Where have we come from, and where are we going?

In honour of OTASA’s 80th anniversary, OTGrow hosted the first in a series of Conversations of the History of OT Groups in South Africa. The emphasis of these conversations is on knowing where we come from so that we can consciously and intentionally steer our OT groups into the future.

At our first session, we heard from therapists with the most years of experience: Dr Rosemary Crouch, Prof Pat de Witt, and Dr Lisa Wegner. They shared their personal experiences in groups throughout their lifetimes as clinicians and academics.

Their input was followed by occupational therapists currently in practice: Debbie Smuts from Denmar Clinic, July Masango from Evexia Day Clinic, and Heidi Morgan from Mondia. The conversation was then opened up to all attendees for comments, questions, and discussion.

Remarkably, the panellists’ combined experience spanned the entire timeline from the 1950s to the present day. Rosemary Crouch was Pat de Witt’s lecturer, Pat de Witt in turn was Lisa Wegner’s and July Masango’s lecturer providing us with continuous snapshots of the growth of OT groups in South Africa.

Did You Know?

• When Rosemary Crouch trained in the 1950s, there were no modules on group work.
• Artwork, discussions, and psychodrama were common techniques used by OTs in mental health as early as the 1970s.
• According to Pat de Witt, psychologists were already pushing back against OT groups in the 1970s, so this is not new. And yet, here we still are, presenting groups.
• Group dynamics has always been a core component of OT group training.
• The range of activities and types of groups OTs engaged in during the 1980s and 1990s has decreased significantly.
• OTs are moving away from psycho-educational groups.

Carving the Way Forward

Some wonderful comments and suggestions were made about the future of OT groups. As you read the list below, reflect on your own thoughts and experiences:

• The need for OTs to standardise group terminology. Different terms are used across training institutions and hospitals, making it difficult to have consistent conversations within the profession. For example: evocative group, group work vs group activities vs group therapy vs occupational group therapy; psycho-social groups and socio-emotional groups; task-centred vs creative groups or craft groups, etc.
• A call to review the position paper on group work to ensure it holds true across all fields of occupational therapy: paediatrics, vocational rehabilitation, corporate, acute psychiatry, and community.
• A strong emphasis on OTs’ unique contribution to group work, particularly through activities. There seems to be a shift away from psycho-educational groups, with some practices handing that over to other MDT members so OTs can focus on what they do best – activities, tasks, and occupation.
• The need to move into a preventative space, with suggestions to present groups in communities to support members who don’t always have access to mental health care.
• As some medical aids consider incorporating counsellors to run groups in mental health care, there’s a need to clearly define the difference between counsellor-led groups and OT-led groups. A suggestion was made to describe the value of OT groups, rather than limiting them by time or number of group members for medical aid purposes.
• July Masango made a pertinent point from his PhD research: South Africans’ engagement and connection with others has drastically declined since COVID, as patients and clients work from home and online. This causes significant isolation. The need for human connection has become dire, as SA sees a rise in mental health crises. The occupational performance area of social participation is becoming increasingly important in this digital age, as clients lose the skills to interact and build healthy relationships.
• The need for research was emphasised again especially quantitative research to prove the effectiveness and impact of OT groups.
• When asked specifically about Projective Techniques and Psychodrama in OT, therapists unanimously agreed: Projective Techniques should be taught at undergraduate level, and Psychodrama at postgraduate level. Both should be clearly defined within the OT scope of practice to demarcate the lines between psychologists, counsellors, and occupational therapists.