Group Leading Basics for the Psychiatric Population

1. Plan the session with the consumers in mind (as much as youre able! ) If you have consumers that will need assignments to keep them busy or out of trouble, then adapt your session to be ready for this. These are patients who may be dual-diagnosed with cognitive disabilities or who are on heavy medication. They may benefit from special jobs to do in order to keep them busy and give you the opportunity to provide verbal praise (see #2). 2. Give lots of verbal praise! Practice giving varied positive verbal reinforcement so that it becomes second nature. 3. You must find balance in when to engage and when to ignore perseverative psychotic verbalizations. This is a delicate matter since sometimes engaging with a consumer will make them escalate and sometimes refusing to engage leads them to escalate. You must be aware at all times of these potential consumers. Do not make eye contact with them unless you are prepared to engage with them and either quickly re-direct them back on topic or provide options to leave or focus on a task. 4. All of these points go back to the structure of the session. Structuring the space and activities before you do a group can go a long way to helping you be successful. a. Make success the goal. Time is an important element to consider. We dont have control over the time blocks assigned for groups, but we do have control over how long the main activity will be within a given session. Use ice breaker activities and closing activities to round out the session in order to keep the main activity less than 45 minutes and probably shorter depending on the group. The goal is to make it to the end of a session without too many bumps, and then verbally praise the consumers for a job well done.

b. Picture it! Visual picture schedules can be a powerful tool in many different situations. Even if you do not have an actual picture schedule, the group will still benefit from having cues that provide them with a concrete sense of timing for the activities in the session. Props, certain songs and large pictures work great. The schedule will provide a visual timeline to indicate how long they will be participating. The pictures will also indicate preferred songs or instruments that might be used as motivators or rewards after participating in a number of other activities. c. Structured space. Chairs and tables can add to a sense of personal space. Chairs are even more helpful if you need to add more structure by including armrests or even a tray that attaches to the chair. Most of the time, it is probably just a matter of deciding if having people sitting around tables, in a semi or full circle or even standing will be the best setting. Tables are nice because they can be a symbolic as well as literal barrier between you and a consumer who may pose a danger. Sitting at a table is an appropriate activity, but it also provides more limited space for out of seat behavior, reaching, grabbing, etc. d. Adapt! Music therapists pride themselves on being able to improvise on the fly by changing the style, tempo, lyrics or dynamics of any given music in order to influence behavior. If one song or music activity is not working, move on and try something else even if it is a song you have been practicing all week for a client or group and you just really wanted to do it. e. Ignore attention seeking behaviors. This idea may be related to the choice of whether or not to ignore a verbally delusional or confused consumer. Many times behaviors such as spitting, hitting, throwing things or bad language are inadvertently reinforced by the startled reactions of staff or therapists on the receiving end. Sometimes these behaviors will fade or the patient will suddenly start talking about a different subject if they are ignored, indicating that whatever they were saying had nothing to do with you and was just verbal chatter and not an attempt at communication.

f. Choices, choices, choices. I dont think that I need to explain this. We all know that clients like to have choices since so much of their freedom has been taken away. Plan you sessions to include choic es and you will have happier and more content consumers. Summary: The structure of a session in physical setup and the way activities are arranged can be very powerful in setting the stage for a successful group experience. Many potential pitfalls can be avoided by paying attention to structure and flow of a session. It is also very important to set up contingencies for behaviors and expectations and follow through on all rewards and promises.