CHAPTER 4
The Occupational Therapy Interactive Group Model (OTIGM): Reconnecting to Me Through My Interaction with You in the "Here and Now"

Louise Fouché

No man is an island. Human beings were created to be social beings. In other words, human beings need people and healthy relationship to be mentally healthy, to be functional optimally and to thrive in all occupational performance areas. People cannot lead quality lives without having others with which to share their life. The old English proverb 'a sorrow shared, is a sorrow halved and a joy shared, is a joy doubled' has deep wisdom.

One of the prominent problems of all clients that approach an occupational therapist for intervention, is that due to their illness/disorder/disability, they have withdrawn from previous relationships, or they have shut others out or they have never been able to form good interpersonal relationships. Irrespective of the field of occupational therapy, interpersonal relationship, or as the American Practice Framework defines it, social participation, should be assessed and if indicated, addressed in therapy.

Group therapy or group work, or as South African occupational therapists have defined it, occupational group therapy, still remains one of the most effective techniques in addressing problem areas with the occupational performance area of social participation.

This chapter sets out to describe an occupational group therapy model, known as the Occupational Therapy Interactive Group Model (OTIGM). This model was designed and developed in South Africa in the mid-1980s by an occupational therapist, M de Beer and a psychologist, C Vorster. The chapter sets out a brief history of the model, the basic principles of the model, effective techniques to implement, group procedures to follow and will end with examples of group narratives in understanding the therapeutic value of the model. The model has developed and grown over the years, and hybrids have formed, where different occupational therapists emphasise slightly different aspects of the model. However this chapter will provide a good overview of the model, keeping it simplistic for those who are unfamiliar with it.

4.1 A BRIEF HISTORY

Dr Marianne de Beer was lecturing at the University of Pretoria in the early 1980, and recalls that she felt unprepared and not confident in her knowledge or skills of groups to teach group work to the occupational therapy students. De Beer was promised that resources would be made available in her quest to improve her knowledge and skills in group work. She then visited all the occupational therapists who had become well known for their group skills across South Africa, people like Rosemary Crouch, Dain van der Reyden, Madeleine Duncan. She observed them leading groups and interviewed them. De Beer explained that she observed excellent, effective therapy, and when she questioned them, their answers were based on their therapeutic experiences, excellent clinical reasoning and instinct as occupational group therapists. Each occupational therapist presented groups differently and there did not seem to be one way to present groups which could be used to extrapolate a unifying theory. De Beer realised that was not enough to provide guidelines or training for occupational therapy students, who often had neither the experience nor the natural instincts within groups.

De Beer then approached Professor Vorster, who was lecturing at the Department of Psychology at the University of Pretoria at the time. She joined his group therapy sessions participating and spending time immersing herself in the theory and application. Vorster supported Yalom's perspective of group therapy and taught his students the Group Psychotherapy principles. However, in the pure form these principles are not within the occupational therapy scope of practice as defined by the Occupational Therapy Board at the Health Professionals Council of South Africa. At this point Vorster and de Beer collaborated and developed the Occupational Therapy Interactive Group Model (OTIGM), specifically designed for occupational therapists. This model has been used since the mid-1980s to train students at the Medical University of South Africa (Medunsa) and at the University of Pretoria and later for under- and postgraduate students at the University of the Witwatersrand. The model has grown since then and although occupational therapists may emphasise different aspects of the model within their clinical application, they remain true to the core of the model.

4.2 THE OCCUPATIONAL THERAPY INTERACTIVE GROUP MODEL IN CONTEXT

There are numerous different approaches to group therapy. Each approach and theory has specific underlying assumptions on which the therapeutic intervention is based. Some examples are cognitive-behavioural groups, Rogerian groups, expressive groups, Dialectic-Behavioural Therapy, etc. The Occupational Therapy Interactive Group Model follows a psychosocial approach.

The psychosocial approach emphasises the importance of people as social beings and the role interpersonal relationships have on mental health and well-being. Occupational therapists that strictly follow a Psychosocial: Interactive approach, take it one step further and believe that illness is rooted in poor relationships. Due to problems experienced within intimate or significant relationships, mental health care users develop unhealthy interpersonal patterns. This causes them to become overly anxious about forming relationships and they either withdraw or avoid others or continue unhealthy patterns. As they withdraw, they have fewer opportunities to keep their social skills intact and their social skills become neglected. This makes it even more difficult for them to form new and healthy interpersonal relationships. This lack of interpersonal relationships causes psychological discomfort which can culminate in a mental illness. In a nutshell one of the assumptions of the approach is that a break in relationships is the cause of mental illness and in order to improve mental health and well-being, interpersonal relationships need to be addressed.

If occupational therapists believe this premise and follow the Psychosocial: Interactive approach, it stands to reason that they would need to focus on the mental health care users' interpersonal relationships, his/her behaviour patterns and his/her poor social skills during treatment. If these are not pertinently addressed in therapy, the occupational therapist would merely be treating the mental health care user symptomatically which means the cause of the illness would be ignored, allowing the symptoms to return as soon as they become stressed or treatment is ended. The root cause (in terms of interpersonal relationships and social skills, i.e. occupational social participation) needs to be identified and treated in order for treatment to be effective and long-lasting. This is the theoretical foundation and premise on which the Occupational Therapy Interactive Group Model is based; only then can occupational group therapy become effective and life-changing.

In essence the Occupational Therapy Interactive Group Model focuses on training or changing social skills, focuses on forming healthy interpersonal relationships, all within the group context. The occupational therapist achieves this by facilitating interaction between the group participants. Through the interaction, cohesion, i.e. a sense of belonging and acceptance is facilitated that allows group members to feel safe enough to take risks. The risks can be: trying new behaviour patterns, new social skills and new ways of relating to other people within their group. Core to the model are principles of the 'here-and-now' (Moreno 1975), process illumination, selection of activity as a catalyst, and are all techniques used as a means to improve mental health care users' social skills and interpersonal relationships. The model moves away from didactic (or psycho-educational groups) and instead of talking about a subject like assertiveness (or conflict management or stress management), these skills are facilitated in the here-and-now, as and when a specific group member requires the skills within the group. Therefore, the model provides opportunities for group members to interact, to relate to each other, through the participation in carefully, selected activity(ies). Each group participant and the group collectively then reflect on the group members' experiences. They can reflect on their habits, behaviours, social skills, methods of relating to each other within the group as displayed during the specific activity. At times feedback is provided by fellow group members in order for the group member to develop insight as to the impact his/her skills and behaviour had on others in the group. New opportunities are facilitated in order to change these behaviours or practise the new skills, in the group, right here, right now.

Groups are a generic technique/medium/skill used by many professionals but occupational therapists all over the world should to be clear as to the unique contributions which they bring to groups used as intervention in treatment. They can incorporate their unique knowledge and skills with group work especially regarding occupational performance areas and activities/tasks analysis and selection. They have something exclusive and distinctly different to offer in comparison to other health care professionals.

4.3 THE...