Group therapy in stages of recovery from addiction
Presented by: Raghda Elgamil
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group.Group therapy, focuses on the group of clients and attempting to benefit from sharing their experiences.In group therapy; both patient - patient interactions and patient - therapist interactions are used to effect changes in maladaptive behavior in each group member.Counseling is usually led by a therapist, but it is encouraged in a group counseling session that all members of the group contribute in some way.
Irvin Yalom was partially responsible for the continued development of group counseling after WWII. He came up with 12 therapeutic principles that describe the different factors of counseling that can positively affect the clients.Yalom (1995) defined therapeutic factors as "the actual mechanisms of effecting change in the patient“. Yalom identified 12 factors that influence the processes of change and recovery among group therapy clients.
• Instillation of hope - encouragement that recovery is possible• Universality - feeling of having problems similar to others, not alone• Altruism - helping and supporting others• Guidance - nurturing support & assistance• Self understanding- teaching about problem and recovery• Interpersonal learning - learning new ways to talk about feelings, observations and concerns
• Imparting informations : finding out about themselves & others from the group• Cohesion - feeling of belonging to the group, valuing the group• Catharsis – release of emotional tension• Existential factors – life & death are realities• Identification– modeling another’s manners & recovery skills• Corrective recapitulation of family of origin issues – identifying & changing the dysfunctional patterns or roles one played in primary family
Group therapies are used widely in the treatment of substance use disorders in short term residential rehabilitation, long term therapeutic community, partial hospital, intensive outpatient, drug free outpatient, and after care programs.
Maintain abstinence Personal and lifestyle changes toInitiate supportabstinence abstinence
Members are in the 1st phase of abstinence.Features They are in period of active dependency on the group. usually use a great deal of denial for their addiction. Goals Initiate abstinence by: Providing education about addiction, recovery, and relapse. Resolving ambivalence by overcoming denial and enhancing motivation to change. Installing hope and optimism for change. Finding behavioral alternatives for using drugs.
Features • Members are in phase of maintaining abstinence • Members begin to gain a sense of self - reliance • Members have overcome their denial around addiction.Goals Maintenance of abstinence by: • Teaching recovery skills to manage the addictive disorder over the long term. • Creating an experience of positive membership and a recovery oriented group • Using interpersonal learning to improve interpersonal relationship. • Understanding and resolving rather than avoiding problems contributing or resulting from addictive disorders
• Size:3-15, Optimal size:8-10 members.• Frequency & Duration:Until the mid-1960s, the length of a group therapy session seemed fixed: 80- to 90-minute session were part of the entrenched wisdom of the field.consensus among therapists that after about 2 hours,the session reached a point of diminishing returns:the group becomes weary, repetitious & inefficient.
• Groups that meet less than once weekly generally have considerable difficulty maintaining an interactional focus. If a great deal has occurred between meetings in the lives of the members, such groups have a tendency to focus on life events and crisis intervention.The number of sessions in group therapy depends on the makeup, goals, and setting of the group.
• Supportive group therapy: (Once a week up to 6 months)• Analytically-oriented group therapy: (1-3 times a week for 1-3 years)• Psychoanalysis of groups: (1-5 times a week for 1-3 years)• Transactional group therapy: (1-3 times a week for 1-3 years)• Behavioral group therapy: (1-3 times a week up to 6 months)
Milieu groups Psycho-Psychodrama educational Group therapy Therapy or Skill groups counseling
• Offered in a residential program, usually involve a group meeting to start or end the day• A community group may review the upcoming day schedule, discuss issues, ask each patient to state a goal of the day, and have patients listen to and reflect on the reading of the day.
• Provide information about specific topics related to addiction and recovery• Help patients to learn how to cope with challenges of recovery• Use a combination of lectures, discussions, educational videos, and behavioral rehearsals• Completion of written assignments such as, a recovery workbook, or a personal journal
• Aimed at helping patients develop and/or improve their intra personal and interpersonal skills• Example: problem solving methods, stress management, and skills for relapse prevention strategies.
• These groups are unstructured, and give the participants an opportunity to create their own agenda.
Although many different types and structures of group therapy are available for the treatment of addictive disorder, many of the problems issues addressed are similar:
• Understanding addiction and recovery: o Understanding effects and symptoms of addiction. o Denial and other defenses. o Stages of recovery.• Physical and lifestyle issues: o Craving management. o Types and purpose of treatment. o Defining personal goals. o Achieving balance in life.
• Psychological / behavioral and spiritual issues: o Self esteem . o Understanding feelings and their effects on relapse. o Managing anxiety. o High risk factors.• Family/ interpersonal / social domains: o Effects of addiction on family. o Role of family in treatment. o Resolving marital or family conflicts. o Resisting social pressure to use. o Managing high risk people, places, and events.
To provide effective group treatment, it is necessary for the therapist to be familiar with and skillful in addiction treatment and group therapy.Knowledge base required for providing competent addiction treatment involves the following: Knowledge of the effects of various drugs of abuse as well as medical, psychological, social, family and spiritual consequences of addiction. Understanding of the process of recovery and relapse.
Tools or strategies required for the recovering persons to manage the recovery process. The therapists should be familiar with the twelve steps self help approaches (NA, AA). Counselor should have an understanding of counseling theory and experience for individual counseling. The group leader should be able to respond to both individual or group dynamics or group processes simultaneously. Counselor should be familiar with stages of group (e.g. beginning, middle, work stage, closing)
Group leader should be familiar with the kinds of interventions she/he would more often use, and how to deal with problem situations that commonly occurs in the group sessions. Basic intervention skills include; active listening, clarification, questioning, summarization, encouraging and supporting, modeling, eliciting feedback, and addressing problems that commonly arise.
The therapist effectiveness is a complicated mix of knowledge, experience, skills, talent, commitment and dedication. The leader can never close the gap between himself and the group. If he does, he is no longer what he must be. He must walk a tightrope between the consent he must win and the control he must exert.
Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work.