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children. J, ChildPsychol. &Psychiat., 1959; 7,107-123. Lyle, J. G. The effect of an institutionalised environment

upon the verbal development of imbecile children. 11 1. The Brooklands Residential Family Unit. J. Ment. Defic. Res., 1960; 4:14, 14-22.

McConkey, R. Education without understanding? Spec. Educ.: Forward Trends, 1981; 8:3, 8-10.

McConkey, R. Interaction: the name of the game. In Smith, B. (Ed.). Interactive Approaches to rhe Education of Children wirh Severe Learning Difficulties. Birmingham: Westhill College, 1988.

Nelson, K. (Ed.). Event Representation and Cognitive Development. Chicago: Lawrence Erlbaum, 1985.

Piaget, J. The Origins oflntelligencein Children. New York: ’International Universities Press, 1952.

Rousseau, J. J. Emile. London: Dent. 1963. Skinner, B. F. The Technology o f Teaching. New York:

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understanding? Spec. Educ.: Forward Trends, 1983;

Snow, C. E. Mothers’ speech to children learning language. Child Devel., 1972; 43, 549-566.

Stevens, M. The Educational Needs of Severely Subnormal Children. London: Arnold, 1971.

Thorndike, E. L. Educational Psychology. Vol. 1 1 1 . The Psychology of Learning. New York: Teachers College, 1913.

Tizard, B., Hughes, M. Young Children Learning. London: Fontana, 1984.

Wells, G. Language Development in the Pre-School Years. Cambridge: CUP, 1985.

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10~2, 21-24.

Educ. Psychol., 1959; 29, 60-71.

3-11.

Groupwork with people who have mental handicaps - AN APPROACH MARRED BY SCEPTICISM?

Angela Cole

Groupwork is a method of working which is not widely used with people who have mental handicaps, although the few available reports of its use indicate that it is an applicable approach.

This article highlights some of the potential benefits that groupwork can offer. It examines why groupwork is not in more common usage, and concludes that scepticism, based upon low expectations of people with mental handicaps, is a significant factor.

T h e available Brit ish l i terature concerning work with people who have mental handicaps rarely refers to groupwork as a useful approach. Where it does, it is usually in relation to work with families and carers. By contrast, behaviour modification is a well- documented method of teaching, particularly in its application to this client group.

This slant in the literature reflects what is happening in practice: behaviour modification is an accepted, well- utilised technique; groupwork is not. This article examines some of the possible reasons why groupwork is not more widely used and argues that it is an

approach which could have positive benefits. Whilst behaviour modification offers one form of structured approach with proven results, groupwork can offer an alternative - thus increasing the scope for workers to meet needs in different ,ways.

Groupwork defined - and applied to current practice

The focus of this article is upon work with small groups of people where there is a shared, defined purpose. As such, a parallel can be drawn with behaviour modi f ica t ion , where t h e goal of intervention is clear and purposeful. Although the nature of groupwork has

~~

ANGELA COLE is a Senior Lecturer in Mental Handicap, The Anglia Higher Education College, Victoria Road South, Chelmsford CM1 1LL.

long been debated Bernard Davies’ (1975) definition of a group can help to pinpoint one of its main tenets:

. . . a group is not just a place, an arena, in which help is provided for one individual, for another individual, and another, and another, whether simultaneously or one at a time. Rather, a group is a vehicle which collectively moves the individuals concerned . . .”.

< <

T h u s , groupwork is not about working with a collection of individuals, where worker/individual interactions are the medium for change. It is about consciously using the group to promote change, using the interactions between group members and the dynamic of the group itself.

It is in this conscious use of the group, and what happens within it, that a dist inction can be made between “groupwork” as the term is used here, and work with groups of people who have mental handicaps as it is largely practised at present. For example, the promotion of change can take place in two ways: either workers can use group processes within existing groups to .

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achieve identified goals and meet identified needs; or groups can be specifically formed for this purpose. Douglas (1976) has listed seven reasons for using a groupwqrk approach (see Figure l), of which perhaps the first - that there is a “common problem” - is the most important. The difficulty here, however, is that this does not usually apply to people with mental handicaps located within existing groups, for they are often together by virtue of their handicap rather than because they have common needs and a common goal. Thus, it may not be possible to identify shared needs, goals, and purpose.

