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Section 31: Conducting Successful Group Therapy. Albert L. Hasson, M.S.W. University of California, Los Angeles Integrated Substance Abuse Programs. Overview. Advantages of group therapy Basic therapist tasks Creating a healthy group atmosphere Group structure. Why Group Therapy?.
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Section 31: Conducting Successful Group Therapy Albert L. Hasson, M.S.W. University of California, Los Angeles Integrated Substance Abuse Programs
Overview • Advantages of group therapy • Basic therapist tasks • Creating a healthy group atmosphere • Group structure
Why Group Therapy? • Humans are social • Positive peer support • Develop social skills • Opportunity to educate • Positive feedback • Provides structure • Reduces isolation • Observe recovery • Offer family-like support • Cost effective • Instill a sense of hope • Provide encouragement • Shared experience • Learn coping skills
Therapeutic Factor • “An element of group therapy that contributes to improvement in a patient’s condition and is a function of the actions of the group therapist, the other group members and the patient himself”. • Bloch and Crouch, 1985
Essential Therapeutic Group Elements • Installation of Hope • Universality • Imparting Information • Altruism • Corrective Recapitulation of Primary Family • Development of socializing techniques
Advantages of Group Therapy for the Participant • Group members realize that their problems are not so unique • They feel more alike, and less isolated • A feeling of empathy and belonging develops • (Kline, 2003)
Advantages of Group Therapy for the Participant • Feedback from multiple sources • The opportunity to modify one’s working model • To form different, and healthy relationships • (Pistole, 1997)
Advantages Continued • The group represents an opportunity for members to practice their behavior in a real-life setting • Affording recognition of their own feelings, how they feel and act towards others and how others perceive them • (Yalom 1995)
Group Therapy is a Force for Change • Group pressure to change or improve can be strong • Positive feedback should be fostered which ultimately encourages growth • Reduces defensiveness and increases personal sharing • (Berg, et al., 2006)
Limitations to Group Therapy • Not everyone feels safe in a group situation • Some people prefer a one-to-one relationship to explore personal issues • Individuals may be too hostile to benefit from the group • Verbal monopolizers, sociopaths, hostile or extremely aggressive or self-absorbed individuals might be better off in an individual setting
Group Models • Psychoeducational • Skills Development • Relapse Prevention/Cognitive Behavioral Therapy • Social Support • Interpersonal Process
Psychoeducational (PsychEd) Groups • Presents structured, group specific content • Utilizes audio-visual media • Discussions facilitated around the materials • Instills self-awareness • Provides options for growth • Identifies community resources • Provides an understanding of recovery • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
PsychEd Group Goals • Increase patient awareness • Increase motivation • Assist patients to incorporate information • Establish abstinence • Maintain abstinence • Promote pro-social behavior • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
PsychEd Group Characteristics • Provide an opportunity to teach patients and their families about: • Addiction, human behavior, motivation, physical, behavioral and psychological impact of drugs and alcohol • Generally structured • Follow a manual or are pre-planned curriculum • Should actively engage participants in group discussion around the subject content • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
Skills Development Groups • Cognitive-behavioral oriented • Coping mechanisms • Drug refusal skills • Recognizing, avoiding and managing triggers • Useful with substance abusers who typically lack life skills • Provides an environment to practice • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
Skills Development Group Characteristics • Primary goal to build or strengthen behavioral and cognitive resources • Controlling emotions • Improving refusal skills • Relaxation Training • Specific number of sessions • Limited to 8-10 participants • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
Cognitive-Behavioral/Relapse Prevention (CBT/RP) Groups • Well accepted in substance abuse treatment • Promotes cognitive restructuring • Presents dependency as a learned behavior • Changes behavior by altering thinking patterns, beliefs and perceptions • Facilitates the development of social networks to support abstinence • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
CBT/RP Characteristics • Provides structure • Promotes an examine of behaviors, thoughts and beliefs that lead to maladaptive behavior • Goal oriented • Often manual driven • Focuses on immediate problems • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
Relapse Prevention (RP)Groups • Focus on maintaining abstinence or minimize relapse • Helpful for people in crisis • Anticipate, identify and manage high-risk situations • Work towards a life balance • Process of habit change • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
RP Group Characteristics • Focus on activities, problem solving and skills building • Often derived from principals of cognitive therapy • A form of skills development • Work to increase a sense of self-control • Effective in group or individual format • SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
CBT/RP Group Structure • Brief individual check-in • Review of topic handout • Present any potential future problem • Schedule time • Pledge to keep group contents confidential and to not drink alcohol or use drugs until next visit
The Group Format • Location and time should be consistent • Important to begin and end on time • Open or Closed • Length of group (60-90 minutes) depending on type of group and number of members • Number of group members (ideally 8-10)
Elements of Group Facilitation • Group members do best when they are involved • Group leaders should encourage members to participate • Ask open ended questions personally directed to specific individuals within the group • Interest should be shown to each member with equal consideration • Create environment conducive for interaction
Facilitator Skills • Need to understand skills development • Specialized training in Relapse Prevention • Familiar with group process issues • Monitor patients for signs of potential relapse • Nonjudgmental, supportive, & non-punitive • Manage abstinence violation effect and minimize the impact of a single lapse • Understand the impact of a potential relapse
Facilitator Skills • Focuses on changing cognition (beliefs, judgments and perceptions) • Fosters the develop of problem-solving skills • Knowledgeable in cognitive-behavioral therapy theory • Should be active/directive • Best to be non-confrontational
Group Facilitator Characteristics • Self-confident • Risk taking • Sense of humor • Flexible • Creative • Immersed in the present • Free from negative emotions • Compassion • Energetic • Honest • (Kottler, 1983)
Qualities of a Group Leader • Must work to develop a consistent, positive relationship with the patient • Show concern, acceptance, genuineness and empathy • Be an active listener • Observant (recognize non-verbal cues) • Be clear about the nature of the group rules • Yalom, 2005
Leadership Responsibility • Creating and convening the group (set time and location) • Choosing group members • Facilitator/Leader is the unifying force • Recognize and deter any threats to group cohesiveness (tardiness, absences, sub-grouping, extra group socialization, etc.) • Yalom, 2005
Group Norms • Promote active involvement of group members • Encourage non-judgmental acceptance of others • Self disclosure • Desire for change • Can be implicit or explicit • Often change or adapt • Are always shaped by the group leader • Yalom, 2005
Aspects of a Healthy Group • Assumes responsibility for its own functioning • Can determine when it is working effectively or wasting time • Promotes safe, self-disclosure of intimate parts of themselves • Is considered to be important to the group members • Allows for continuity from one meeting to another • Engages all group members • Yalom, 2005
Thank you • Questions? • Alhasson@ucla.edu