Discussion 1: Social and Community Support “Groups offer a number of advantages over individual or other counseling methods including creating a sense of universality or the understanding that clients are not alone in their struggles” (Yalom & Lesczc, 2005). The use of group treatment in treatment recovery centers is often the primary mode of treatment and offers a number of advantages. Clients undergoing individual treatment may not receive the necessary support or feedback from individuals who have gone through similar situations who might help in the recovery process (Cuizon, 2009). Building a support network of professionals, peers, and family members is fundamental when building a solid relapse prevention plan. Creating a support network and maintaining it may provide the best long-term results. Prevention programs are most often conducted in a group setting when clients are developing effective strategies for recovery (Weiss, Jaffee, de Menil, & Cogley, 2004). Addiction is also a disease of isolation, so group support has a fundamental function of making the addiction public and requiring people with problems with addiction to become more accountable for choices that they make in persisting with destructive and addictive behaviors. For this Discussion, review this week’s resources. Consider the role that groups and communities might play in addiction recovery and possible ways in which societal interactions might help an individual in recovery maintain sobriety. In addition, think about your own views concerning society’s obligations toward individuals suffering from addiction. Due 01/21/2019 (Please be detailed in response, Use 3 APA references, Use sub-headings in response) Post your position on whether society has an obligation to help individuals with addiction. Explain why and how. Then explain three ways that community support or a group approach may assist in the recovery of clients with problems with addiction. Support your response using the resources and current literature. *********************************************************************************** Discussion 2: Clinical Supervision Clinical supervision is not only needed in the early stages of a career, but is often beneficial if used throughout a career. It is important to understand that clinical supervision is a healthy aspect of clinical work and not an indication of lack of knowledge. No matter how good an addiction professional you are, it is important to consult and connect with other professionals about cases. For this Discussion, read this week’s resources and explore benefits of clinical supervision in addiction treatment and consider how supervision might change over a counselor’s career. Due 01/21/2019 (Please be detailed in response, Use 3 APA references, Use sub-headings in response) Post a description of two benefits of receiving clinical supervision throughout your career as an addiction professional. Then explain how that supervision might change over the addiction professional’s career. Support your response using the resources and the current literature. References Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). New York, NY: Pearson Education, Inc. Chapter 10, “Group Therapy for Treatment of Addictions” (pp. 217-239) Chapter 12, “12-Step Facilitation of Treatment” (pp. 263-284) Bogo, M., Paterson, J., Tufford, L., & King, R. (2011). Interprofessional clinical supervision in mental health and addiction: Toward identifying common elements. The Clinical Supervisor, 30(1), 124–140. Laschober, T. C., de Tormes Eby, L., & Sauer, J. B. (2013). Effective clinical supervision in substance use disorder treatment programs and counselor job performance. Journal of Mental Health Counseling, 35(1), 76–94. Monroe Whitley, C. E. (2010). Social work clinical supervision in the addictions: Importance of understanding professional cultures. Journal of Social Work Practice In The Addictions, 10(4), 343–362.
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Chapter 10 Group Therapy for Treatment of Addictions
Laura R. Haddock
Walden University
Donna S. Sheperis
Lamar University
One very common treatment modality for substance use disorders is group counseling. Within the last
decade, studies have indicated approximately 94% of treatment facilities within the United States
utilize group counseling for treatment of substance abuse (Weiss, Jaffee, de Menil, & Cogley, 2004
2004), and
it has replaced individual counseling as the treatment approach of choice (Johnson, 2004
2004; Ruis &
Strain, 2011
2011). In addition to the low cost of group counseling, the popularity of this approach has
evolved from peer-based self-help groups such as Alcoholics Anonymous (AA) and Narcotics
Anonymous (NA) to include psychoeducational and psychotherapeutic approaches (Behavioral Health
Treatment, 1997
1997; Center for Substance Abuse Treatment, 2005a
2005a).
Groups have a number of important functions in substance abuse treatment, including education,
therapy, and support. This chapter will address the theory behind utilizing a group counseling
approach as well as examine common types of groups employed for treatment of addictions.
Additionally, ethical and legal issues, managing diversity in group settings, and group therapy with
family members will be discussed.
