Group interventions

This page will look at some examples of OT group interventions commonly used in mental health settings. However it is important to note that there are many more out there!
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How can an Occupational Therapist use group work to support mental health?

What is Group Work in occupational therapy?

Group working is a therapeutic tool

Working in and with groups is a core skill of occupational therapists. Occupational therapists often use group therapy as a way to assess and as part of interventions in inpatient and community psychiatric settings. The group interventions can has many benefits for both the patient and the group as a whole. Working as a group can nurture a sense of togetherness, connects patients to themselves and can inspire a more collective way of thinking.

What benefit can therapeutic groups offer:

Peer support
Encourage friendship.
Provide people with a variety of roles.
Develop communication skills.
Provide physical and emotional contact.
An opportunity for people to be creative.
Increase self-esteem.
Build a sense of community.
Accountability - hold each other accountable for each others goals and progress.
Stimulate people to think and to do.
Collaborative work with patients
Enjoyment and fun.

What are OT therapeutic groups NOT

Their primary aim is not to fill time and reduce boredom.

There are lots of different types of groups an Occupation Therapist can use to support people: some of the most common groups used in occupational therapy in mental health are: evaluation groups, task orientated groups, activity groups and psychoeducation groups.

Note:- Some groups might have elements of more than one in them.

Evaluation group

Purpose of this group is for the OT and service user to evaluate/assess their needs in a group setting. This is often used in inpatient mental health settings.

An evaluation group is similar to the start of the OT process - where you are assessing their skills and limitations within a group setting or scenario. Such as where you are trying to assessment 'interpersonal skills' within a group setting.

In an evaluation group an OT will not take part in it (just as in a standard assessment)

Example of an evaluation group might be:-

Social discussion group (A newspaper group) - To assess social interactions, concentration, processing, communication.
Breakfast group - To assess activities of daily living, function, mobility, concentration, processing and social interaction.
Creative Group - To assess social interaction, emotive response, concentration and communication.

Task-oriented group

This type of group is focused on a task, such as directing or creating or producing an end product in a shared environment. This type of group functions to make the group members aware of each other's personalities, values, needs and approaches while they work together to accomplish a predetermined and mutual goal.

Example of this include:

A cooking group - Cooking a group breakfast
A gardening group - Maintaining a ward/community allotment
A creative group - Giving a group chance to be creative as an occupation task

Click on the pictures below to find out more about some of these mental health groups

Horticulture groups

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Creative groups

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Activity groups

The intention of activity groups is using an activity to develop one’s skills. This might include opportunity to learn new skills and practice the skills in the group context - Gain skills, knowledge, and attitudes for performing an activity for the chosen theme. OT in more of a rehabilitative approach (to regain lost skill due to ones mental health) or a developmental approach (develop new skills).

Examples:

Current affairs discussion groups
Relaxation - mindfulness
Life skills - IT skill
Exercise - Walking groups/Yoga/Tai Chi/
Cooking groups

Relaxation groups

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Life skills

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Psychoeducational groups

The intention of a psychoeducational group is to inform a group about their condition, treatment or self management. This might include opportunity to learn new knowledge/techniques, share and practice techniques in the group context. This can be a stand alone group but can also be built into other groups Such as within a task orientated and activity groups.

Psychoeducation combines the elements of cognitive-behaviour therapy, group therapy, and education. The basic aim is to provide the patients and/or families knowledge about various facets of the illness and its treatment so that they can work together with mental health professionals for a better overall outcome.

It can often empower individuals and groups of individuals and help them understand and manage the symptoms of their mental health condition to lead more fulfilling lives.

Psycho education approaches are often part of individual and group interventions in occupational therapy. We can also use them as part of self help strategies and interventions.

Common psycho educational areas might include...

Medication awareness
Understanding your mental health symptoms/diagnosis
Identify early warning signs
Challenging negative thoughts/thinking patterns
Creating a stay well plan
Sleep Hygiene
Hearing voices
Assertiveness
Understanding stress
Mood and food

Understanding your mental health better group resources

Click on the picture to access some tools & resources you could use in a psychoeducation focused group

Improving your sleep group resources

Click on the picture to access some tools resources you could use in sleep hygiene focused group

How do Occupational Therapists Structure a group

How to structure a group

Length of group

The length of the group session will depend on a person’s ability and level of concentration. It could be as short as 15–20 minutes, or last up to an hour. When is the most appropriate time for the activity itself? When will staff be available? Will it clash with other activities?

