Ritual

1. Greetings to Members Each Time the Group Meets

   "The Tea Group is meeting in the dining room. We would be very pleased if you would join us." (Each resident is escorted to the room in the same order every week to promote predictability and minimize wandering.)

2. Attendance is Voluntary

   If a resident refuses, they are encouraged to come for a trial only and told that they may leave when they like. No one is ever forced to come. Members who choose not to attend are told that their presence will be missed, and their regrets will be given to the group.

3. The Meeting is Opened

   The meeting is opened with formal introductions if membership is relatively new, or greetings if members know everyone. Everyone's name is mentioned several times, and they are encouraged to greet one another. Absent members are mentioned, and each resident's contribution to the last meeting is mentioned and acknowledged. Whatever conversation or comments members initiate is given preference, and the facilitator takes cues from them.

4. The Making of the Tea Comes Next

   All decisions, even the smallest, such as what type of tea to use, how many tea bags to use for the size of the carafe, whether the tea has steeped long enough, how to arrange the table, are reflected back to the group for consensus. The residents are so unused to having their opinion asked that in the beginning they take each question very seriously. By reflecting all decisions back to the group, the facilitator builds up their sense of control.

5. Residents are Asked to Look Out for Each Others Needs

   As many of the tasks as possible are delegated to members of the group. In this way, the facilitator tries to identify possible roles for each resident, draws out competencies, and tries to promote interaction among the members of the group.

6. Conversation Develops

   Conversation develops if the facilitator is patient and lets things happen. If no one starts the conversation, the facilitator can start with a short conversation about what (s)he did over the weekend. Each resident is asked if they had a similar experience some time in their lives. For example, if the facilitator relates that she went skiing: Has any one else enjoyed skiing with their families? Playing in the snow? Sleigh riding?" Each participant is asked about their experience with snow. New conversations develop and the conversation takes new twists and turns. If a resident or guest begin to monopolize the conversation, the facilitator can say, "Let's ask Mary if she ever did that" to move the conversation along. If the conversation lags, the facilitator can say, "It is certainly nice to get together and have this time to get to know each other better isn't it?" . (Residents always respond positively to this in our groups. It seems to give them something positive that is easy to respond to and expresses their feelings when sometimes they can not.) Silence is also acceptable. Sometimes, just being in a pleasant atmosphere away from the noise of the unit, may be what a resident enjoys. When residents feel comfortable and safe, they feel free to risk more ideas, and begin to interact more freely.

7. The Facilitator

   The facilitator must resist the temptation to set up themes or specific topics. Such structure inhibits members from expressing themselves about things that are important to them.

8. If a Member Wishes to Leave Early

   Members are encouraged to stay, but if they can tolerate no more, they are invited to say their goodbyes, are thanked for their participation, and then are escorted back to their unit.

9. When the Meeting Comes to a Natural End

   Usually in about 45 minutes, the facilitator thanks everyone individually for coming, and acknowledges their contribution. Members help with as much of the clearing of the table as possible.

10. Those Who Were Unwilling or Unable to Attend are Visited

    Those who are unwilling or unable to attend are visited with a half cup of tea and a cookie and are told they were missed at the Tea Group. A recap of the meeting is given to reaffirm their membership in the club.

11. After the Meeting

    The facilitator, trainee/co-facilitator and "guest" staff member discuss the meeting. They make brief notes about each resident's participation on the evaluation sheet (PDF, 142.85, 1pg.) to help keep track of changes, and serve as reminders of issues that were brought up by residents or staff and need to be followed-up. The evaluation sheets help track the outcomes of the group and individual residents.

Roles

• The facilitator creates a positive reality for the participants by promoting their sense of control, safety, identity, and membership. This is accomplished by: encouraging, accepting and praising, members' participation; directing their participation by encouraging the reticent, checking the talkative; and, listening to, following and using the ideas of others. The facilitator is often the mediator and interpreter for the group. Humor, diplomacy, and quick thinking are used to deflect and defuse provocative or belligerent comments from a resident. The challenge for the facilitator is to enable independence while ensuring safety and freedom from failure or embarrassment. This takes faith, trust, vigilance and ingenuity. For example, instead of wiping a resident's chin, the facilitator would hand him a napkin with a telling gesture as might be done to a friend or family member. Most residents will respond appropriately to this familiar cue. The residents' self-esteem is protected by asking for opinions and advice instead of facts. The key to the success of the program is that residents are never exposed to negative feedback of any kind. Mistakes are not corrected unless the resident asks for help to correct them. The facilitator is the model and sets the standard for impeccable good manners and considerate behavior that is appropriate to a formal tea party.

• The members are the real hosts of the Tea Group, not the facilitator. This fact must be reflected to anyone participating in the group. The members, because of their dementia, can not assume the role of host unassisted, but take their cues from the facilitator. Every effort is made to treat the residents as competent, respectable and independent adults capable of doing for others and receiving thanks for it.

• Invited guests are there to observe and learn from the interaction between the facilitator and the members, and to notice the behavior triggered by the different techniques used. They are asked to act as guests and allow themselves to be served by the members of the Tea Group. They are also asked to refrain from making any helping gestures toward residents, and behave as they would when invited to a friend's home for tea.

• Non-participating staff are asked to avoid interrupting the Tea Group. If absolutely necessary, good manners are used to excuse the interruption. Staff need to keep other residents from interrupting the group also. They can teach respect for the program and the residents participating in it, by conveying the idea that the tea group is an important, therapeutic activity that is much more than "just a tea party".