Author: John Carter
1 Groups and Substance Abuse Treatment Substance Abuse Treatment: Group Therapy NCBI Bookshelf
Therefore, clinicians ought to be wary about relying too heavily on educational groups, even when teaching content derived from EBTs. What should be done about this treatment modality mismatch between research and clinical contexts? Some might propose that the burden is on clinicians to adapt existing EBTs into group formats. Such would likely be a daunting task, however, especially in light of limited resources and training for doing so. At any rate, remarkably little research exists concerning what SUD clinicians do in group therapy, and thus the extent to which a treatment modality mismatch is a barrier in EBT implementation is unknown. A first step, then, would be to explore clinicians’ perspectives on complexities with group therapy facilitation in SUD specialty treatment settings.
Group Leader Roles and Responsibilities
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available. It’s important to have moments of levity during addiction recovery to help build camaraderie and enthusiasm, and playing charades can provide some. Afterward, participants may be invited to share any surprising or revealing thoughts they had, if they feel comfortable doing so. Setting short- and long-term goals gives people in recovery something to work for, but they can sometimes struggle with determining what those goals should look like. Role-playing is an effective way to help group members practice handling any tough situations that may arise during treatment, such as making apologies and amends to family members. One of the most common experiences people in recovery share is cravings and triggers to drink or use drugs, and discussing them can help prevent relapse.
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Client engagement was discussed extensively in terms of limitations of manualized or more structured therapies in the context of group therapy. Clinicians stressed the importance of finding a “middle ground” between standardization and individualized care. To the first question, the therapist can respond with the assurance, “People disclose in here when they are ready.” To the second, the member who has made the disclosure can be assured of not having to reiterate the disclosure when new clients enter. Further, the disclosing member is now at a different stage of development, so the group leader could say, “Perhaps the fact that you have opened up the secret a little bit suggests that you are not feeling that it is so important to hide it any more. My guess is that this, itself, will have some bearing on how you conduct yourself with new members who come into the group” (Vannicelli 1992, p. 160 & p. 161). During early recovery, it is particularly important to avoid making the 12-Step program’s encouragement of “unquestioning acceptance” a focus of analysis in group therapy.
Interventions
In a recent survey of group therapy SUD specialty clinicians in the United States, 69% reported that all of their facilitated groups were open-enrolling groups, with only 10% reporting that none of their groups were open (Author, 2017). However, open-enrolling groups are rarely studied in clinical trials, due at least in part to difficulties in controlling for equivalent group comparisons and in analyzing data (Morgan-Lopez & Fals-Stewart, 2008; Weiss et al., 2004). Professionals within the entire healthcare network need to become more aware of the role of group therapy for people abusing substances. To build the understanding needed to support people in recovery, group leaders should educate others serving this population as often as opportunities arise, such as when clinicians from different sectors of the healthcare system work together on a case. Similar needs for understanding exist with probation officers, families, and primary care physicians. Each group has a client leader, and the clinician circulates among the groups to ensure that the topic is understood and that discussion is proceeding.
Groups and Substance Abuse Treatment
After a conflict, it is important for the group leader to speak privately with group members and see how each is feeling. The leader can introduce a cognitive element by asking clients about their thoughts or observations or about what has been taking place. Describe the impasse, namely, that it is important that both client and therapist feel that they are in a credible relationship, but the way things are shaping up, it must be increasingly difficult for the client to come in week after week knowing that the therapist doubts him. The therapist needs to be able to use humor appropriately, which means that it is used only in support of therapeutic goals and never is used to disguise hostility or wound anyone. Largely due to the nature of the material group members are sharing in process groups, it is all but inevitable that ethical issues will arise.
Even where a privilege of confidentiality does exist in law, enforcement of the law that protects it is often difficult (Parker et al. 1997). Clinicians should be aware of this legal problem and should warn clients that what they say in group may not be kept strictly confidential. Some studies indicate that a significant number of therapists do not advise group members that confidentiality has limits (Parker et al. 1997). Group leaders carefully monitor the level of emotional intensity in the group, recognizing that too much too fast can bring on extremely uncomfortable feelings that will interfere with progress—especially for those in the earlier stages of recovery. When emotionally loaded topics (such as sexual abuse or trauma) come up and members begin to share the details of their experiences, the level of emotion may rapidly rise to a degree some group members are unable to tolerate. Group leaders never should attempt to use group techniques or modalities for which they are not trained.
Because a group facilitator generally is part of the larger substance abuse treatment program, it is recommended that the group facilitator take a practical approach to exceptions. This practical approach is to have the group facilitator discuss the potential application of the exceptions with the program director or member of the program staff who is the lead on the confidentiality regulation. In groups that are mandated to enter treatment, members often have little interest in being present, so strong resistance is to be expected.
- The group leader might ask the verbose client, “Bob, what are you hoping the group will learn from what you have been sharing?
- Despite individual efforts, however, group therapy often is conducted as individual therapy in a group.
- On the other hand, however, it is possible for SUD group clinicians to overemphasize the importance of flexibility.
- Resistance arises as an often unconscious defense to protect the client from the pain of self-examination.
It is just as unhelpful to clients to let the conflict go too far as it is to shut down a conflict before it gets worked through. The therapist must gauge the verbal and nonverbal reactions of every group member to ensure that everyone can manage the emotional level of the conflict. As the client moves forward, the clinician can keep in mind the issues that a client is not ready or able to manage. As this process goes on, the leader should remember that the client’s priorities matter more than what the leader thinks ought to come next. Unless both client and leader operate in the same motivational framework the leader will not be able to help the client make progress.
Recruitment consisted of visiting staff meetings and/or email solicitations; clinicians were free to decline participation without knowledge of or reprisal from their employers. Participants were interviewed privately by the first author, either on site at their clinics or at a university office. In most cases, interviews were completed in one visit (two participants required two visits). Participants were reimbursed $30 per hour for the interview, and $15 for completing a survey that included demographic information. Special consideration is sometimes necessary for clients who speak English as a second language (ESL).
Addiction Recovery Group Activities
The difficulty of navigating differing and shifting stages of change also pertained to clinicians’ reported difficulties with utilizing MI principles in groups. Although most clinicians endorsed the use of MI (especially for New Day and SUD Intensive Clinic), six expressed difficulties with facilitating MI in groups, in terms of limited experience or difficulty balancing the needs of individuals with groups. Finally, clinicians reported several ways in which flexible group facilitation sometimes required departing from planned material.