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NCBI Bookshelf. Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. This chapter presents five models of groups used in substance abuse treatment, followed by three representative types of groups that do not fit neatly intobut that, nonetheless, have special ificance in substance abuse treatment. Finally, groups that vary according to specific types of problems are considered.
The purpose of the group, its principal characteristics, necessary leadership skills and styles, and typical techniques for these groups are described. Substance abuse treatment professionals employ a variety of group treatment models to meet client needs during the multiphase process of recovery. A combination of group goals and methodology is the primary way to define the types of groups used.
This TIP describes five group therapy models that are effective for substance abuse treatment:. Each of the models has something unique to offer to certain populations; and in the hands of a skilled leader, each can provide powerful therapeutic experiences for group members.
Also discussed are three specialized types of groups that do not fit into the five modelbut that function as unique entities in the substance abuse treatment field:. This list of groups is by no means exhaustive, but it demonstrates the variety of groups found in substance abuse treatment settings. View in own window. They examined 18 psychological and behavioral theories of how change occurs, including the components of a biopsychosocial framework for understanding substance abuse.
Their result was a continuum of six for understanding client motivation for changing substance abuse behavior. The six stages are:. If the group is composed of members in the action stage who have clearly identified themselves as substance dependent, the group will be conducted far differently from one composed of people who are in the precontemplative stage.
Priorities change with time and experience, too. For example, a group of people with substance use disorders on their second day of abstinence is very different from a group with 1 or 2 years of sobriety. Theoretical orientations also have a strong impact on the tasks the group is trying to accomplish, what the group leader observes and responds to in a group, and the types of interventions that the group leader will initiate.
Before a group model is applied in treatment, the group leader and the treating institution should decide on the theoretical frameworks to be used, because each group model requires different actions on the part of the group leader. Since most treatment programs offer a variety of groups for Pure co ed looking to lose it all abuse treatment, it is important that these models be consistent with clearly defined theoretical approaches.
In practice, however, groups can, and usually do, use more than one model, as shown in Figure Therefore, the descriptions of the groups in this chapter are of ideal, pure forms that rarely stand alone in practice. Despite such discrepancies between neat theory and untidy practice, little difficulty will arise if the group leader exercises sound clinical judgment regarding models and interventions to be used.
One exception to this assurance, however, should be noted. Close adherence to the theory that dictates the way an interpersonal process group should be conducted has crucial implications for its success. Figure summarizes the characteristics of five therapeutic group models used in substance abuse treatment. Psychoeducational groups are deed to educate clients about substance abuse, and related behaviors and consequences. Frequently, an experienced group leader will facilitate discussions of the material Galanter et al. While psychoeducational groups may inform clients about psychological issues, they do not aim at intrapsychic change, though such individual changes in thinking and feeling often do occur.
The major purpose of psychoeducational groups is expansion of awareness about the behavioral, medical, and psychological consequences of substance abuse. Psychoeducational groups are provided to help clients incorporate information that will help them establish and maintain abstinence and guide them to more productive choices in their lives.
Additionally, they are useful in helping families understand substance abuse, its treatment, and resources available for the recovery process of family members. Principal characteristics. Psychoeducational groups generally teach clients that they need to learn to identify, avoid, and eventually master the specific internal states and external circumstances associated with substance abuse. Psychoeducational groups are considered a useful and necessary, but not sufficient, component of most treatment programs.
For instance, psychoeducation might move clients in a precontemplative or perhaps contemplative stage to commit to treatment, including other forms of group therapy. For clients who enter treatment through a psychoeducational group, programs should have clear guidelines about when members of the group are ready for other types of group treatment.
Often, a psychoeducational group integrates skills development into its program. Psychoeducational groups should work actively to engage participants in the group discussion and prompt them to relate what they are learning to their own substance abuse.
To ignore group process issues will reduce the effectiveness of the psychoeducational component. Psychoeducational groups are highly structured and often follow a manual or a preplanned curriculum. Group sessions generally are limited to set times, but need not be strictly limited. The instructor usually takes a very active role when leading the discussion.
Even though psychoeducational groups have a format different from that of many of the other types of groups, they nevertheless should meet in a quiet and private place and take into the same structural issues for instance, seating arrangements that matter in other groups.
As with any type of group, accommodations may need to be made for certain populations. Clients with cognitive disabilities, for example, may need special considerations. Leadership skills and styles. Leaders in psychoeducational groups primarily assume the roles of educator and facilitator. Still, they need to have the same core characteristics as other group therapy leaders: caring, warmth, genuineness, and positive regard for others.
Leaders also should possess knowledge and skills in three primary areas. First, they should understand basic group process—how people interact within a group. Second, leaders should understand interpersonal relationship dynamics, including how people relate to one another in group settings, how one individual can influence the behavior of others in group and some basic understanding of how to handle problematic behaviors in group such as being withdrawn.
Finally, psychoeducational group leaders need to have basic teaching skills. Such skills include organizing the content to be taught, planning for participant involvement in the learning process, and delivering information in a culturally relevant and meaningful way. To help clients get the most out of psychoeducational sessions, leaders need basic counseling skills such as active listening, clarifying, supporting, reflecting, attending and a few advanced ones such as confronting and terminating Brown It also helps to have leadership skills, such as helping the group get started in a session, managing though not necessarily eliminating conflict between group members, encouraging withdrawn group members to be more active, and making sure that all group members have a chance to participate.
As the group unfolds, it is important that group leaders are nondogmatic in their dealings with group members. Finally, the group leader should have a firm grasp of material being communicated in the psychoeducational group. The group leader will need to understand group member roles and how to manage problem clients. Leaders will use a variety of resources to impart knowledge to the group, so each session also requires preparation and familiarization with the content to be delivered.
