ATTENDANCE:

· Offering reminders to group members can help increase group attendance. These reminders, such as "Good bye, I'll see you in group tomorrow." or "Good Morning. We have group this afternoon.", also demonstrate social behavior which group members can model.

· The group leader can help increase attendance by finding group members and reminding them that it's time for the session, while the group leader is setting up the group materials and greeting members as they arrive.

· For some people, decreasing the number of prompts or reminders that it takes to get them to come to group could be their initial or short term goal. Remember that even if a client doesn't actively participate in groups here, there is a lot we can do to help them prepare for groups they will be assigned to in the future, such as in the community.

GROUP RULES:

· It is helpful for the whole group to agree on the ground rules for the group. Write down the rules and keep them handy for reference and reminders. You may want to make a poster of the group rules for the wall.

· Some common group rules include: A. "What you hear here, stays here." Or "Don't talk outside of group about what people say in group." B. "Be respectful of other group members. Listen when someone is speaking." C. "Let the group leader know if you need to miss a group session."

· The leader of the group may want to keep a checklist to record participant's behavior during sessions. This data can be a helpful reminder later when writing progress notes.

PARTICIPATION:

· Try to give everyone a chance to contribute to the discussion. Avoid letting one or two individuals monopolize the session.

· Help bring quiet group members into the discussion by asking them questions such as "What do you think, (name) ?"

· Be sensitive not to put someone on the spot by calling on them to talk if they seem anxious about being in the group, or if they are new to the facility, or if they don't know the other group members or leader. Let the individual get used to the environment.

· There may be occasions when just getting to the group and sitting through it is an accomplishment for a client. Not everyone will participate at the same level. Try to gently encourage a quiet group member.

· Avoid letting any group member(s) monopolize the session. There may be times when an individual urgently needs to discuss something current. It's good to be flexible enough to allow the discussion to flow in the direction the group members need it to flow. However, it is important that the leader also redirect the discussion back on topic if it drifts too far off topic. And it is also an important function of the group leader to make sure that the group meets the needs of all members as much as possible. Make sure everyone has a chance to speak and yet respect that not everyone will have something to say at every session.

· An individual's short term goal for the group might be to share group time with other members, not interrupt others, or conversely, be assertive and say something at least one time per group session. By making this a goal, it can be easier to remind a group member when they need to let others speak, for example. Also, staff may want to monitor these kinds of behaviors as symptoms of the client's illness, so you'll provide valuable data in your progress notes and during shift report.

DISRUPTIONS:

· Establish group rules and behavioral expectations for the group at the first session.

· Post the group rules in the group room and review them frequently. Remind folks of the rules as needed.

· While the group leader continues making a presentation, for example, the group's co-leader can manage the disruption, such as moving to sit between two clients who are whispering.

· Keep the group members safe. Ask the disruptive individual to leave the group. Call for other staff to help if necessary.

· If the disruptive person won't leave the group, keep in mind that the group can always leave the area. Get up and move the group to another room away from the disruptive person.

· You can give points to someone who is able to calm down and stop disrupting group. Thank them and praise their self-control.

· It is not always safe or wise to confront a disruptive patient, such as during a manic or psychotic episode. Don't press the individual about the group topic when the symptoms of their mental illness are interfering with their ability to have a meaningful discussion with the group.

ATTENTION:

· Redirect attention back to the group discussion promptly if someone drifts and others don't follow what they are saying. Try to help the majority of the group members have time to complete a discussion. But also be sensitive to giving an individual time to talk if others aren't giving them the chance.

· During a long pause or silence, ask a question about the group topic for the day. Try to pull the group back on topic.

· If you're not getting good attention to the session's topic or activity, it's OK to stop and ask the group how they feel about the topic. Sometimes you will get a good discussion and learning from talking about why a certain topic is hard to discuss in a group, for example.

· For most of our clients, the ability of individual group members to pay attention during group will probably be a psychiatric symptom to monitor and report on to the team. Make note of changes from one session to the next, or anything significant, and mention it in your charting notes.

· For some clients who are distracted, using a hand gesture to draw their eye back to the blackboard, speaker, or worksheet can be helpful. Be tactful when using verbal prompts to bring someone's attention back to the group activity.

TOPICS:

· The main topic of the group you are co-leading has probably been predetermined. You will have prepared materials available to use. You and your co-leader may also plan guest speakers, a video which supplements the information already prepared, or bring in additional readings or handouts on the subject. Don't hesitate to consult with other staff who have lead similar groups, too.

· Define goals for the group and individual group members and work toward these goals. Avoid letting the group's purpose get too vague. That will make it harder to know when someone has completed the group and what they learned from the group.

· You and the co-leader will bring different experiences and information to the group. This can be a real plus, so don't hesitate to offer your perspective and share in preparing for the sessions.

· Outline topics you plan to cover over several sessions, to increase continuity and cover the material thoroughly.

· Organize the topics for each session in a logical order, start to finish. If you have any questions about pre-requisites or additional topics, consult with other group leaders. Plan on having 10-15 sessions total for successful completion of the group.

HANDOUTS:

· You may want to take worksheets or information sheets to hand out to the group. This helps structure the discussion and is especially helpful for patients who are having trouble tracking the conversation.

· Having handouts gives you something to refer to if the discussion pauses or the group needs to focus on a relevant topic.

· Be flexible. If the group discussion drifts off the scheduled topic, be sensitive to whether the group is talking about things they seem to need to talk about and process.

HOMEWORK:

· Many patients are good about taking homework materials with them to work on outside of group. However, very few actually return to group with the materials in hand. And very seldom does someone complete the material outside of group. However, don't discourage group members from taking homework materials when available. It's a good way to encourage independence, gives them something to work on with other staff, encourages thinking about the group material throughout the day, and makes something available for them to read and do.

· You can offer extra points for turning in completed homework. And points for reviewing that work in group.

· Encourage group members to show their homework assignments to their Primary Nurse. It will give the Primary Nurse a good idea what the group is working on and help give the unit staff ideas about how to reinforce those new skills or information throughout the day.

ENDING THE SESSION:

· It is helpful to end the group at ten or fifteen minutes before the hour, so group members have a little time before the next group. They may have to walk to another unit for their next group, visit the restroom, or have a cigarette break.

· In closing, briefly summarize what was covered during the session.

· Thank the group for their participation. Not only is it a pleasant way to end, but demonstrating social amenities reminds the group members to use these little social graces, too.

POINTS:

· The purpose of points is to help motivate the individuals to attend and participate in treatment.

· For someone who has a hard time getting to groups, you might want to give a few bonus points for being on time to group. It helps to tell the person ahead of time that you will give them 5 points (or 10 points, if necessary) for getting to group on time.

· Give up to one point per minute that the patient was in group.

· Some patients may respond better if they don't have to wait until points store is open to spend the points on something they want. The team may want to recommend that an individual patient receive a points store item immediately for coming to group on time, participating in a group discussion, completing a worksheet or homework assignment, etc. This kind of special program can be arranged with Behavioral Psychology staff.

Written by Ann Zaiser, 1998. All rights reserved.

To send email to Ann This page was updated on 12 February 2003.