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Section 31: Section 31: Conducting Successful Group Conducting Successful Group
TherapyTherapy
Albert L. Hasson, M.S.W.Albert L. Hasson, M.S.W.
University of California, Los AngelesUniversity of California, Los Angeles
Integrated Substance Abuse ProgramsIntegrated Substance Abuse Programs
11
OverviewOverview
Advantages of group therapyAdvantages of group therapy Basic therapist tasksBasic therapist tasks Creating a healthy group atmosphereCreating a healthy group atmosphere Group structureGroup structure
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Why Group Therapy?Why Group Therapy?
Humans are socialHumans are social Positive peer supportPositive peer support Develop social skillsDevelop social skills Opportunity to educateOpportunity to educate Positive feedbackPositive feedback Provides structureProvides structure Reduces isolationReduces isolation
Observe recoveryObserve recovery Offer family-like supportOffer family-like support Cost effectiveCost effective Instill a sense of hopeInstill a sense of hope Provide encouragementProvide encouragement Shared experienceShared experience Learn coping skillsLearn coping skills
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Therapeutic FactorTherapeutic Factor
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Essential Therapeutic Essential Therapeutic Group ElementsGroup Elements
Installation of HopeInstallation of Hope UniversalityUniversality Imparting InformationImparting Information AltruismAltruism Corrective Recapitulation of Primary Corrective Recapitulation of Primary
FamilyFamily Development of socializing techniquesDevelopment of socializing techniques
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Advantages of Group Therapy for Advantages of Group Therapy for the Participantthe Participant
Group members realize that their Group members realize that their problems are not so uniqueproblems are not so unique
They feel more alike, and less isolated They feel more alike, and less isolated A feeling of empathy and belonging A feeling of empathy and belonging
developsdevelops (Kline, 2003)(Kline, 2003)
66
Advantages of Group Therapy for Advantages of Group Therapy for the Participantthe Participant
Feedback from multiple sourcesFeedback from multiple sources The opportunity to modify one’s working The opportunity to modify one’s working
model model To form different, and healthy relationshipsTo form different, and healthy relationships
(Pistole, 1997)(Pistole, 1997)
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Advantages ContinuedAdvantages Continued
The group represents an opportunity for The group represents an opportunity for members to practice their behavior in a members to practice their behavior in a real-life settingreal-life setting
Affording recognition of their own feelings, Affording recognition of their own feelings, how they feel and act towards others and how they feel and act towards others and how others perceive themhow others perceive them
(Yalom 1995)(Yalom 1995)
88
Group Therapy is a Force for Group Therapy is a Force for ChangeChange
Group pressure to change or improve can Group pressure to change or improve can be strongbe strong
Positive feedback should be fostered Positive feedback should be fostered which ultimately encourages growthwhich ultimately encourages growth
Reduces defensiveness and increases Reduces defensiveness and increases personal sharingpersonal sharing
(Berg, et al., 2006)(Berg, et al., 2006)
99
Limitations to Group TherapyLimitations to Group Therapy
Not everyone feels safe in a group situationNot everyone feels safe in a group situation Some people prefer a one-to-one relationship to Some people prefer a one-to-one relationship to
explore personal issuesexplore personal issues Individuals may be too hostile to benefit from the Individuals may be too hostile to benefit from the
groupgroup Verbal monopolizers, sociopaths, hostile or Verbal monopolizers, sociopaths, hostile or
extremely aggressive or self-absorbed extremely aggressive or self-absorbed individuals might be better off in an individual individuals might be better off in an individual settingsetting
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Group ModelsGroup Models
PsychoeducationalPsychoeducational Skills DevelopmentSkills Development Relapse Prevention/Cognitive Behavioral Relapse Prevention/Cognitive Behavioral
TherapyTherapy Social SupportSocial Support Interpersonal ProcessInterpersonal Process
1111
Psychoeducational (PsychEd) Psychoeducational (PsychEd) GroupsGroups
Presents structured, group specific contentPresents structured, group specific content Utilizes audio-visual mediaUtilizes audio-visual media Discussions facilitated around the materialsDiscussions facilitated around the materials Instills self-awarenessInstills self-awareness Provides options for growthProvides options for growth Identifies community resourcesIdentifies community resources Provides an understanding of recoveryProvides an understanding of recovery