Warm up

Tell people what is happening and what is expected of them, so they can relax and begin to enjoy the session. Perhaps tell participants how long the group will last, or where the toilets are. Your reassurance, enthusiasm and encouragement will make people feel welcomed, acknowledged and accepted.

Main event

Reduce distractions and keep interruptions to a minimum. It will encourage people to participate and be easier for them to concentrate.

Encourage residents to communicate with each other.
Link up what people say by using your knowledge about their individual experiences and interests.
Address the whole group, rather than specific individuals.
Make sure that equal time is given to individual contributions, one at a time. Provide stimuli one at a time.
Sense the pace needed for the group and the activity.
Help people to focus on the subject.
When reminiscing, remind people that they are in the present (for example, ‘And now we’re here, enjoying a cup of tea…’). This is especially important if they have memory problems.
Summarise what has been done and said.
Be clear about what has to be done next.
Do not disclose confidences.

Concluding

It is important to actually end the group. It helps people to orientate if they know what will happen next (for example, lunch or tea) and what is expected of them. To end a session, you can summarise what has been done, plan the next session and thank everyone for attending.

TOP TIPS: Planning and running groups

Set realistic, achievable aims.
Group together people with similar interests, abilities and needs.
Offer activities that people want to do.
Be creative and experiment.
Plan ahead and prepare well for regular activities but remain flexible to support impromptu activities.
Always have a back-up plan. Your planned activities may not always work or be right on the day.
Keep clear and up-to-date records.
Set aside time to review and revise how you are working regularly.
Don’t get downhearted if an activity does not go so well. Take the opportunity to evaluate, learn for the future, and try again.
Groups are not for everyone – some people do not enjoy group situations.
People you have established a rapport with and who trust you are more likely to attend and participate in a group.
Consider the seating arrangements – for example, sit a restless person next to a member of staff that they know.
If needed, make sure that people have their glasses and hearing aids with them and that they are worn. Use the hearing loop system if you have it.
Group activities need a clear beginning, middle and end.
A quiet area with few disturbances and interruptions, equipment, music, props (objects, writings, clothes).
Make sure the room is set up and ready before you start.

Evidence Based Practice

Occupational Therapy practice needs to be led by evidence.

This is a list of relevant scientific research and articles relevant to group work in mental health settings

Please take the time to familiarise yourself with the research base in order to provide the most up-to-date care to your patients.

Relevant articles

Rouse, J., & Hitch, D. (2014). Occupational therapy led activity based group interventions for young people with mental illness: A literature review. New Zealand Journal of Occupational Therapy, 61(2), 58-63.

Petersen, K. S., Bjørkedal, S. T. B., Torsting, A. M., & Eplov, L. F. (2019). Occupational therapy interventions in mental health: a scoping review of recent evidence. International Journal of Therapy and Rehabilitation, 26(9), 1-21.

Zedel, J., & Chen, S. P. (2021). Client’s experiences of occupational therapy group interventions in mental health settings: a meta-ethnography. Occupational Therapy in Mental Health, 37(3), 278-302.

Nilsson, I., & Lundgren, A. S. (2018). Making meaning around experiences in interventions: identifying meaningfulness in a group-based occupational therapy intervention targeting older people. Ageing & Society, 38(9), 1887-1911.

Tokolahi, E., Hocking, C., Kersten, P., & Vandal, A. C. (2014). Cluster-randomised controlled trial of an occupational therapy group intervention for children designed to promote emotional wellbeing: Study protocol. BMC psychology, 2, 1-11.

Cakmak, S., Hüzün, S. Ü. T., Öztürk, S., Tamam, L., & Ufuk, B. A. L. (2016). The effects of occupational therapy and psychosocial interventions on interpersonal functioning and personal and social performance levels of corresponding patients. Archives of Neuropsychiatry, 53(3), 234.

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