What a difference a group makes

June 1998, "My room with a view", by Susie Mallett

I had a very difficult time working alone with a young man recently, and wished each day that I could conjure up a group out of thin air to work with him. He would have enjoyed it so much and I could have used the pedagogic powers of the group. This would have made everything so much easier for everybody.

Making the best of it

I know that a group would certainly have been the answer but it is not always possible to do what one knows is best, especially on the spur of the moment. So we struggled on and succeeded anyway.

Groups are not always the answer, but individual sessions are also not always the answer either. It is so important to be able to judge when one or the other is needed and if and when possible to provide what is best.

"Working the group" is like working an audience!

I am now back working in groups and I realise how important it is that I should know how to ”work the group", how I can use the dynamics of the group and when to step back into the wings.

The group is actually sometimes far more capable of taking the lead in certain situations than I am, and I must then hand over the reins to the group as a whole, or the individuals in it.

I have to encourage them to do the leading, especially in the stroke group, when talking is sometimes not someone’s strongest point but perhaps stronger than in another member.

This is just what I experienced on Tuesday and Thursday last week

We have a new member in the stroke group

On Tuesday it was so interesting to see how the whole group took this potential new member immediately to their hearts. The last new member had joined our group of six about two years ago and it was obvious from the group reaction that it was again time for change.

And a change it will be as the group's whole routine has to change when there is a new group member, someone who has yet to learn the ropes. At least for the first few weeks. This always does every one, including me, the power of good.

Back to Tuesday

This very shy and nervous, youngish man arrived with his wife to watch our programme for the first time on Tuesday morning having been recommended to come by the physio of another group member.

He has aphasia and found it very difficult to express himself with strangers. He understood what we were talking about and watched us with interest, and he had many questions.

Only five months after his stroke he still is not able spontaneously to find the words that he needs but we took it slowly and between us we answered his questions and tried to reduce his fears. These were mostly that he would not be able to do what we were doing in the group.

Some clients in the stroke group are progressing very well and, as they have been attending for several years now, they know the routine of the session inside out. Our new, but on Tuesday still potential, client wondered how he could work with us. The group told him: “by taking one step at a time”.

On Tuesday, as the group disbanded one by one, they all took the new man by the hand and said that they looked forwarded to seeing him again on Thursday. He now had very little choice, as his future "colleagues" just assumed he would be there again!

Having stayed to talk to me a while longer, to discuss how he could rearrange his other appointments for the week, he left for home a little apprehensive but with a smile in his eyes.

Thursday

Much to our delight and pleasure, our potential client has become a new member of the group, turning up bright and early, actually almost beating me in the door.

He was immediately shown to his place by other group members, shown where the bathroom is and where to place his belongings.

For them he was already one of us!

The day was very tiring for us all. I felt like I was running around in circles but I was delighted at how suddenly my clients could do so much more for themselves, even correcting positions, without even a word from me.

I spoke to one of the clients about it later, as her husband gave me a lift through the monsoon weather to the dentist's. She told me that there are many things at work. She tries to do her best to show the newcomer what to do and to make him feel at ease. At the same time, because I am having to explain more about the programme, she has to concentrate more on what she is doing, since she doesn't get as much personal input from me.

There is also a third point, that I noticed in everyone. They wanted to help me. They knew that it was difficult for me too and they wanted to show me that they did not need my help.

I told them all that their help is much appreciated and I am thrilled if they can now do things alone, but no cheating!

We had a tiring but delightful morning's work!

We always finish the morning session at the table with a drink and a chat, and a game or a sing- song.

On this day each of my clients had a picture taken from old calendars to look at. It was either a painting or a photograph depicting flowers, people, landscapes or townscapes.

The clients always choose their own pictures and, depending on their ability to speak, to talk in front of a group, and the speed at which they think and the language that they use as mother tongue, I chose what they do with the picture. Some of them tell me the story behind the picture delving deep into their imaginations and coming up with the most amazing biographies.

Some describe the picture itself and others tell me about the season or the general style of life at the time depicted in the picture. Sometimes I ask questions, either directly about what they can see, or asking them to name the objects they see and the colours of the objects depicted.

They can tell me about the people in the pictures, I ask what their names could be and what jobs they have, and whether they have families, gradually making it more and more complicated and less guided by myself.

One member of the group weaves intricate stories about the lives of the people, knowingly explaining the reasons for an expression on a face, telling us details right down to why someone has dirt on his clothes. A lady who several years ago needed lots of questions about objects and colours to get her started, now delights in describing the patterns of light and shade, and the colours and textures in the paintings.

One man who can speak quite clearly and think quickly but does not like to talk while at the table with the whole group, always says keine Ahnung (no idea) when he is asked to describe his picture. I always tell him that apart from the artist or the photographer, he could be the only other person who does know. This is usually enough to conquer his fear of saying something "wrong", and encourages his imagination to start playing with ideas and the rest of the group throw in a few suggestions.

A few helping hands

Now it was the whole of the group who wanted to make suggestions for our new client.

He was third in line, so that he would get the idea of what we were doing, but he was not last so that he would have less time to worry about it being his turn. I asked people randomly around the table, always bearing in mind how easy or difficult the task was for them, and I always considered who it would be best for each to follow.

When the new group member’s turn came I led the group and showed them what to do. I encouraged them to watch out for when they should remain silent in anticipation of an answer, and when and how they could offer encouragement. This actually came spontaneously and they took over from me quite naturally. I showed one man how to look at the new client directly and let him copy the mouth movements for words that he was searching for. I showed how, if he would say the first letter and wait a little, that then the new man would perhaps be able to say the word at the same time.

The whole group was delighted with this, especially when by the time they had all had a go at helping in their different ways, the new client who until then had been able to utter only "No" as a response to everything, told us that there was a "pink flower" and "green leaves" on his picture.

The group went on to tell him how they had learnt to speak, two of them describing how they had done so through singing. A spontaneous conclusion to the session was that, without getting out our song sheets, we sang a song that just about everyone all over the world must know, a song that Elvis made famous but I know only in German: Muss I denn zu Städtele hinaus.

By the time that the encore came the partners and carers had arrived and our ranks were swollen, so we could give a really hearty rendition.

The group went home smiling inside. Our new client left with the recommendation to get some CDs on the player with the sing-a-long songs that he has known since childhood. Those songs that we don’t realise we know each and every word to, until they come on the radio.

They are probably songs that we would never usually choose on a CD . They are those songs that become Ohrwurms, songs and melodies that stay with us all day long in our head, disturbing our every thought.

These are the songs that encourage stroke clients to use their voices again. They are so familiar that they take away the fear of making mistakes and after a while speech begins to return.

Notes

„Muss I denn zum Städtele hinaus“

http://www.youtube.com/watch?v=_byoKAi4CJE

At military tempo, from the DDR ("East Germany")

http://www.youtube.com/watch?v=fZsOlXMF6zc&feature=related

Marlene D, more our stroke group tempo!

http://www.youtube.com/watch?v=E9W6m_PhXq4&feature=related
http://www.youtube.com/watch?v=0xZhYhg09lk&feature=fvw

Broken Heart/Muss I denn - The King, Elvis Presley