section 31: conducting successful group therapy

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

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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)

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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)

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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)

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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

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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

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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


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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

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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


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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


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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

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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


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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


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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


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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

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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)

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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

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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

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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

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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

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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

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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


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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


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Thank youThank you

Questions?Questions?

[email protected]

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section 31: conducting successful group therapy

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