Group treatment is typically the most feasible method of
delivering interventions to clients in inpatient mental health settings, given
that occupational therapists working in these settings often have dozens of clients
on their caseloads who need daily treatment. Additionally, group treatment
provides excellent opportunities for helping clients develop social skills, such
as observing social norms and learning to communicate assertively about their
health needs.
However, in certain cases, group treatment may provide a
context in which some clients can escape or avoid treatment. Some clients,
particularly adolescents, may refrain from participating verbally in groups,
allowing other peers to respond to all discussion prompts. Though these clients
are physically present—often a requirement of inpatient mental health settings,
they have essentially “dropped out” of treatment. Group treatment thus is often a challenging context for occupational therapists to assess clients’ level
of comprehension and “buy-in” of treatment content; their ability to apply new
learning; and perhaps, most importantly, their self-awareness of their mental
health needs.
Although there likely are many options, here are few possible
responses to this treatment challenge:
Response 1: Change
group content to better reflect needs of clients who are “dropping out”
Response 2: Provided
increased structure to group discussiion
Response 3: Use
nonverbal methods to teach and communicate about content
As an example of client-centered intervention, Response 1 is elementary. However, it may be especially challenging in an inpatient mental health setting to achieve. Response 1 may necessitate individual meetings with clients who
have “dropped out” in order to learn what content and activities are most relevant, valuable to them during group treatment. For clients with limited insight, including adolescents who are not voluntarily
participating in treatment, but instead are compelled by family members, this
process may be especially challenging. Likely, motivational interviewing strategies may be beneficial needed to elicit awareness and motivation to make health changes from clients who are not voluntarily participating in treatment. Response 1 also may require more time
than is available in many inpatient settings and thus may be difficult to implement routinely.
Response 2 can be implemented in multiple ways, but possibly
the most subtle and natural way to elicit verbal participation consistently from
all group members is to deliver treatment content in the familiar context of a
board game. Board games facilitate multiple appropriate social behaviors such
as turn taking, sharing, and attending to the needs of peers. Clients who
decline to participate in less structured group discussions often will
participate verbally while playing a game, perhaps due to a sense of
responsibility to their peers who are also playing a game that may be absent in
a less structured group discussion.
Finally, Response 3 may enable clients who decline to participate
verbally in groups not only to learn, but demonstrate their understanding of treatment
content. The following group session summary illustrates the use of this
approach by minimizing required verbal participation and increasing non-verbal
activities:
"Recovery Pictionary"
Treatment goals:
- Assess
and address group members’ awareness of construct: “Recovery"
- Facilitate
group members’ ability to identify:
a. Personal
definitions of recovery
b. Barriers
to recovery, both external and internal
c. Supports
for maintaining recovery, both external and internal
Group session activities:
1. Warm up: Group members take turns playing “Pictionary”
with prompt: “A dream or goal you have for your future”
2. Brief group discussion of recovery:
Verbal prompts: What does recovery
mean? What does it bring to mind? How does the way we think about recovery
impact our recovery?
Non-verbal prompts: Visual
representations of recovery, and their “pros” and “cons”
3. Pictionary game: Group members take turns drawing
pictures to illustrate the prompts:
“What are
barriers to your recovery?” “What are supports to your recovery?”
4. Group members create a picture of what their recovery
looks like, including incorporating their personal dreams or life goals they
drew/communicated during the warm-up
5. Group members are prompted to share verbally the content of their recovery
pictures with the group
