1. Remember that you, as the SLT, are not the expert on social communication difficulties post brain-injury – the attendees are the experts. Don’t make the group about ‘teaching’ – take a step back and let the clients attending take the lead. We’ve witnessed magical things happen – peers taking feedback from peers about more difficult aspects of their behaviour, in a way that never would be tolerated if it came from us. We usually have 15 minutes at the start of the session where client’s talk about what has happened over the past month and this usually sparks a story related to social communication issues.
2. You can mix abilities in groups – skill sets will surprisingly complement each other – we’ve paired people who are very verbose with clients who do not initiate communication at all. Someone who is back at work but struggling with verbal presentations may find talking to clients at a lower level a gentle way to practice. As long as you hold a client’s individual needs and goals in your head and draw them out, you can work with a very mixed group.
3. Projects are the way forward for groups – since we switched to purely project working, the reported satisfaction of attendees went up significantly. You can pick any project – but present ideas to the group so they can choose, and make sure you have their buy-in. Successful projects to date in our group include: writing a leaflet to give to others at the start of the brain injury rehab process, making short videos showcasing client’s skills, a book club, a social media project – tweeting and instagramming about life in general… These projects have allowed us to work on client’s individual goals such as turn-taking, initiation, planning, talking in groups, keeping comments appropriate etc but in a practical and meaningful way.
4. Breaks – group work can be draining for both therapists and attendees – we run for 45 mins, have a half an hour break and then run for another 45 minutes. Great things happen in the 30 minute break – the attendees go off together for coffee and amazing friendships have formed that have brought extra benefits for those attending that we had not anticipated.
5. At it’s biggest our group has been around 10 clients, at it’s smallest 3. Up to 10 is a good number as long as there are 2 therapists. When we’ve had 10, we’ve split off into 2 groups for some tasks.
6. Keep the group relaxed and casual- our clients report they hate really structured groups that take themselves seriously. We do not talk down to our clients and, as mentioned in point 1, set them up as the important people with crucial & helpful information to share. Tea, coffee and biscuits are also very important!
7. All of our clients have needed reminders about the group date & time each month. We now email everyone a week in advance. Sometimes a group member will call another at the start of the session to remind them to get out of bed! Bottom line, if you want people who’ve suffered a brain injury to turn up to your group,you’ll have to remind them! Save memory goals for something different!
8. Linked to point 7- don’t expect any homework you set to be completed! Again, email reminders are helpful, but expect to do most of the work that needs doing in the group itself- anything else is an unexpected bonus!
9. Don’t talk formally about how the brain injury happened- in the early days we used to do group introductions and asked people to give a brief history of what happened to them. It just didn’t sit right with us- we leave clients to share their stories if/when they want to- we just remind each other of names if required and crack on.
10. Be flexible – sometimes the group session will take an unexpected turn. Our group can often descend into giggles/bring out anger/make someone frustrated/go off on a tangent. We have to make judgements all the time- sometimes great things come out of unexpected turns- sometimes we remind clients that the break/end is coming up and steer everyone back to task.