by the extent of trust between members.
Stages of group development refer to the phases a group passes through during its existence. These stages are dynamic and unpredictable and may be characterized by fluc-tuations. While formulations of group stages have been identified, they all share a common trajectory in which the group must first be formed, followed by building of relationships, deciding aims and procedures, accomplishing tasks, and then terminating.
Features of Groups
Two features are common to all groups: content and process. Content refers to tasks done during the group and what is said or discussed. For example, if an occupational therapy group cooks a common meal, the activities involved in cook-ing and the necessary conversation about gettcook-ing the cooking done is the content. Process refers to how things are said and done and how the group goes about accomplishing its goals. For instance, how members of the group decide together what to cook and whether everyone has a say in the decision-making are parts of the process.
Two types of group behavior contribute to the group process:
• Group task functions that enable the group to accomplish its aims related to content (Bales, 1950)
• Group-building and maintenance functions that help create and sustain relationships and connections between members (Bales, 1950) Members can take on different roles in groups that contribute to these functions. For example, the initiator-contributor comes up with and suggests new ideas or procedures while the energizer prods the group to action. These roles both contribute to group task functions. Group-building and mainte-nance functions are supported by such roles as the encourager (who gives praise and agrees with others), the harmonizer (who helps resolve differ-ence between members), and the gatekeeper (who facilitates communication between members).
Group members may also take on individual roles such as dominator, playboy (clown), or aggressor (Benne & Sheats, 1978) that may become detri-mental to the group process if not addressed.
Concepts Specific to the Functional Group Model
The functional group model is based on con-cepts of interaction analysis, group membership and leadership functions, group dynamics, the phases of group development, and the impact of
Box 9.1 Levels of Group Development
Mosey (1970) identified five levels of group devel-opment in which each level represents an increas-ingly cohesive, balanced, and self-determining group.
•Parallel groups in which members pursue individ-ual tasks with minimal interaction
•Project groups in which members engage in short-term activities that are related and that require some interaction
•Egocentric cooperative groups in which members cooperate together on a long-term activity and are able to respond to each other emotionally but still need a leader to keep the group together
•Cooperative groups in which members address each other’s social and emotional needs along with the activity goals of the group and are largely self-determining
•Mature groups in which members balance achieving the group’s goals with meeting social and emotional needs and leadership comes from co-equal members
group process on individual growth. Based on these concepts, the functional group model reflects the principles that groups:
• Encompass a common goal and dynamic interaction of their members
• Have capacity for self-direction
• Can become increasingly independent of designated leadership
• Can address individual needs
• Provide multiple types of feedback and support
• Can support members’ growth and change (Schwartzberg et al., 2008)
The functional group model also recognizes that members bring to groups an innate drive for competence (White, 1959, 1971) and a hierar-chy of needs (i.e., physiologic, safety, belonging and love, esteem and
self-actualization) (Maslow, 1970).
Central to the functional