From the Executive Summary
With the recognition of addiction as a major health problem in this
country, demand has increased for effective treatments of substance
use disorders. Because of its effectiveness and economy of scale, group
therapy has gained popularity, and the group approach has come to be
regarded as a source of powerful curative forces that are not always
experienced by the client in individual therapy. One reason groups work
so well is that they engage therapeutic forces—like affiliation, support,
and peer confrontation—and these properties enable clients to bond
with a culture of recovery. Another advantage of group modalities is
their effectiveness in treating problems that accompany addiction, such
as depression, isolation, and shame.
Groups can support individual members in times of pain and trouble,
and they can help people grow in ways that are healthy and creative.
Formal therapy groups can be a compelling source of persuasion,
stabilization, and support. In the hands of a skilled, well-trained group
leader, the potential healing powers inherent in a group can be harnessed
and directed to foster healthy attachments, provide positive peer
reinforcement, act as a forum for self-expression, and teach new social
skills. In short, group therapy can provide a wide range of therapeutic
services, comparable in efficacy to those delivered in individual therapy.
Group therapy and addiction treatment are natural allies. One reason is
that people who abuse substances are often more likely to stay sober and
committed to abstinence when treatment is provided in groups, apparently
because of rewarding and therapeutic benefits like affiliation, confrontation,
support, gratification, and identification. This capacity of
group therapy to bond patients to treatment is an important asset
because the greater the amount, quality, and duration of treatment, the
better the client's prognosis (Leshner 1997; Project MATCH Research
Group 1997).
The primary audience for this TIP is substance abuse treatment counselors;
however, the TIP should be of interest to anyone who wants
to learn more about group therapy. The intent of the TIP is to assist
counselors in enhancing their therapeutic skills in regard to leading groups.
The consensus panel for this TIP drew on its considerable experience in the group therapy field. The panel was composed of representatives from all of the disciplines involved in group therapy and substance abuse treatment,
including alcohol and drug counselors, group therapists, mental health providers, and State government representatives.
This TIP comprises seven chapters. Chapter 1 defines therapeutic groups as those with trained leaders and a primary intent to help people recover from substance abuse. It also explains why groups work so well for treating substance abuse.
Chapter 2 describes the purpose, main characteristics, leadership, and techniques of five group therapy models, three specialty groups, and groups that focus on solving a single problem.
Chapter 3 discusses the many considerations that should be weighed before placing a client in a particular group, especially keying the group to the client's stage of change and stage of recovery. This chapter also concentrates on issues that arise from client diversity.
Chapter 4 compares fixed and revolving types of therapy groups and recommends ways to prepare clients for participation: pregroup interviews, retention measures, and most important, group agreements that specify clients' expectations of each other, the leader, and the group. Chapter 4 also specifies the tasks that need to be accomplished in the early, middle, and late phases of group development.
Chapter 5 turns to the stages of treatment. In the early, middle, and late stages of treatment, clients' conditions will differ, requiring different therapeutic strategies and approaches to leadership.
Chapter 6 is the how-to segment of this TIP. It explains the characteristics, duties, and concepts important to promote effective group leadership in treating substance abuse, including how confidentiality regulations for alcohol and drug treatment apply to group therapy.
Chapter 7 highlights training opportunities available to substance abuse treatment professionals. The chapter also recommends the supervisory group as an added measure that improves group leadership and gives counselors in the group insights about how clients may experience groups.
Throughout this TIP, the term "substance abuse" has been used to refer to both substance abuse and substance dependence. This term was chosen partly because substance abuse treatment professionals commonly use the term "substance abuse" to describe any excessive use of addictive substances. In this TIP, the term refers to the use of alcohol as well as other substances of
abuse. Readers should attend to the context in which the term occurs in order to determine what possible range of meanings it covers; in most cases, however, the term will refer to all varieties of substance use disorders described by DSM-IV. The sections that follow summarize the content in this TIP and are grouped by chapter.
Because human beings by nature are social beings, group therapy is a powerful therapeutic tool that is effective in treating substance abuse. The therapeutic groups described in this TIP are those groups that have trained leaders and a specific intent to treat substance abuse. This definition excludes self-help groups like Alcoholics Anonymous and Narcotics Anonymous. Group therapy has advantages over other modalities. These include positive peer support; a reduction in clients' sense of isolation; real-life examples of people in recovery; help from peers in coping with substance abuse and other life problems; information and feedback from peers; a substitute family that may be healthier than a client's family of origin; social skills training and practice; peer confrontation; a way to help many clients at one time; structure and discipline often absent in the lives of people abusing substances; and finally, the hope, support, and encouragement necessary to break free from substance abuse. |
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