People with mental handicaps have diverse needs, like any other people. Some may have a particular need in common at the same time. To bring these people together into a formed group is to do so with a specific goal. With a shared goal, group processes and interactions can be used to help group members achieve change.

Using groupwork as a vehicle for meeting commonly held needs requires boundaries, goals, and structure which are separate from day-to-day “care”. On this basis, work groups within adult training and special education centres, staffed group homes, training groups, and so on, do not necessarily imply that groupwork is taking place. Groups are an everyday occurrence in work with people with mental handicaps, but groupwork is not.

Groupwork, then, is a goals-based approach which seeks to promote change in the social functioning of group members through interaction within the group. Furst and Ware (1983), Sines and Moore (1986), Hodgetts (1986), and Hodgson (1987) provide some of the few examples of groupwork available in the British literature. All of these give descriptions of formed groups with a defined purpose and provide a useful contrast to the majority of “groups” which currently exist.

A fitting approach Heap (1977) has pointed out that one

of the advantages of groupwork is that:

“. . . The worker is rarely the main agent of change. This is a function of the group itself. Fundamental to the groupwork method is the liberation and mobilisation of members’ own ability to help themselves and each other through participation in the group . . .”.

(1)

(2) To use peer learning;

(3) To use group pressures;

(4) To use interpersonal interaction;

(5)

(6)

(7)

That there is a common problem;

To use the support system of the group;

To use the social nature of group meetings;

To use the resources of the group.

FIGURE 1. Seven reasons for using a groupwork approach (Douglas, 1976)

Groupwork is an approach which facilitates change. It moves away from “doing to” or “for” people, towards enabling them to achieve change through their own efforts. This change of emphasis is in keeping with trends towards greater self-advocacy for people with mental handicaps and an increased likelihood of other people valuing and respecting their views and experiences. It facilitates personal growth through pressure and learning from group members, rather than through worker/ client relationships with their inherent power structure and dependency. This is of fundamental importance, for dependency in this society is often linked with devaluation. Thus, an approach which promotes mutual support, self-realisation, and self- c o n t r o l , t h r o u g h e x p e r i e n t i a l interaction, can help people gain palue a n d d e c r e a s e t h e i r f ee l ings of powerlessness. As Reid (1976) has written:

“Group treatment, even more so than individual treatment, is a learning process. The increased resources for learning lie in the usage of peers for correction of distortions, helping with change in life style, support in a change in fundamental attitudes to life, support in equating actions with words, and with these changes a decrease in inferiority feelings and an increase in self-esteem and self- confidence”.

The move towards community care has placed an increased emphasis upon the importance of socialisation skills in helping people with mental handicaps i n t e g r a t e w i t h t h e r e s t of t h e community. Douglas (1976) has pointed to the significant correlation between social functioning and group experience and has indicated that groupwork is a

beneficial approach for people who need help in this area.

Interpersonal skills are elements of social functioning which often receive little attention in social education programmes. By definition, these skills are concerned with relations between people and are learned through person- to-person contact. People with mental handicaps may not easily be able to conceptualise abstract ideas presented by a worker. However, as Laterza (1979) states:

“. . . when the same information is presented in such a way that the individual can become directly involved in ‘doing’ rather than ‘talking’, he becomes an active participant in the change process”.

Using a s t ruc tured groupwork approach can provide the arena to achieve this, for:

“the social interaction aspects of personal change are enriched and accelerated in the group as a socialising environment. The goal of social competence assumes functioning in a group rather than in isolated activities” (McBroom, 1976).

Thus, groupwork is an approach which can have a positive application with people who have mental handicaps, in a way which empowers them rather than continuing to place them in a dependent role. Why, then, is it not more widely used?

Scepticism and negativism Gunzburg (1974) commented that

experiments in rehabilitation work, presenting imaginative and successful approaches, were unlikely to have any impact “unless the more sceptical practitioners . . . are shown by facts and figures that such a deviation from

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Low expectations of people with mental handicaps

SCEPTICISM about applicability of groupwork

Absence of training opportunities

for workers

presenting Lack of publicity approach / \ as applicable and

beneficial

Workers lack knowledge and skills to use approach

FIGURE 2. The effect of low expectations upon groupwork training opportunities for workers

established approaches is not a gimmick but produces tangible and better returns than would have been obtained in traditional ways”. This is also true of groupwork.

