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Research on the outcomes of intervention has become very important in countries such as South Africa where clients from the middle economic sector are supported by medical insurance/aid systems. Effectiveness of different techniques, time values, curative factors and analysis of quantitative and qualitative data are only some of the outcomes that need to be researched.

This is not the only reason, because in the broader urban and rural communities the accountability of the profession of occupational therapy depends on researched interventions which will be effective, economic and culturally suitable. Within the profession, occupational therapists need to make informed choices as to the type of intervention that is suitably employed. They need to be well informed and skilled to use group work within the economic environment and this depends to an extent on the research that has been undertaken on the subject. ‘Research, therefore, is about understanding our world and the specific concepts in which we work. It is also about identifying limits and looking for alternative theories or approaches’. These are wise words from Jennifer Creek (2002, p. 54).

The World Health Organisation (WHO) stated in 2004 that ‘Occupational therapists need to be able to demonstrate that therapeutic interventions are clinically effective so that the finite resources available can be used to deliver the best possible outcomes for the population served’. Ramano et al. states in his publication in 2018 that ‘scientific rigor is required in occupational therapy research that supports the practice of activity‐based groups for promoting social functioning’ (p. 2).

In 1993 Finlay (in Creek 2002) stated that ‘a lot of research on groups has been done, but findings are often contradictory and diversity of groups and outcomes studied can be confusing. Moreover, little of the research is related directly to occupational therapy practice’. (p. 205). There has been research into the comparison of individual activities to group work as well as freedom of choice in group activities by clients by Henry, Nelson and Duncombe in 1984. The results revealed that members should be involved in the choice and adaptation of group activities. Also in 1984 Kramer, Nelson and Duncome studied the outcome of presenting three different types of activity to chronic psychiatric patients. They found differences in affective meaning. There have been a couple of descriptive studies undertaken which have not revealed a lot of significance.

Catherine Beynon‐Pindar (2017) included an interesting chapter on group work in occupational therapy in her book ‘Occupational Therapy Evidence in Practice for Mental Health’. She describes ‘an intensive group programme to explore occupation‐centred, evidence based approaches to group work practice in a residential setting’ (p. 1, chapter 4). The population described consists of women with a variety of self‐defeating behaviours, eating disorders and dissociation. She confirms that occupational group therapy is a core skill of the profession.

Crouch (1987) undertook a quantitative study which compared the effectiveness of certain occupational therapeutic group techniques in the assessment of acutely disturbed adult psychiatric patients. The objectives were to compare the evaluation/assessment of a psychiatric patient based on group observations with those assessments based on individual observations made by other members of the psychiatric team over a longer period of time. She also set out to validate the role of the occupational therapist in the use of group techniques for assessment purposes. The two types of groups used in the research were art groups and discussion groups. The occupational group therapy short‐term assessments of the group members compared favourably with those assessments made by other team members over a longer period. It was found that the assessments made by the occupational therapist are a reliable contribution to the team evaluation of the patient and in a shorter period (Figure 2.1).

In more than a decade, the situation has changed considerably and there is some sound research on group work in occupational therapy emerging from all over the world.

In 2007 Crouch and Mogotsi undertook a research project in the psychiatric department of Johannesburg hospital. They assessed the efficacy of group writing in improving occupational performance, thereby enhancing employment possibilities and sustainability in persons with bipolar affective disorder. The study took place over eight sessions using an experimental and control group. It was a longitudinal study and the results from the Canadian Occupational Performance Measure (COPM) showed a significant improvement in occupational performance in participants over a period of time.

FIGURE 2.1 The author leading occupational group therapy with a group of patients in an acute psychiatric unit.

Ramano and de Beer (2017) carried out an intensive and comprehensive research study on the improvement of social functioning of individuals with major depressive disorder (MDD). He compared the results of two occupational therapy group programmes over a period of four months. The study included 100 participants.

The outcome of Ramano's and de Beer (2017) research is that ‘The therapeutic use of tangible activities and participants' social interaction in occupational therapy groups, are found to be curative and appropriate in reducing symptoms and improving functioning of patients with MDD since it enhanced their well‐being’ (p. 133). Ramano succeeded in isolating important symptoms of MDD such as lack of interest in everyday activities, tiredness and lack of energy, suicidal ideation, hopelessness, lack of concentration, etc. and through both quantitative and qualitative methods was able to conclude with significant results in the improvement of patients suffering from MDD.

In 2008 Crouch undertook intensive research into the use of stress management groups in the rural community in South Africa. This will be discussed further in Chapter 13.

In 2014 Casteleijn undertook doctorial research to establish that the sequential levels of creative ability according to DuToit (2009) measures increasing amounts of creative ability. The tool she developed is called the Activity Participation Outcome Measure (APOM). This outstanding research statistically confirms that ‘the levels of creative ability exist and that the levels resemble the characteristics of an interval scale of measurement’ (p. 181). This important finding is indeed very relevant to occupational group therapy and is being used in the measurement of outcomes regarding the performance of group members.

Included in Casteleijn's (2014) study is the Creative Participation Assessment Tool (CPA) which is a descriptive tool developed by van der Reyden in 2002 and has been used by occupational therapists and students to assess creative ability of participants in groups and individually. In 2002 Casteleijn and Smit adapted the CPA and established that it is valid and reliable.

Mona Eklund well‐known occupational therapist in Scandinavia, published a paper on the Wile Online Library in April 2006 entitled ‘Therapeutic Factors in Occupational Group Therapy identified by patients discharged from a Psychiatric Day Centre and their significant others’. She found that the most important factors of the group dimension were group interaction, talking in a group and the therapist's attitude and behaviour.

In 2019 Christopher undertook research into occupational therapy groups as a vehicle to address interpersonal relationship problems. Their study was aimed at the mental health care users' perceptions. This is a qualitative study where 11 groups specifically directed at interpersonal relationships were carried out. This study has specific reference to the content of this book and many of the chapters relate to occupational group therapy. The authors discuss how group members experienced a ‘downward spiral’ in interpersonal relationships supposedly caused by their mental illness. ‘During group therapy, this downward cycle appeared to start to reverse, as the participant received acceptance, authentic support, and social connection. This seemed to have provided a safe place to practices social skills and as a result strengthen self‐esteem, and positive relationships, leading to a greater level of acceptance and mental health’ (in Radnitz et al. 2019, p. 8.). This article is highly recommended.

Very little research is to be found on group work with the physically disabled. Mehdizadeh et al. (2017) published an excellent research paper on stroke survivors and the effect of group‐based occupational therapy on performance and satisfaction. Their results show a significant change and improvement in ADL performance but unfortunately they do not state the effect that working in a group had on the clients.