Describe Coles 7-step Format for Group Leadership 

1. Introduction

2. Activity

3. Sharing

4. Processing

5. Generalizing

6. Applicaion

7. Summary

Names

Warm up

Set the mood

Expectations of the group

Explaining the purpose clearly

Brief outline of session 

Coles 7-step Format for Group Leadership

Step 2: Activity

Step 2: Activity

Timing - simple - short - 

Therapeutic goals -

Physical and mental capacities of the members

Knowledge and skill of the leader

Adaptation of an activity 

Step 3: Sharing

Volunteer starts first

Can show work

Members share what the experience was like for them Acknowledge each members contributions

Coles 7-step Format for Group Leadership

Step 4: Processing

Step 4: Processing

Members EXPRESS how they feel about the experience

Processing can reveal more relevant information 

Coles 7-step Format for Group Leadership

Step 5: Generalizing

Step 5: Generalizing

Address cognitive learning

Therapist reviews members responses- sum them up in a few general principles

Should not be pre planed – come from member responses

Look at areas of disagreement

Takes Generalization one step further

Therapist helps group understand how to apply principles learned can be applied

Coles 7-step Format for Group Leadership

Step 7: Summary

Step 7: Summary

Verbally emphasize the most important aspects of the group so that they will be correctly

Some times members help

Thank members for their participation 

Directive leadership

OT defines a group, and structures activity – therapeutically appropriate

Use authority sparingly

Absolutely necessary in lower functioning groups FOR: cognitive behavioral, sensorial motor, & cognitive disabilities

Facilitative leadership

OT facilities - earns - gathers support from members

OT is resource person

OT brings required knowledge to group – educator

Not suitable with low functioning clients

Advisory leadership

OT is most passive in this leadership style

OT advises on issues – like stress on job – energy conservation- architectural & social barriers

Motivation comes from the group

Schutz 

Inclusion 

Control 

Affection

This theory concentrates on three interpersonal needs that most people share:

(1) the needs for inclusion,

(2) for control and for (3) affection.  

Schutz maintains that people begin relationships in order to satisfy one or more of these needs.

Will I be respected?

Can I be my self?

Control:

Where do I stand?

How much influence?

Too much responsibility 

Rebellion:  Leadership struggle at some point

Irvin D. Yalom,

The Theory and Practice of Group

1. Orientation: Hesitant participation, search for meaning, dependency (socialization)

2. Conflict: Dominance – Rebellion (struggle for control)

3. Development of group cohesiveness (early phase [Group Cohesiveness] and late phase [Maturity-teamwork])

Explicit Norms 

Non- explicit norms 

Norms are rules that a group uses to define its appropriate and inappropriate values

Explicit Norms are written or spoken openly. 

Non- explicit norms are not verbalised but assumed.

Explicit Norms 

Non- explicit norms 

Group leader’s responsibilities in establishing and maintaining norms in a therapeutic group

OT is key to shaping norms:

Yalom 

1) Technical expert

2) Model-setting participant 

Explicit Norms 

Non- explicit norms

Norms can be changed

Yalom Therapeutic norms:

Self-reflection

Encouraging self disclosure

Encouraging free interaction among group members

Reinforcing the importance of the group

Regrading members as free agents of change and setting an atmosphere of safety and support

Classic break down of member roles

Initiator- contributor 

Information seeker

Opinion seeker

Information giver

Opinion giver

Coordinator

Orienter

Evaluator - critic

Energizer

Procedural technician

Recorder

Encourager 

Harmonizer

Compromiser

Gatekeeper and expediter

Standard setter

Group observer and commentator 

Follower

Aggressor

Blocker 

Reconition seeker

Self-confessor

Playboy

Dominator

Help- seeker

Special interst pleader

Leader-attending

Concreteness

Primary accurate empathy

Immediacy

Advanced accurate empathy

Confrontation

Concreteness

Refers to the ability to elicit information about a client/problem

Ask open ended questions - not yes no questions 

Primary accurate empathy PAE 

Superficial empathy- 

Practice by asking how do you feel questions

Accurate means to identify the emotion 

Immediacy:

Direct mutual communication between a client and therapist 

Group bogs down - ask what is happing now? 