Group leaders should have ongoing training and formal supervision. Supervision benefits all group leaders of all levels of skill and training, as it helps to assure them that people in positions of authority are interested in their development and in their work.
If direct supervision is not possible as may be the case in remote, rural areasthen Internet discussions or regular telephone contact should Pure co ed looking to lose it all used. Techniques to conduct psychoeducational groups are concerned with 1 how information is presented, and 2 how to assist clients to incorporate learning so that it le to productive behavior, improved thinking, and emotional change.
Adults in the midst of crises in their lives are much more likely to learn through interaction and active exploration than they are through passive listening. As a result, it is the responsibility of the group leader to de learning experiences that actively engage the participants in the learning process. Four elements of active learning can help. First, the leader should foster an environment that supports active participation in the group and discourages passive note taking. Accordingly, leader lecturing should be limited in duration and extent.
The leader should concentrate instead on facilitating group discussion, especially among clients who are withdrawn and have little to say. They need support and understanding of the content before expressing their views. Techniques such as role playing, group problemsolving exercises, and structured experiences all foster active learning. Second, the leader should encourage group participants to take responsibility for their learning rather than passing on that responsibility to the group leader. Most people, at one time or another, have had unpleasant experiences in traditional, formal classroom environments.
Therefore it is critically important for the group leader to be sensitive to the anxiety that can be aroused if the client is placed in an environment that replicates a disturbing scene from the past. Overall, leaders should create an environment where participants who are having difficulty with the psychoeducational group process can express their concerns and receive support. Fourth, people with alcoholism and other addictive disorders are known to have subtle, neuropsychological impairments in the early stage of abstinence. Verbal skills learned long ago that is, crystallized intelligence are not affected, but fluid intelligence, needed to learn some kinds of new information, is impaired.
As a result, clients may seem more able to learn than they actually are. Therapists who are teaching new skills should be mindful of this difficulty. Most skills development groups operate from a cognitive—behavioral orientation, although counselors and therapists from a variety of orientations apply skills development techniques in their practice.
Many skills development groups incorporate psychoeducational elements into the group process, though skills development may remain the primary goal of the group. Coping skills training groups the most common type of skills development group attempt to cultivate the skills people need to achieve and maintain abstinence.
Skills development groups typically emerge from a cognitive—behavioral theoretical approach that assumes that people with substance use disorders lack needed life skills. Clients who rely on substances of abuse as a method of coping with the world may never have learned important skills that others have, or they may have lost these abilities as the result of their substance abuse. Thus, the capacity to build new skills or relearn old ones is essential for recovery.
Since many of the skills that people with substance abuse problems need to develop are interpersonal in nature, group therapy becomes a natural treatment of choice for skills development. Members can practice with each other, see how different people use the same skills, and feel the positive reinforcement of a peer group rather than that of a single professional when they use skills effectively. Because of the degree of individual variation in client needs, the particular skills taught to a client should depend on an assessment that takes into individual characteristics, abilities, and background.
The suitability of a client for a skills development group will depend on the unique needs of the individual along with the skills being taught. Most clients can benefit from developing or enhancing certain general skills, such as controlling powerful emotions or improving refusal skills when around people using alcohol or illicit drugs. Skills might also be highly specific to certain clients, such as relaxation training. Skills development groups usually run for a limited of sessions.
The size of the group needs to be limited, with an ideal range of 8 to 10 participants perhaps more, if a cofacilitator is present. The group has to be small enough for members to practice the skills being taught. While skills development groups often incorporate elements of psychoeducation and support, the primary goal is on building or strengthening behavioral or cognitive resources to cope better in the environment.
Psychoeducational groups tend to focus on developing an information base on which decisions can be made and action taken. Support groups, to be discussed later in this chapter, focus on providing the internal and environmental supports to sustain change.
All are appropriate in substance abuse treatment. While a specific group may incorporate elements of two or more of these models, it is important to maintain focus on the overall goal of the group and link methodology to that goal. In skills development groups, as in psychoeducation, leaders need basic group therapy knowledge and skills, such as understanding the ways that groups grow and evolve, knowledge of the patterns that show how people relate to one another in group, skills in fostering interaction among members, managing conflict that inevitably arises among members in a group environment, and helping clients take ownership for the group.
In addition, group leaders should know and be able to demonstrate the set of skills that the participants are trying to develop. Leaders also will need ificant experience in modeling behavior and helping others learn discrete elements of behavior. Other general skills, such as sensitivity to what is going on in the room and cultural sensitivity to differences in the ways people approach issues like anger or assertiveness, also will be important.
Depending on the skill being taught, there may be certain educational or certification requirements. For example, a nurse might be needed to teach specific health maintenance skills, or a trained facilitator may be needed to run certain meditation or relaxation groups.
The specific techniques used in a skills development group will vary greatly depending on the skills being taught. The process of learning and incorporating new skills, however, may be difficult, especially if the approach has been used for a long time. For instance, individuals who have been passive and nonassertive throughout life may have to struggle mightily to learn to stand up for themselves. As a consequence, it is crucial for leaders of skills development groups to be sensitive to the struggles of group participants, hold positive expectations for change, and not demean or shame individuals who seem overwhelmed by the task.
Furthermore, many behavioral changes that seem straightforward on the surface have powerful effects at deeper levels of psychological functioning. For instance, assertiveness may touch feelings of shame and unworthiness.Pure co ed looking to lose it all
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