Chapter 64– Group Therapies

 refers to milieu, psychoeducational recovery, coping skills, family, and therapy groups

Goals of group therapies

 to help the individual achieve and maintain abstinence and improve quality of life
 create a milieu in which group members can bond with each other, thus reducing the
stigma associated with addiction and the humiliation of having lost control of one’s own
behavior

Organization of Group Therapies

 4 basic leadership qualities identified by Yalom for effective group therapy: acceptance,
caring, meaning attribution and executive function
 Leaders facilitate exploration of problems and sharing support & feedback
 Most incorporate principles of 12-steps

Types of groups
Milieu groups
 Offered in residential and hospital programs and involve a meeting to start or end the day
 A morning group reviews the day’s schedule and issues pertinent to the community of
patients and asks each patient to state a goal for the day or reflect on a recovery or
inspirational reading. An evening wrap-up group reviews the day’s activities and provides
participants a chance to discuss their experiences and what they learned.

Psychoeducational recovery group

 provide information about SUD and recovery and help patients learn to cope with recovery
challenges such as cravings, social pressure to use, boredom, anger, other negative
emotions, sober relationships, and assessing the impact of SUDs on the family. These
groups promote recovery from physical, mental, relationship, and spiritual perspectives.

Coping skills
 These help patients develop or improve intrapersonal and interpersonal skills. They may
teach problem-solving methods, stress management, or relapse prevention (RP) strategies.
RP groups help patients identify and manage early signs of relapse, identify and manage
high-risk factors, or learn how to intervene early with a lapse or relapse.

Counselling groups
 In these groups, participants identify problems, conflicts, or struggles to work on during the
session. Any of the issues in Table 64-1 may be discussed. These issues focus on raising self-
awareness more than on education or skill development although participants learn many
things and are exposed to coping strategies that others use to cope with problems.
Specialized groups
 May be based on:
o Developmental age – adolescents, older adults
o Clinical populations – women, criminal justice involvement, co-occurring psychiatric
illness
o Professionals – pilots, healthcare professionals

Format
 Last 60-90 minutes
 May be limited number of sessions or open-ended
 Size and frequency vary
 Educational presentations – SUD, treatment recovery, family issues, HIV, psychiatric issues
etc.
 Brief stories
 Guest presenters with expertise in specific areas – psychiatrist, psychologist, nurse, social
worker, spiritual leaders
 Workbooks, journals, worksheets, videos
 Readings- the “Big Book”
 Behavioral assignments, role plays, arts
 Can last several days to a year

Group Process Issues

 Keeping the group focused and productive
 Facilitate quite members in discussion and self-disclosure
 Redirect members who are more dominating/talk too much
 Balance between discussing problems and solutions/coping strategies

Family Psychoeducational Workshops

 aim to educate the family, provide support, help reduce the family’s burden, increase
helpful behaviors, decrease unhelpful behaviors, and provide hope

Empirical validation of group therapies

 controlled trials are few and limited
 Weiss et al. reviewed 24 prospective treatment outcome studies comparing group therapy
with one or more treatment conditions.
o findings showed three important patterns
 additional specialized group therapy can enhance the effectiveness of
“treatment as usual”
  no differences were found between group and individual modalities
 no single type of group therapy demonstrated any consistent superiority in
efficacy.
 Several effective group treatments have been developed and implemented for women with
SUDs, many of whom also had mood, anxiety, or other psychiatric issues
o RCT of a Women’s Recovery Group (WRG) demonstrated significant reductions of
alcohol and drug use and improvements in anxiety, depression, and general mental
health symptoms at 6 and 9 month post treatment
o Compared to a mixed-gender control group treatment condition, women in the
WRG endorsed feeling safe, embracing all aspects of the self, having their needs
met, and feeling intimacy, empathy, and honesty in group sessions
o sessions focused on issues common in other group therapies for SUDs and also on
issues specific to women and their recovery such as caretaking, substance use
through the lifecycle, substance use and reproductive health, women and their
partners including violence and abuse, and psychiatric issues such as anxiety,
depression, or eating disorders.

Common issues for pts

 Challenged are adherence to session attendance and early termination
 Most commonly cited reason for early termination was time problems (42%)
o Relapse to use 30%
o Not helpful 30%
o Wanting a different treatment such as individual therapy 30%

Counselor training
 Most have a bachelor’s or master’s degree
 Knowledge of the medical, psychological, social, family, and spiritual consequences of SUDs
 Familiar with 12-steps
 Be familiar with individual counseling as well as group process

Limitations of group therapy

 little or no individual treatment
o Patients often reported that there were certain types of problems or issues that they
would not discuss in group sessions and that they preferred the privacy and
confidentiality afforded by an individual counseling or therapy session – child or
sexual abuse, victim or perpetrator of violence, deviant behaviours, psychiatric
symptoms, sexual identity issues etc.

The need for physician input and support

 suggest topics for groups
 can run a group
 Present topics of expertise
 Educate an encourage patients to participate in group treatments
 Monitor and discuss group participation, identify and resolve barriers
 Collaborate with group treatments for individual pts