THEORY BEHIND GROUP WORK
The research supporting the use of group work in the treatment of a variety of concerns is well
established. Essentially, group counseling is an interpersonal treatment approach that emphasizes an
expression of thoughts and feelings geared toward insight and behavioral change. Yalom and Lesczc
(2005
2005) proposed that groups offer a number of advantages over individual or other counseling
methods including creating a sense of universality or the understanding that clients are not alone in
their struggles. The empathy and support provided through group work creates the necessary
atmosphere for the counseling process. Participants can explore relationship styles, try on new
behaviors, and participate in rehearsal for change using the medium of the group (Corey, 2011
2011).
Ideally, through interpersonal learning and group cohesiveness, members develop a greater
understanding of themselves and can capitalize on this insight by making necessary changes in the
way they live their lives (Yalom & Lesczc, 2005
2005).
Group counseling can be used for many purposes, both preventative and remedial in nature (Corey,
2011).
2011
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Preventative groups are those that members participate in to avoid using substances. They
take place in schools, agencies, and communities. Remedial groups address unhealthy behaviors that
currently exist and have resulted in negative consequences for the client. In addictions counseling,
aftercare groups that offer treatment in an outpatient setting following an inpatient treatment stay
would be considered remedial.
The content of the group may be preset or determined by the membership (Corey, 2011
2011). Advantages of
group counseling include using a collective mind-set to gain perspective on an individual counseling
issue. Concepts related to interpersonal skills and trust are inherently worked through in a group
environment. However, group counseling is not for everyone. The dynamics and interpersonal risks
involved may prove to be too overwhelming for some clients, and some counseling issues are not best
treated through the group process.
GROUP TREATMENT OF ADDICTION
When treating addiction, there are specific dynamics that make group counseling the approach of
choice. Although the design of a group may vary, there are certain benefits that contribute to the
behavior change process. While many evidence-based interventions are individualized, addictions
counselors disproportionately conduct treatment clients in groups (Sanders & Mayeda, 2009
2009).
The influence of group members who have similar experiences is helpful in breaking down the denial
frequently associated with addiction (Sadler, 2003
2003; Washton & Zweben, 2008
2008). Because individuals who
participate in long-term substance abuse typically exhibit poor communication skills and the inability
to perpetuate healthy interpersonal relationships, group therapy affords an opportunity to interact
with others, promoting effective social skills and self-disclosure; explore new behaviors in a safe
environment; and emotionally invest in others and in education about addiction (Campbell & Page,
1993; Johnson, 2004
1993
2004).
Joan has been a problem drinker for a number of years. She and her husband, Michael,
have experienced a decline in their relationship over the last 5 years. Michael says he cannot talk to
Joan, that she shuts him out, and that all she does is blame him for their troubles. How might group
treatment for Joan’s alcohol abuse facilitate a different style of communication in her marriage? Is
Joan’s behavior in group related to how she interacts with her husband, or are these unrelated
concepts? What impact might feedback from other group members have on Joan? Is it possible she
might be able to hear the observations of other group members or a group facilitator in spite of the
fact that she rejects her husband’s observations or perceptions about her relating style?
Group therapy also offers an opportunity for positive interpersonal exchange to replace isolated selfinvolvement. Group members presented with an opportunity to identify and relay needs and emotions
may result in their identifying and confronting maladaptive patterns of behavior (Weiss et al., 2004
2004).
According to Campbell and Page (1993
1993), “Any effective therapeutic intervention must target not only
drug use, but also a means by which meaningful communication can occur” (p. 34). Additionally, many
individuals with addictions have blind spots for their own defenses but not necessarily those of others.
Thus, the members may assist one another in confronting defense mechanisms and blind spots,
resulting in accomplishment of treatment goals. Finally, group treatment uses peer influence and
motivation to enhance individual commitment to recovery (Johnson, 2004
2004).
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AN OVERVIEW OF TYPES OF GROUPS
The general purposes of a therapeutic group are to assist members in determining the issues they are
most interested in addressing while increasing members’ awareness and understanding of themselves
and others in their lives, and providing participants with the support needed to make these changes
(Corey, Corey, & Corey, 2013
2013). Essentially, members get an opportunity to “try on” new behaviors in a
setting that is safe and receive honest feedback from others concerning these behaviors. Often it is the
first time individuals have an opportunity to learn how others perceive them.
The Association for Specialists in Group Work (ASGW, 2000
2000) developed a four-category
system for classifying types of group work. ASGW standards identify standards of competence for the
leaders and identifies particular areas of group work, including (1) task groups, (2) psychoeducational
groups, (3) counseling groups, and (4) psychotherapy groups. As counseling groups are not aimed at
major personality changes and not concerned with the treatment of severe behavioral disorders, they
are not frequently implemented for addictions work.
