1. Group Therapy Susan Boettcher, M.S. CCC-SLP Elise Peltier, M.S. CCC-SLP Clinical Methods 2016

2. Why Group Therapy? Group therapy is a frequently used service delivery mode Group therapy is the dominant model in many therapeutic settings, such as public schools Unfortunately there is limited research in the area of group intervention. Most in our field was done in the 60s and 70s with kiddos receiving articulation intervention.

3. Research Borgus and colleagues (1973) found a primary benefit to group therapy is the decrease in continual pressure to perform. Children seemed to do better with intensive frequent bursts of demand followed by a rest period. Children also seemed to benefit from peer examples especially in regards to behavior expectations. Boyle (2007) compared language intervention of 161 children 6-11 yrs. old and found no significant difference between the outcomes for individual therapy and group therapy.

4. Research cont. July 2010, Cirren and colleagues did a study of peer reviewed articles from the last 30 years regarding service delivery models for school age children. –No conclusive outcomes regarding group vs. individual. –More research in this area is needed. –For now, reason/historical knowledge will guide service delivery decisions.

5. Group therapy has advantages Clients motivate each other. Clients/families recognize that others have problems similar to their own. Provides opportunities for socialization, peer interaction, and carryover. There are increased opportunities to learn by observing others. Self-monitoring is encouraged to reduce the client’s dependence on clinician cues.

6. Group Size Groups whose primary purpose is to teach new skills tend to be smaller Groups geared for generalization of previously mastered skills tend to be larger Recommended group size for children is 2 to 6 members Recommended group size for adults is 5 to 7 (e.g. conversation groups)

7. Group Composition Grouping clients by age and disorder type is preferable, but not always possible. Primary client characteristics to consider in group formation are age, gender, disorder type and disorder severity. For pediatric groups, the developmental level of the members should be within 2 to 3 years of one another.

8. Group Therapy How-to: Anticipate the challenges ahead of time. –Adequate seating/materials/lighting. –Personal preferences of group members. –Scheduling that best works for all members. Be prepared. –Have materials planned ahead of time. –Organization of materials will be critical to flow of the session. –Seating plan is a good idea to increase participation and/or behavior management.

9. How-to cont. Determine type of group –All working on same task/same target –All working on same task/different targets –All working on individual tasks/targets Have data collection system set-up before hand. –Will need to collect for multiple people –Think about level of complexity – Practice

10. How-to cont. Hone behavior management skills. –Review expectations of the group. –Anticipate challenges. –Watch sessions before you take over. Determine if group will be clinician- directed or client-directed. –Skill level –What is being targeted –How varied the group targets are

11. How-to cont. Scaffolding is critical for multiple group members to participate in the same activity. –Plan how this will work. – (example) No support, “prime the pump”, multiple choice Be sure that each group member knows what their individual goals are. –May need to schedule time to discuss separately.

12. How-to cont. Balance time spent with each client/ encourage equal participation. –Systematically seek responses. –Limit time allowed to speak. –“Prime the pump” –Change roles in the group. Leader, recorder/scribe, time keeper, encourager, materials manager, trouble shooter, speaker Don’t apologize – groups are great.

13. Disadvantages to Group Therapy Group members receive less individual attention Fewer opportunities to address individual client weaknesses Clients who are shy may be reluctant to participate in a group Group members’ progress will vary within the group

14. References Roth, F., and Worthington, C. (2005) Treatment Resource Manual for Speech-Language Pathology, 3rd Edition Boyle, J., McCartney, E., Forbes, J., & O'Hare, A. (2007). A randomized controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment. Health Technology Assessment, 11(25), 1–158. Cirrin, F., Schooling, T., Nelson, N., Diehl, S., Flynn, P., Staskowsky, M., Torrey, T., Adamczyk, D., (2010) Evidence- Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children. Language, Speech and Hearing Services in the Schools, vol. 43, 233-264.