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Group Psychotherapy & Treatment of Addiction (Overview)

Overview on the uses and benefits of grouptherapy in relation with addiction treatment..
By: Dr. Raghda Elgamil - specialist of psychiatry & Head of Developed Unit

 Historical overview

The founders of group psychotherapy in the USA were Joseph H. Pratt, Trigant Burrow and Paul Schilder.

After World War II group psychotherapy was further developed by Jacob L. Moreno, Samuel Slavson, Hyman Spotnitz, Irvin Yalom, and Lou Ormont.

Yalom's approach to group therapy has been very influential not only in the USA but across the world, through his classic text "The Theory and Practice of Group Psychotherapy".

Moreno developed a specific and highly structured

 form of group therapy known as Psychodrama.

What’s group psychotherapy?

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group.

Group therapy, focuses on the group of clients and attempting to benefit from sharing their experiences. 

In group therapy; both patient - patient interactions and patient - therapist interactions are used to effect changes in maladaptive behavior in each group member. 

Counseling is usually led by a therapist, but it is encouraged in a group counseling session that all members of the group contribute in some way.

Therapeutic Principles in Group Counseling

Irvin Yalom was partially responsible for the continued development of group counseling after WWII.  He came up with 12 therapeutic principles that describe the different factors of counseling that can positively affect the clients. 

Yalom (1995) defined therapeutic factors as "the actual mechanisms of effecting change in the patient“.

 Yalom identified 12 factors that influence the processes of change and recovery among group therapy clients.

Ø  Therapeutic Principles in Group Counseling

      Altruism - helping and supporting others

      Cohesion - feeling of belonging to the group, valuing the group

      Universality - feeling of having problems similar to others, not alone

      Interpersonal learning - learning new ways to talk about feelings, observations and concerns

      Guidance - nurturing support & assistance

      Catharsis – release of emotional tension

      Identification– modeling another’s manners & recovery skills

      Corrective recapitulation of family of origin issues – identifying & changing the dysfunctional patterns or roles one played in primary family

      Self understanding- teaching about problem and recovery

      Instillation of hope - encouragement that  recovery is possible

      Imparting informations : finding out about themselves & others from the group

      Existential factors – life & death are realities

   

Uses of group psychotherapy in addiction treatment

Group therapies are used widely in the treatment of substance use disorders in short term residential rehabilitation, long term therapeutic community, partial hospital, intensive outpatient, drug free outpatient, and after care programs.

 

General features & goals of group therapy in addiction

 

Structural organization of group therapies

      Size:

3-15, Optimal size:8-10 members.

      Frequency & Duration:

Until the mid-1960s, the length of a group therapy session seemed fixed: 80- to 90-minute session were part of the entrenched wisdom of the field.

consensus among therapists that after about 2 hours, the session reached a point of diminishing returns: the group becomes weary, repetitious & inefficient.

 

      Groups that meet less than once weekly generally have considerable difficulty maintaining an interactional focus.

 If a great deal has occurred between meetings in the lives of the members, such groups have a tendency to focus on life events and crisis intervention.

The number of sessions in group therapy depends on the makeup, goals, and setting of the group.

 

 

      Supportive group therapy:

    (Once a week up to 6 months)

      Analytically-oriented group therapy:

    (1-3 times a week for 1-3 years)

      Psychoanalysis of groups:

    (1-5 times a week for 1-3 years)

      Transactional group therapy:

    (1-3 times a week for 1-3 years)

      Behavioral group therapy:

    (1-3 times a week up to 6 months)

Types of group therapy used in treatment of addiction

Milieu groups

         Offered in a residential program, usually involve a group meeting to start or end the day

         A community group may review the upcoming day schedule, discuss issues, ask each patient to state a goal of the day, and have patients listen to and reflect on the reading of the day.

 

 

Psycho-educational

         Provide information about specific topics related to addiction and recovery

         Help patients to learn how to cope with challenges of recovery

         Use a combination of lectures, discussions, educational videos, and behavioral rehearsals

         Completion of written assignments such as, a recovery workbook, or a personal journal

 

 

 

Skill groups

         Aimed at helping patients develop and/or improve their intra personal and interpersonal skills

         Example: problem solving methods, stress management, and skills for relapse prevention strategies.

 

Therapy or counseling

         These groups are unstructured, and give the participants an opportunity to create their own agenda.

 

Counselor training and supervision

To provide effective group treatment, it is necessary for the therapist to be familiar with and skillful in addiction treatment and group therapy.

Knowledge base required for providing competent addiction treatment involves the following:

ü  Knowledge of the effects of various drugs of abuse as well as medical, psychological, social, family and

    spiritual consequences of addiction.

ü  Understanding of the process of recovery and relapse.

ü  Tools or strategies required for the recovering persons to manage the recovery process.

ü  The therapists should be familiar with the twelve steps self help approaches (NA, AA).

ü  Counselor should have an understanding of counseling theory and experience for individual counseling.

ü  The group leader should be able to respond to both individual or group dynamics or group processes simultaneously.

ü  Counselor should be familiar with stages of group     (e.g. beginning, middle, work stage, closing)

ü  Group leader should be familiar with the kinds of interventions she/he would more often use, and how to deal with problem situations that commonly occurs in the group sessions.

ü  Basic intervention skills include; active listening, clarification, questioning, summarization, encouraging and supporting, modeling, eliciting feedback, and addressing problems that commonly arise.

ü  The therapist effectiveness is a complicated mix of knowledge, experience, skills, talent, commitment and dedication.

ü  The leader can never close the gap between himself and the group. If he does, he is no longer what he must be. He must walk a tightrope between the consent he must win and the control he must exert.