Clare is an OT practitioner in an elementary school that provides services for children on the autism spectrum (Figure 14-1). She has put together a group of four children, age 10, diagnosed with Asperger’s syndrome who need to improve interpersonal skills. Clare has decided that for the fall quarter she will work on playground skills. All four children express a desire to have friends, but when they are observed on the playground, she notes that they tend to move off by themselves. Clare organizes a game in which they must work together, using equipment to gather foam circles in a particular order. They need to plan a strategy to move quickly, but the first time through they gather only 3 of the 12 circles. One child becomes distracted, two fight over who will climb to get the circles, and one just quits when no one listens to her ideas. In the discussion with Clare afterward, they blame each other and one child “melts down,” lying on the floor sobbing while the others continue to yell at each other. After regrouping, they identify a plan to split up the tasks and agree to take turns. On the second run, they collect 7 of the 12 circles before the interaction breaks down. This time, Clare films the entire process, and the children watch the video and are able to assess their actions in the game and what they would do differently the next time.¹⁰

Figure 14-1 Children with Asperger’s syndrome frequently work in groups to develop socially appropriate responses.

Clare knows that she needs to set up a situation in which the children are bound to clash if she is to teach them how to handle things differently. By using video, the children can see their behavior and perhaps find new ways of interacting. It is easy to forget that some of the best lessons are learned when there is tension in a group, or a failure by a group or members of a group. It is the leader’s responsibility to help members see their responsibility in the group situation and identify more effective actions.

Review of Group Dynamics

As mentioned earlier, sometimes the difficulty in the group is simply the result of poor planning. One example is doing a project that involves short-term memory, like current events, with a group of adults with early dementia. Although some members will respond well, those who shut down or become anxious will negatively affect the dynamics of the group. As leaders develop a stronger understanding of their client population, planning activities that fit their needs becomes second nature. Group dynamics is defined as the “interacting forces within a small human group.”⁸ Those interacting forces make up the relationships between members and there are a number of variables within these relationships.⁴

Consider the relationship between the group leader and its members. Leadership can take on a direct approach, in which the leader decides what the activity is, what the discussion will be about, who speaks first and second, and so on. This may work well with a group of people who need that structure, such as a group of adults with an exacerbation of severe mental illness, or children with attention-deficit/hyperactivity disorder. This structure helps the leader manage the action and influence the dynamics of the group with the potential effect of decreasing creativity and free thought. A more “hands-off” style of leadership allows for more group interaction. Long-standing groups with a fairly constant membership get to a point at which the leader spends much of the time observing. However, if the leader starts out using this style for newer groups, it can lead to tangential discussions, long silences, or a takeover by more powerful group members. In such a group there can be a tendency for the leader to engage in an interaction with a single member, leaving the others to observe. Early on the leader must work harder to establish the norms and manage conflicts so that members feel they can trust the leader and benefit from the group process.9,11,5

The other dynamic variables lie within the relationships of the members. Members can take on a variety of roles in the group. These roles can either be productive, supporting the work of the group and enhancing the therapeutic relationships, or unproductive, distracting the group and leading to dissatisfying results. Benne and Sheats ² identify three sets of roles for group members. Two sets are focused on bringing the group members together and moving the group toward its end goal, and one set describes the roles individuals take on primarily to meet their own needs. The group task roles include the initiator-contributor, the information seeker, and the opinion seeker. (See Box 14-1 for all 12 roles and their definitions.) The group building and maintenance roles include the encourager, the harmonizer, the compromiser, and the observer (Box 14-2). Individual roles include the aggressor, the blocker, and the dominator (Box 14-3).² One member often fills more than one role and members take on different roles on different days, depending on the tasks and individual skills or interests. Not every role is filled or even needed in some groups. However, a group lacking members willing to take on important tasks or harmonizing roles or the existence of members engaging in behaviors consistent with individual roles are the crux of most group challenges^2,9,11 (Figures 14-2, 14-3, and 14-4).