Psychoeducational Groups
A variety of issues common to recovery from addiction require specific planned treatment
interventions. Because the focus of treatment combines educating members with fostering selfunderstanding through the dynamics of the group, these groups are sometimes referred to as
psychoeducational treatment groups. Psychoeducational groups are an increasingly popular and
important source of help for many clients. Perhaps their greatest asset is that they provide a planned
framework that can be replicated, modified, and/or adapted to fit different types of client groups.
In structured psychoeducational groups, it is not unusual for the agenda to be established before the
group session. Compared to less structured, process-centered approaches, structured group
approaches give the counselor greater responsibility for group goals and the way the group conducts
its work. Although in psychotherapeutic approaches members are encouraged to take informal
leadership roles and develop their own goals, agendas, and contracts, in psychoeducational groups the
members’ input is generally limited to modifying goals, agendas, and contracts the counselor has
already developed. The interventions are planned and focus on specific learning outcomes. Integrating
behavioral therapies with experiential learning is common practice. The group can aim to help
members translate what they learn into specific action.
There are a variety of time-limited, structured groups that focus on transferring information about
drugs and the consequences of use. Meetings usually contain a combination of educational material,
exercises, role-play, and simulations to help members process discussion of the material and the
problems they are experiencing outside the group.
It is not uncommon for school counselors to implement time-limited structured groups that
are preventative in nature. For example, elementary school counselors might utilize programming
that examines the reasons that children use drugs and offer alternatives to drug use. Parents may also
be included in the process through the use of homework.
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In a series of studies on the efficacy of group work, members of groups with specific purposes,
homogeneous concerns, clear agendas, and structured group meetings demonstrated greater success
with treatment outcome than members of groups with less structure (Martin, Giannandrea, Rogers, &
Johnson, 1996
1996; Toseland & Rivas, 2001
2001). Members report that they appreciate the leader providing
specific information and effective strategies to help with their concerns. Thus, in a group program for
individuals recovering from substance abuse, the leader can provide information about addiction,
communication skills, assertiveness/social skills training, and other topics deemed appropriate. Studies
have shown that even spiritual concerns can be successfully addressed within this format, allowing
participants to examine beliefs and gain increased understanding of their feelings, problems, and
questions within this domain (Phillips, Lakin, & Pargament, 2002
2002). Psychoeducational designs also
provide members with an opportunity to discuss specific concerns and learn stress reduction and
other coping techniques.
Leaders of psychoeducational groups vary depending on the topics to be covered; they may be licensed
professional counselors or paraprofessionals trained in the treatment of addictions.
Group leaders should keep in mind that members’ concerns and needs are not always served by a
time-limited, structured-group approach. A flexible structure maximizing member input has been
found to be more effective in helping members to vent their concerns and give and receive help from
fellow group members (Toseland & Rivas, 2001
2001). Group counselors should be savvy enough to
determine the goals and specific agendas that will best meet the needs of members.
There are also psychoeducational groups designed to assist in the prevention of addiction. Drug Abuse
Resistance Education (D.A.R.E.) and similar programs are based on the theory that teaching children
about the harmful effects of alcohol and drugs while helping them build self-esteem will deter the
desire to abuse chemicals later in life (Doweiko, 2010
2010). The D.A.R.E. program is typically conducted by
local law enforcement and taught within a classroom setting. There is a great deal of testimonial
support for these programs, but very little empirical evidence that they are effective in reducing
substance abuse among children or adolescents (Doweiko, 2010
2010; Gorman, 2003
2003).
Psychotherapeutic Groups
Psychotherapeutic groups are commonly utilized in addictions treatment. Because group members
have serious impairments in functioning as a result of their substance abuse, these types of groups
explore the foundation of current behaviors, seeking to build insight and replace dysfunctional coping
patterns with healthy ones.
Group psychotherapy offers a number of advantages over individual counseling. Group members can
learn from and offer feedback to each other and provide behavioral models for each other; this is
useful for clients who do not trust the counselor. The group format provides an opportunity for clients
to work on many of the interpersonal deficits that contribute to their own addiction within the safety
of the group setting.
Counselors sometimes utilize experiential activities with members. For example,
genograms, or family maps, help counselors and clients see a family more clearly. A genogram is a
visual representation of a person’s family tree, created with lines, words, and geometric figures
(Gladding, 2010
2010). For addictions treatment, the genogram may reveal patterns of addiction,
codependence, or other problem behaviors in the client’s family system.
