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Delivering high-quality leadership in TR group programs

This is an excerpt from Therapeutic Recreation Leadership and Programming By Robin Kunstler, ReD, CTRS and Frances Stavola Daly, EdD, CTRS, CPRP


Warm-Up Phase

The warm-up or orientation phase of the TR group sets the tone for the rest of the session. With adherence to a consistent format, the group members will know what is to take place at each session. Routine promotes a safe and secure environment in which to experiment with new behaviors and can be a comfort to inexperienced group members.

The TRS should start by introducing himself if necessary, warmly welcoming the group members, stating the name and explaining the purpose of the group, and introducing or asking the members to introduce themselves. While giving an introduction is a good rule to follow, the TRS can decide to dispense with some aspects of the introduction on the basis of his knowledge of the members and their abilities and needs. However, a sincere greeting that motivates participants to want to be involved in the group is essential. Any new members, staff, or volunteers should be introduced: The presence of people who are not known to members can create an atmosphere of confusion or suspicion. The TRS might say something like this:

Good morning, everyone. My name is Stuart. I am the Therapeutic Recreation Specialist. I’d like to introduce Rachel, a student intern starting with us today. I want to welcome all of you to the horticulture program. The purpose of this program is to exercise your fine motor skills, sharpen your mental abilities, and enjoy the experience of nature as we do our gardening and planting. Let’s go around and introduce ourselves to each other.

By stating the purpose of the group, the TRS provides direction for the clients’ participation in the program and a framework for their actions. While clients may enjoy a TR group experience and derive benefits from their engagement, unless the purpose of the activity is clearly articulated they may not focus on the outcomes they are trying to achieve. For example, in a psychiatric facility, the TRS engaged the clients in a game of Battle of the Sexes. Clients were divided into male and female teams, and each team took turns asking the other team trivia questions that it hoped the opponents could not answer. The clients had fun, and most verbally participated in the game; but the purpose of the group was never discussed. When the group was over, the clients were asked what they learned from the activity. Each client who responded had a different answer. Some said they had learned a particular piece of information from the trivia questions. Another learned that “men are smarter than women.” While the intent of the group was to increase their attention span and to improve communication skills, none of the clients identified those outcomes. Because the purpose of the group was not discussed at the beginning of the session, the clients were not focused on trying to reach their desired goals. The group experience was seemingly successful, but an opportunity may have been missed: An explanation of the purpose of the group might have helped clients direct their efforts and attention toward working on specific skills.

Next, if applicable, the TRS reviews what went on in the previous session or sessions. This serves to remind the members of what they have accomplished and to orient new members or a member who missed the previous session. The TRS may ask members to describe the previous session or use a questioning technique to elicit this information from them. For example, he might say, “Kenneth, can you tell us what you accomplished during the last session?” Engaging the clients as soon as possible in the warm-up stage is a valuable motivational technique and begins two-way communication.

Using multiple channels of communication ensures that everyone in the group is “on the same page.” Communication involves the conveying of information clearly and articulately and in a voice that is loud enough for all members to hear. A microphone can be used to help members hear the TRS, but this is generally not necessary in a small group. If the TRS is soft-spoken, he must work to project his voice or use a microphone so that the group can hear him and maintain their focus on the group’s activities.

Alternative communication devices such as communication boards should be used when appropriate. Picture boards, written instructions, and large print can supplement verbal communications. If clients speak a language other than the TRS’s, an interpreter or written translations could be provided. If clients have cognitive limitations, use simple sentences, break instructions down into small steps, and use demonstration as much as possible. The warm-up phase builds and reinforces group cohesion, trust, and acceptance.

Warm-Up Activities or Icebreakers

Warm-up activities, also known as icebreakers or mixers, are used to help members get to know each other better, to promote relaxation in people who may feel tense or uncomfortable about being in the group or the overall program, and to promote socialization and group cohesion. There are countless icebreakers to choose from, depending on the size of the group, the time available for the warm-up, and the skills and abilities of the members. The activities should be fun, engage members’ interest, offer a challenge, be an opportunity for interaction, be a preparation for the group experience, and be relatively brief. In a single-session program, spending too much time on the warm-up may leave little time for the main group experience. However, with a closed membership group that will meet for a number of sessions, the TRS may want to spend the entire first session on getting-acquainted activities. For subsequent sessions, reviewing the previous week’s session can serve as an informal warm-up activity, and formal mixers may not be necessary. Mixers can be used at any session if the TRS observes a need to revitalize the participants or break up cliques that may have formed, or if the activity itself relates to the purpose of the group. Icebreakers can be used before or after presentation of the rules of the group.

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Explaining the Rules

During the warm-up phase, the TRS also explains the rules that have been established to facilitate the smooth flow of the activity and makes sure that everyone understands the rules. This happens at the initial meeting and in subsequent group sessions as needed. The rules should be discussed to make sure that everyone understands why the rules exist. If a new member joins the group, the TRS may review the rules with her prior to the session or assign someone to help her learn rules or behaviors that have not been explicitly identified. The TRS may develop a basic set of rules and then, as the group progresses, members can amend or enhance them. Group rules that are set by the members are preferable, but this is not always possible. A written set of rules should be posted or available, and the TRS can refer to the list to briefly summarize the key points. Risk management is a primary reason why the TRS has initial responsibility for developing the rules for a program. For example, in a cooking group, rules might state that all participants must wash their hands before cooking and that members must wear an oven mitt and have the permission of the TRS before using the oven. Rules should be limited to those necessary to guarantee that group interactions are respectful and appropriate for the task at hand. The clients should be informed if there are consequences for not following the rules. For example, a basic rule in many TR groups is that clients cannot physically touch another client without permission; violation of this rule can result in suspension from the program. In addition, individual clients may have their own set of “rules” or guidelines for behavior to follow. At a camp for children with autism, Danny is given a laminated rule card to carry with him at all times to remind him of the proper rules of behavior (see figure 10.3).

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The TRS serves as the first role model of adherence to group rules and norms and should demonstrate all appropriate group behaviors in her interactions with the clients. During the group, the TRS helps members understand the implicit as well as the explicit norms of the group. Implicit norms refer to “the way things are done” and have developed and emerged over the course of the group’s existence. In a leisure education program in a short-term rehabilitation center, after the first two sessions the members have established, without discussion, their preferred seating. One member who tends to be claustrophobic likes to be near the open door. Another member who has problems with incontinence prefers to sit closer to the rest room. Still another who has a hard time hearing the leader always sits next to the TRS. The seating was not discussed openly, but the members have accepted the current arrangement. When a new member joins the group and attempts to sit near the door, the group admonishes her. She responds that she was told to sit anywhere she wanted. While technically this may be true, in reality the group has informally established a seating arrangement that everyone has implicitly agreed to support. When necessary, the TRS may intervene to explain an unspoken but accepted behavior or encourage a participant to help another member learn the ways of the group. By respecting each participant, listening carefully to what the clients are saying, and staying focused on clients’ needs, the TRS models appropriate communication and social behaviors and creates opportunities for open discussion about members’ fears, anxieties, or confusion about participating in the group.

The TRS should also clarify policies regarding confidentiality and reassure members that what they disclose during the group stays within the group, unless it is detrimental to the safety of the client or others. If photographs will be taken, she obtains a separate release from each client. The TRS reviews member responsibilities such as setup of the activity, distribution of supplies, providing assistance to a peer, and cleanup.

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