An air of scepticism about the applicability of groupwork undoubtedly exists amongst many of those who work with people with mental handicaps. Whilst this is, in part, founded upon lack of knowledge about groupwork as an approach, it also represents a negative view of the potential of people to function within, and benefit from, a formal group setting. By beginning to examine the issue in this way, it can be seen that what is being discussed is more fundamental than why one approach is chosen in preference to another. The fact that particular methods of work are largely ignored begins to illustrate the much wider issue of discrimination and prejudice. Certain approaches appear to be unconsciously ruled out on the basis of people’s disabilities, rather than t h r o u g h c o n s i d e r a t i o n of t he i r applicability or adaptability. A vicious c i rc le i s deve loped , where low expectations lead to failure to present appropriate learning opportunities, which compounds the low expectations, and the circle continues (O’Brien and Tyne, 1981).

The fact that workers lack knowledge about groupwork and its applicability to people with mental handicaps is also a reflection of low expectations and scepticism. This is a training issue. Judging by advertisements for courses specifically about mental handicap and

other more general qualifying courses, groupwork is not presented as a relevant or desirable method of working. Consequently, without encouragement and training, workers will not use it. It is, therefore, not written u p and presented as a common, usable, and beneficial approach. Thus, another vicious circle develops (see Figure 2).

Two of the most frequent arguments against the use of groupwork with people with mental handicaps deserve consideration. These concern the applicability of traditional techniques used in group settings, and the time factor involved. Both arguments are rooted in scepticism and lack of knowledge.

Techniques Many of the traditional techniques

regularly used in groupwork do not appear to be immediately relevant for use with people who have mental handicaps. “Brainstorming” with people who may not be able to read or may have poor retentive memory skills would appear to be ruled out as an option. Role-play and the use of video may seem to present enormous problems with people who have difficulty in conceptualising ideas. Discussion within a group may appear to be impossible if group members lack well- developed conversational skills.

These are arguments for inaction, supposedly based upon the “inabilities” of people with mental handicaps. The available reports, however, have shown that these arguments are, more simply,

based upon the “inability” of workers to use their thought and imagination in adapting techniques to suit the needs of g roup members . Role-play, for e x a m p l e , d o e s n o t have to be complicated to become a learning experience, as Hodgetts (1982) showed in his report of its use in the habilitation of adults. It can also be fun, as Hodgson (1987) highlighted in her report of groupwork using transactional analysis. Even verbal communication is not necessarily a requirement for, as Gilbert (1985) states:

“. . . mime, drawing, etc. can be just as illuminating if the worker is imaginative”.

Personal experience of running groups has highlighted the importance of having a fund of techniques which can be put into practice whenever a change of tempo or direction is needed. For example, using games can be fun, and it can also achieve a purpose if used appropr i a t e ly - he lp ing g roup members to develop trust in each other, or relax, or stimulate them to further discussion. Similarly, art and drama can help provoke new ideas and provide variety, thus helping to maintain interest and create energy amongst group members - energy which can then be tapped in helping the group move forward towards the achievement of its goals.

There are, perhaps, two points of fundamental importance in the use of techniques, namely:

that they should be relevant to group members’ own experience of life; and,

that they should be goal-related, that is, they should be selected to facilitate the achievement of the goals of the group.

Bear ing these po in t s in mind arguments against the use of groupwork with people who have mental handicaps, based on lack of applicable techniques, do not stand up to scrutiny.

Time For groupwork to be beneficial

“work” must be at a pace and level that is appropriate for the group members. Thus, a group where the members have mental handicaps may take significantly longer than some other groups to reach the stage at which learning and change take place. The group process may take longer to develop and become the tool for change.

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A discussion group set up in a hostel during the 1970s (Breslin and Sturton, 1974) initially found that meetings were chaotic. Residents were shy and unsure, a n d t h e r e was n o c o n t i n u i t y to discussions. However, after two years of meetings the s taff repor ted tha t residents held more informal discussions among themselves, there was less tension and unresolved conflict, and some of them had visibly improved their communication skills. A more intensive group experiment in the United States found that it took approximately three months for the group to become a viable, cohesive unit (Davis and Shapiro, 1979).