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1212
PsychEd Group GoalsPsychEd Group Goals Increase patient awarenessIncrease patient awareness Increase motivationIncrease motivation Assist patients to incorporate information Assist patients to incorporate information Establish abstinenceEstablish abstinence Maintain abstinenceMaintain abstinence Promote pro-social behaviorPromote pro-social behavior
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1313
PsychEd Group CharacteristicsPsychEd Group Characteristics Provide an opportunity to teach patients and Provide an opportunity to teach patients and
their families about:their families about: Addiction, human behavior, motivation, physical, behavioral Addiction, human behavior, motivation, physical, behavioral
and psychological impact of drugs and alcoholand psychological impact of drugs and alcohol
Generally structuredGenerally structured Follow a manual or are pre-planned Follow a manual or are pre-planned
curriculumcurriculum Should actively engage participants in group Should actively engage participants in group
discussion around the subject contentdiscussion around the subject content SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1414
Skills Development GroupsSkills Development Groups Cognitive-behavioral orientedCognitive-behavioral oriented Coping mechanismsCoping mechanisms Drug refusal skillsDrug refusal skills Recognizing, avoiding and managing triggersRecognizing, avoiding and managing triggers Useful with substance abusers who typically lack Useful with substance abusers who typically lack
life skillslife skills Provides an environment to practice Provides an environment to practice
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1515
Skills Development Group Skills Development Group CharacteristicsCharacteristics
Primary goal to build or strengthen Primary goal to build or strengthen behavioral and cognitive resourcesbehavioral and cognitive resources Controlling emotionsControlling emotions Improving refusal skillsImproving refusal skills Relaxation TrainingRelaxation Training
Specific number of sessionsSpecific number of sessions Limited to 8-10 participantsLimited to 8-10 participants
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1616
Cognitive-Behavioral/Relapse Cognitive-Behavioral/Relapse Prevention (CBT/RP) GroupsPrevention (CBT/RP) Groups
Well accepted in substance abuse treatmentWell accepted in substance abuse treatment Promotes cognitive restructuringPromotes cognitive restructuring Presents dependency as a learned behaviorPresents dependency as a learned behavior Changes behavior by altering thinking patterns, Changes behavior by altering thinking patterns,
beliefs and perceptionsbeliefs and perceptions Facilitates the development of social networks to Facilitates the development of social networks to
support abstinencesupport abstinence SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1717
CBT/RP CharacteristicsCBT/RP Characteristics Provides structureProvides structure Promotes an examine of behaviors, Promotes an examine of behaviors,
thoughts and beliefs that lead to thoughts and beliefs that lead to maladaptive behaviormaladaptive behavior
Goal orientedGoal oriented Often manual drivenOften manual driven Focuses on immediate problemsFocuses on immediate problems
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1818
Relapse Prevention (RP)GroupsRelapse Prevention (RP)Groups
Focus on maintaining abstinence or Focus on maintaining abstinence or minimize relapseminimize relapse
Helpful for people in crisisHelpful for people in crisis Anticipate, identify and manage high-risk Anticipate, identify and manage high-risk
situationssituations Work towards a life balanceWork towards a life balance Process of habit changeProcess of habit change
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
1919
RP Group CharacteristicsRP Group Characteristics
Focus on activities, problem solving and Focus on activities, problem solving and skills buildingskills building
Often derived from principals of cognitive Often derived from principals of cognitive therapytherapy
A form of skills developmentA form of skills development Work to increase a sense of self-controlWork to increase a sense of self-control Effective in group or individual formatEffective in group or individual format
SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
2020
CBT/RP Group StructureCBT/RP Group Structure Brief individual check-inBrief individual check-in Review of topic handoutReview of topic handout Present any potential future problemPresent any potential future problem Schedule timeSchedule time Pledge to keep group contents confidential Pledge to keep group contents confidential
and to not drink alcohol or use drugs until and to not drink alcohol or use drugs until next visitnext visit
2121
