Section 31: Conducting Successful Group Therapy Albert L. Hasson, M.S.W. University of California, Los Angeles Integrated Substance Abuse Programs 1

Overview  Advantages of group therapy  Basic therapist tasks  Creating a healthy group atmosphere  Group structure 2

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 3

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, 1985Bloch and Crouch,

Essential Therapeutic Group Elements  Installation of Hope  Universality  Imparting Information  Altruism  Corrective Recapitulation of Primary Family  Development of socializing techniques 5

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) 6

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) 7

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) 8

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) 9

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 10

Group Models  Psychoeducational  Skills Development  Relapse Prevention/Cognitive Behavioral Therapy  Social Support  Interpersonal Process 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

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 19

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 20

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 21

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) 22

Elements of Group Facilitation  Group members do best when they are involved Group leaders should encourage members to participate 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 Interest should be shown to each member with equal consideration  Create environment conducive for interaction 23

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 24

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 25

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) 26

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,

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,

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,

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,

Thank you  Questions?  31