Again, personal experience has shown that pinpointing the right tempo within a group, and consequently allowing the group time to develop, is not easily achieved. Notes about early group sessions are full of comments such as, “too hurried”, “session too long”, and “not enough time on . . .”. Skills of facilitating in order to achieve maximum performance within the group are only learned through practice. No-one can write a blueprint for a group, precisely because work and , hence, g roup development can only be at a pace appropr i a t e t o pa r t i cu la r g r o u p members. Flexibility is a fundamental requirement.

Groupwork, with any group of people, involves a substantial time commitment, but this is a factor that should be weighed against the potential benefits that the approach can offer. Without knowledge of such benefits the time involved can appear unjustified, unnecessary and, above all, off-putting. The British reports of groupwork already mentioned, and more numerous American reports (Empey, 1977; Davis and Shapiro, 1979; Monfils, 1985;

Wayne and Fine, 1986) indicate that groups with diverse goals, and using a variety of techniques, have a common outcome: individual group members undergo some degree of positive change during the life of the group. When such findings are combined with the self- responsibility and empowering aspects of a g roupwork approach , cost- effectiveness can be argued.

Conclusion: the way forward A structured groupwork approach is

not widely used with people who have mental handicaps. This is not because it is inapplicable, for available reports show that it can be effectively and beneficially applied. Techniques can be adapted and time considerations can be justified in the light of potential benefits to group members. Rather, the relative dear th of groupwork is rooted in underlying scepticism, based upon low expectations of people’s capacity to benefit from a groupwork setting. This scepticism lies behind the lack of training opportunities for workers,

consequently affecting their knowledge of the benefits, applicability, and adaptability of the approach. Without such knowledge, workers are prohibited from considering meeting the needs of their clients using this alternative approach, and people with mental handicaps are prohibited from taking advantage of the opportunities for self- help and self-realisation that the approach can offer.

If groupwork is to be more widely used, and its benefits made available to people with mental handicaps, a re- examination of attitudesand approaches is required by educators, trainers, and managers. Why is it that this approach, which can empower people who have been traditionally placed in a dependent role, is largely overlooked? In order to break into the vicious circle shown in Figure 2 , workers’ expectations need to be challenged and a positive approach needs to be taken towards people with mental handicaps, based not upon their “limitations” but on their potential for change and development.

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Davis, K . , Shapiro, L . Exploring group processes as a means of reaching the mentally retarded. Social Casework, 1979; 60:6, 330- 337.

Douglas, T. Groupwork Practice. London: Tavistock Publications, 1976.

Empey, L. J . Clinical groupwork with multi-handicapped adolescents. Social Casework, 1977; 58: 10,593- 599.

Furst, L., Ware, J. A communication skills group. Mental Handicap, 1983; 11:2, 77-78.

Gilbert, P . Mental Handicap: a practical guide for social workers. L o n d o n : C o m m u n i t y Carel Business Press International, 1985.

Gumburg, H. C. Experiments in the rehabilitation of the mentally h a n d i c a p p e d . L o n d o n : Butterworths, 1974.

Heap, K. Group Theory for Social Workers. Aberdeen: Aberdeen University Press, 1977.

Hodgetts, D. Videotaped role play in the habil i tat ion of mentally

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handicapped ad u 1 t s . A4 en ta l Handicap, 1982; 10:4, 130-131.

Hodgetts, D. A psychotherapy group for people with mental handicaps. Mental Handicap, 1986; 14:3, 121- 123.

Hodgson, C. Rewarding experience which helped clients make gains in self-esteem. Social Work Today,

Laterza, P. An eclectic approach to groupwork with the mentally retarded. Social Work with Groups, 1979; 2:3, 235-245.

McBroom, E. Socialisation through small groups. In Roberts, R. , Northen, H. (Eds.). Theories of Social W o r k w i th Groups . Guildford: Columbia University Press, 1976.

Monfi ls , M . J . Theme-centred groupwork with the mentally retarded. Social Casework, 1985;

Reid, K. Social Groupwork: Heritage and Future. 1976. (Publishing details not traceable.)

Sines, D . , Moore, K . The Magic Shop. Nursing Times, 1986; 12th March, 50-52.

O’Brien , J . , Tyne, A. The Principle of Normalisation. London: CMH, 1981.

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