The Group FormatThe Group Format
Location and time should be consistentLocation and time should be consistent Important to begin and end on timeImportant to begin and end on time Open or ClosedOpen or Closed Length of group (60-90 minutes) Length of group (60-90 minutes)
depending on type of group and number of depending on type of group and number of membersmembers
Number of group members (ideally 8-10)Number of group members (ideally 8-10)
2222
Elements of Group FacilitationElements of Group Facilitation
Group members do best when they are involvedGroup members do best when they are involved Group leaders should encourage members to Group leaders should encourage members to
participateparticipate
Ask open ended questions personally directed to Ask open ended questions personally directed to specific individuals within the groupspecific individuals within the group Interest should be shown to each member with equal Interest should be shown to each member with equal
considerationconsideration
Create environment conducive for interactionCreate environment conducive for interaction
2323
Facilitator SkillsFacilitator Skills
Need to understand skills developmentNeed to understand skills development Specialized training in Relapse PreventionSpecialized training in Relapse Prevention Familiar with group process issuesFamiliar with group process issues Monitor patients for signs of potential relapseMonitor patients for signs of potential relapse Nonjudgmental, supportive, & non-punitiveNonjudgmental, supportive, & non-punitive Manage abstinence violation effect and Manage abstinence violation effect and
minimize the impact of a single lapseminimize the impact of a single lapse Understand the impact of a potential relapseUnderstand the impact of a potential relapse
2424
Facilitator SkillsFacilitator Skills
Focuses on changing cognition (beliefs, Focuses on changing cognition (beliefs, judgments and perceptions)judgments and perceptions)
Fosters the develop of problem-solving Fosters the develop of problem-solving skillsskills
Knowledgeable in cognitive-behavioral Knowledgeable in cognitive-behavioral therapy theorytherapy theory
Should be active/directive Should be active/directive Best to be non-confrontational Best to be non-confrontational
2525
Group Facilitator CharacteristicsGroup Facilitator Characteristics
Self-confidentSelf-confident Risk takingRisk taking Sense of humorSense of humor FlexibleFlexible CreativeCreative Immersed in the Immersed in the
presentpresent
Free from negative Free from negative emotionsemotions
CompassionCompassion EnergeticEnergetic HonestHonest
(Kottler, 1983) (Kottler, 1983)
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Qualities of a Group Leader Qualities of a Group Leader Must work to develop a consistent, Must work to develop a consistent,
positive relationship with the patientpositive relationship with the patient Show concern, acceptance, genuineness Show concern, acceptance, genuineness
and empathyand empathy Be an active listenerBe an active listener Observant (recognize non-verbal cues)Observant (recognize non-verbal cues) Be clear about the nature of the group Be clear about the nature of the group
rulesrules Yalom, 2005Yalom, 2005
2727
Leadership ResponsibilityLeadership Responsibility
Creating and convening the group (set Creating and convening the group (set time and location)time and location)
Choosing group membersChoosing group members Facilitator/Leader is the unifying forceFacilitator/Leader is the unifying force Recognize and deter any threats to group Recognize and deter any threats to group
cohesiveness (tardiness, absences, sub-cohesiveness (tardiness, absences, sub-grouping, extra group socialization, etc.)grouping, extra group socialization, etc.)
Yalom, 2005Yalom, 2005
2828
Group NormsGroup Norms
Promote active involvement of group membersPromote active involvement of group members Encourage non-judgmental acceptance of othersEncourage non-judgmental acceptance of others Self disclosureSelf disclosure Desire for changeDesire for change Can be implicit or explicitCan be implicit or explicit Often change or adaptOften change or adapt Are always shaped by the group leaderAre always shaped by the group leader
Yalom, 2005Yalom, 2005
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Aspects of a Healthy GroupAspects of a Healthy Group
Assumes responsibility for its own functioningAssumes responsibility for its own functioning Can determine when it is working effectively Can determine when it is working effectively
or wasting timeor wasting time Promotes safe, self-disclosure of intimate Promotes safe, self-disclosure of intimate
parts of themselvesparts of themselves Is considered to be important to the group Is considered to be important to the group
membersmembers Allows for continuity from one meeting to Allows for continuity from one meeting to
anotheranother Engages all group membersEngages all group members
Yalom, 2005Yalom, 2005
3030