Section 31:
Conducting Successful Group
Therapy
Albert L. Hasson, M.S.W.
University of California, Los Angeles
Integrated Substance Abuse Programs
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Overview
 Advantages
of group therapy
 Basic therapist tasks
 Creating a healthy group atmosphere
 Group structure
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Why Group Therapy?
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Humans are social
Positive peer support
Develop social skills
Opportunity to educate
Positive feedback
Provides structure
Reduces isolation
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Observe recovery
Offer family-like support
Cost effective
Instill a sense of hope
Provide encouragement
Shared experience
Learn coping skills
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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
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Essential Therapeutic
Group Elements
 Installation
of Hope
 Universality
 Imparting Information
 Altruism
 Corrective Recapitulation of Primary
Family
 Development of socializing techniques
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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)
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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)
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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)
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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)
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Limitations to Group Therapy
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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
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Group Models
 Psychoeducational
 Skills
Development
 Relapse Prevention/Cognitive Behavioral
Therapy
 Social Support
 Interpersonal Process
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Psychoeducational (PsychEd)
Groups
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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PsychEd Group Goals
 Increase
patient awareness
 Increase motivation
 Assist patients to incorporate information
 Establish abstinence
 Maintain abstinence
 Promote pro-social behavior
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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PsychEd Group Characteristics
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Provide an opportunity to teach patients and
their families about:
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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Skills Development Groups
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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Skills Development Group
Characteristics
 Primary
goal to build or strengthen
behavioral and cognitive resources
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Controlling emotions
Improving refusal skills
Relaxation Training
 Specific
number of sessions
 Limited to 8-10 participants
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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Cognitive-Behavioral/Relapse
Prevention (CBT/RP) Groups
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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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
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SAMSHA-Substance Abuse Treatment: Group Therapy TIP 41
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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
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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)
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Elements of Group Facilitation
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Group members do best when they are involved
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Ask open ended questions personally directed to
specific individuals within the group
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Group leaders should encourage members to
participate
Interest should be shown to each member with equal
consideration
Create environment conducive for interaction
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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
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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
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Group Facilitator Characteristics
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Self-confident
Risk taking
Sense of humor
Flexible
Creative
Immersed in the
present
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Free from negative
emotions
 Compassion
 Energetic
 Honest
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(Kottler, 1983)
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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
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Yalom, 2005
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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, subgrouping, extra group socialization, etc.)
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Yalom, 2005
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Group Norms
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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
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Yalom, 2005
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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
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Yalom, 2005
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Thank you
 Questions?
 [email protected]
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