Advanced accurate empathy AAE 

Goes deeper than PAE 

1) Become awaer of hiden feelings

2) See patterns of behavior 

3) Draw logical conclusions 

Confrontation - can be extension of AAE

Involves resolution of discrepancies, games, distortions, used to avoid self-understanding

Not harsh - but act of caring 

The Intentional Relationship Model 

(IRM)  

Occupational Therapy and Use of Self

The Intentional Relationship:

How can one's therapeutic use of self be utilized specifically to promote occupational engagement and promote positive therapy outcomes? 

Intentional Relationship Model: (IRM) 

IRM for OT

Central focus is positive occupational engagement 

Components of Intentional Relationship Model: (IRM) 

1) The client

2) The interpersonal events the that occur during thearapy 

3) The therapist 

4) The occupation 

Situational characteristics 

Situational characteristics 

Generally inconsistent 

Reflect acute emotional states 

Likely to surface when they interfere with the clients planed activity

Enduring characteristics

Enduring characteristics are more stable and not related to the clients immediate situation.

Preferred style of communication  

Trust

Need for control

General orientation to relationships 

Usaual way of responding to change, fustration, or challange 

Therapeutic relationship

Sharing

Witnessing 

Mutual feelings 

Interested in therapy process

Discuss overcome interpersonal events 

Joke

Six Therapeutic Modes 

Six Therapeutic modes 

1) Advocating

2) Collaborating

3) Empathizing

4) Encouraging 

5) Instructing 

6) Problem - solving 

Advocating mode:

Personal, material resources 

Six Therapeutic modes 

Collaborating mode:

Make joint decisions 

Empathizing:

Understand the clients perspective 

Encouraging mode:

Instill client with hope

Instructing mode: 

Educational aspects of therapy 

Problem Solving mode:

Focus on bio mechanical, cognitive, rehabilitation 

Verbal Communication 

Formally recognized spoken or sign language 

Clear audible mouth movements 

Clear, brief, and accurate

Emotionally modulated 

Confident tone

Professional respectful 

Intentional timing 

High Content

Verbal Communication 

More emphasis on the context

Emotional tone

Infection of voice

Other events in broader environment 

Low Content Verbal Communication 

Non Verbal Communication 

Not formally recognized language

Sounds

Tone of voice

Facial expression

Body movements

Postures

Insight on feelings that other wise would not be communicated 

Therapeutic Listening 

Therapeutic Listening:

Empathic listening:

Recounting

Accepting 

Affirming any client perception

Therapeutic Listening:

Guided listening:

Alternative approach- shape what client is saying by making summary statements 

Clarify - Organize - client statements 

Common Obstacles to listing

Planning your response to such an extent that it distracts you from what a client is saying

Filtering what the client has said based on what you wish to hear or based on some other prejudiced notion of the client

Comparing a client to someone else (either in your own mind or aloud

Common Obstacles to listing

Common Obstacles to listing

Evaluating the accuracy or veracity of the communication judging either praise or criticism)

Analyzing drawing connections, or formulating

Intrusive thinking (e. g, distracting thoughts that pass through your mind)

Chronic reliance on nonverbal responding

Common Obstacles to listing

Common Obstacles to listing

Dropping hints at your reaction

Being right or needing to convince the client that you are right

Introducing a topic that takes the conversation off the original topic

Reassuring or normalizing rather than listening typically motivated by the therapists’ anxiety or need rather than by the client s actual preference for reassurance)

Common Obstacles to listing

Common Obstacles to listing

Over using prompts or utilizing them to give a (False) impression that you are listening (e. g , uh huh)

Self disclosing how something would have made you feel or recounting something similar that happened to you

Asking Further probing questions 

Positive Feedback

When praising a client, comment on or describe a specific behavior e g , You’ve gotten that grasp to work rather than making a more generalized statement such as well done or great job Thus guideline also applies when providing feedback of an interpersonal nature

Positive Feedback  

Use more generalized statements with parsimony

Never describe a behavior as “perfect” because it encourages clients to strive for an unrealistic level of performance