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Finally, because of the nature of group therapy, each individual might find other members who
provide a reflection of his or her family of origin, allowing the individual to work through problems
from earlier stages of growth.
Individuals may participate in group counseling as part of an inpatient treatment regimen or as an
adjunct to individual counseling in an outpatient setting. The majority of substance abuse
rehabilitation programs use counseling groups as the primary method of working with clients
(Doweiko, 2010
2010; Weiss et al., 2004
2004). For clients receiving inpatient treatment as a result of involuntary
commitment, a common difficulty is resistance to group work. Many members begin with attitudes of
resentment, blaming others, and operating under the conviction that they do not need counseling.
Techniques and strategies must be employed to address resistance.
Individuals who experience chronic substance dependence or usage exhibit behavioral characteristics
that can interfere with the ability to develop effective communication and to sustain healthy
interpersonal relationships. As use of substances persists, social, personal, and work-related activities
are negatively affected (Campbell & Page, 1993
1993). Social and psychological problems develop or are
exacerbated by the prominence of drugs in the user’s lifestyle. Psychosocial aspects of the individual’s
life become so impaired that interpersonal interactions develop with maladaptive behavioral patterns
(American Psychiatric Association, 2013
2013). In attempting to treat these issues, a variety of methods may
be employed, including methods intended to prompt reversion to past experiences, approaches to
work with unconscious dynamics, and techniques designed to assist members in processing traumatic
circumstances so that catharsis can occur (Corey et al., 2013
2013).
While psychotherapeutic groups typically do not have specific agendas for each session, the group
counselor may choose to offer specific topic areas for a session, encouraging the participants to
explore pertinent life issues. If group topics address real-life issues of the group members, they can
generate meaningful discussion (Corey et al., 2013
2013). The topics chosen should reflect the purpose of the
group. When working with participants suffering from addiction, topics could include identifying and
dealing with family-of-origin issues, painful affective states that may contribute to the urge to use
chemicals, and shame-based issues. Additionally, grief issues are a common focus of process groups as
newly sober members attempt to cope with loss of friends, loss of coping mechanisms, and in general,
loss of a way of life.
Inpatient treatment providers frequently encounter grief issues. Group members may
struggle to say goodbye to a drug or behavior of choice, loss of power or money, or the social
relationships associated with their addiction (Bradley, Whiting, Hendricks, Parr, & Jones, 2008
2008). Group
leaders may suggest writing letters to say goodbye, designing eulogies, or even holding an actual
funeral service for the issue.
It has been posited that up to 50% of individuals receiving treatment for addiction also have cooccurring disorders (James & Gilliland, 2005
2005). Group counseling helps dually diagnosed clients develop
the insight they need to sustain recovery from chemical dependence while maintaining psychiatric
stability (Center for Substance Abuse Treatment, 2005b
2005b). The group process offers members the
opportunity to share experiences involving addiction and mental illness in an atmosphere of
acceptance and support while learning how their addictions influence their mental illness and how
their mental illness affects their addiction. The group format allows clients to challenge one another in
a climate that reinforces the reality and acceptance of both the addiction and the mental illness.
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A skilled counselor knowledgeable in both addictions and group therapy treatment is recommended to
facilitate group psychotherapy of addicted clients. The counselor should be educated about mental
illness and well versed in the jargon of self-help groups, such as AA, as clients may use self-help
language as a defense to keep them from getting into deeper issues. A skilled group counselor will be
able to balance the need to attend to substance abuse issues, while maintaining awareness about
mental illness, resistance, and behavior destructive to the group therapy process. The group counselor
must also be sensitive to the fact that not all addicted clients are compatible with group counseling.
Individuals with severe pathology may not be capable of making the affective connection necessary to
facilitate recovery (Behavioral Health Treatment, 1997
1997).
Unfortunately, there is limited evidence that group psychotherapy approaches are effective in the
treatment of substance disorders (Doweiko, 2010
2010). However, treatment approaches that incorporate a
larger proportion of group counseling to individual counseling are positively associated with increased
likelihood of treatment success (Panas, Caspi, Fournier, & McCarty, 2003
2003). Additionally, studies indicate
that substance-addicted clients participating in group counseling as part of a treatment regimen
improved significantly on depression, suicide risk, and trauma symptoms (Hunter, Witkiewitz,
Watkins, Paddock, & Hepner, 2012
2012; Sunich, 2013
2013).
Self-Help Groups
Instead of seeking help from a mental health professional, many …
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