Avoid comparisons to other clients or to famous people when providing positive feedback It robs the client of the chance to experience the accomplishment as an individual

Negative Constructive Feedback

When giving constructive feedback focus on one ISSUE at a time

It decreases the risk of overwhelming clients, so the clients can focus their energy on that single issue Avoid being indirect or vague about the feedback overprotecting clients In this way can lead to confusion about the nature of the feedback, a decreased impact of the feed back 

Bidirectional communication-

Bidirectional communication-

communication that does feel reciprocal to the therapist because, at minium, it involves some indication that the client has received the communication. More typically, bidirectional communication involves an ongoing give-and-take during which both client and therapist may independently initiate and maintain sharing of thoughts and feelings.

Emotional modulation

Emotional modulation-

Emotional modulation-adjusting the extent to which one’s verbal communication is marked by emotionality in tone of voice and choice of Words according to the situation at hand and one’s estimation of the client’s preference and level of tolerance for emotional intensity.

Empathic listening

Empathic listening

recounting, accepting, and affirming any perception or experience a client offers.

Guided listening

Guided listening-

strategic approach in which a client attempts to limit, structure, or organize what the client is saying by making one or more clarifying statements.

High-context communication

High-context communication-

-places less emphasis on explicit verbal description of events and more emphasis on the context surrounding what is being said, such as the emotional tone or inflection of voice or other events in the broader social environment.

Low-context communication-

Low-context communication-

places more emphasis on the literal spoken word and less emphasis on inflection, tone of voice, or to the context that frames the communication. People from low-context cultures typically do not hypothesize about what was left unsaid or pay as close attention to subtle changes in inflection or tone.

Nonverbal communication

Nonverbal communication

not based in a formally recognized spoken or signed language. lt includes sounds, tone of voice, facial expression, body postures, movements, and gestures.

Therapeutic communication

Therapeutic communication

-characterized by leadership, responsibility taking, empathy, and intentionality on the part of the therapist.

Therapeutic listening

Therapeutic listening

-therapist’s efforts to gather information from a client in such a Way that it promotes greater understanding, validation, and support.

Verbal communication

Verbal communication

-use of a formally recognized spoken or signed language.

Rapport Building

Rapport Building

Make eye contact

Ask client how to address them, name

Introduce self

Ask how to pronounce their name 

Orient to treatment environment

Impersonal small talk

How are you feeling today

Let client know a little about your self

Impression Management 

Impression Management

Physical self-presentation

Emotional self -presentation 

Project take-charge attitude

Sense of pride-energy 

Professional boundaries

Setting Emotional Climate

High intensity - loud voice -energy animated geastures 

Low intensity - soft voice - advocating collaboration - problems solving modes

Managing emotional intensity 

Witnessing: Clients' expression -nonverbal

Emotional resonance: Feeling same emotion as the client

Labeling: the clients' emotional expression

Intervening in the clients' emotional expressen 

Responding to sadness

Responding to sadness

Witnessing 

Remain present 

See if client invites you to the emotion

Handing the client a tissue

Responding to Anger

Responding to Anger-Signs

Client rises - Quick impulsive movements

Tensing Jaw - grinding teeth

Clenching fists - Pacing - Yelling - Rage -

Verbal threats - 

Encroaching on personal space 

Responding to Anger

Responding to Anger

Rise when client rises - Urge them to sit back down and talk 

Instruct client to describe feelings

Remind that he has a choice in how to communicate anger 

Consequences - let them leave room 

Maintain a safe distance -Set boundaries 

Remove dangerous objects from room

Interview Guidelines include:

Interview Guidelines include:

7. Listening well

8. Responding (non-verbally or verbally) to a response

9. Responding therapeutically .

10. Never apologizing for interview length or the questions

Interview Guidelines include:

Interview Guidelines include:

12. Knowing when to stop

l3. Redirecting hyper-verbal or tangential clients

14. Spotting and clarifying ambiguities, doorknob comments and contradictions in content

15. Summarizing, seeking feedback, and establishing closure