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Protocol

Skoun’s Fixed Membership Group (F.M.G)

Aims…………………………………………………………p.2 Means……………………………………………………….p.3 General structure of the groups…………………………..p.4 Placement consideration…………………………………..p.9 Rules and regulations………………………………………p.12 Specific interventions……………………………………….p.15 Topics………………………………………………………...p.21 Scheduling…………………………………………………...p.22

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II-Aims:
Because human beings are by nature sociable beings, group therapy is a powerful therapeutic tool that is effective in treating substance abuse. Group therapy has advantages over other modalities these include positive peer support; reduction in clients' sense of isolation, real-life examples of people in recovery, information and feed-back from them…Through these characteristics, group therapy is a commonly used method in drug treatment to help many clients at one time build structure and skills that promote recovery. At Skoun we aim at helping our clients: • • • • Build life skills thus improving their quality of life and promoting physical and mental growth through a balanced way of life Build cohesiveness between peers and others, increasing thus the sense of belonging to the community and encouraging socialization Tackle issues not directly related to drugs and consequently restoring other areas that have been damaged by their drug using Increase their motivation to stop their drug use hence promoting recovery

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II- Means:
In order to reach these aims we use at Skoun different technique that has proven effective scientifically. Through the following means we deliver to our clients tools, which will help them, reach a satisfying life style. In our Fixed Membership Groups patients will learn: Different Coping skills: Coping skill’s training attempts to cultivate the abilities clients need to achieve and maintain abstinence (or the control of their drug use depending on their objectives). We provide at Skoun tools that are necessary to our patients to deal with the substance use disorder itself and with other issues that have been damaged by the illness.

These are: • • Early Recovery Skills which helps clients control cravings and cope with situations that would eventually lead to drug using Relapse Prevention Skills which help clients maintain abstinence or recover from relapses or solve issues that may lead to relapse Social skills which help clients deal with interpersonal situations in constructive drug free way Problem solving techniques which help client work out their issues productively Psycho-education that provides clients with learning material that helps them understand and deal with different subjects related by near or by far to substance use Processing which helps client disclose personnel issues and work them through with other group participants

• •

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Interpersonal interactions (includes peer support) that help clients reduce the sense of isolation increase the sense of security and enhance the ability to share openly their experienc

III- General structure of the group:
The groups conducted at Skoun are Fixed Membership Groups (F.M.G), they are characterize by a number of criteria that must be respected: The Skoun’s F.M.G is a: 1. Time limited group 2. Closed group 3. Predetermined topic group

1. Time limited: A fixed number of cessions will be insured (13 cessions) during a time frame of 3 months (group cycle). They will include an introductory cession and 12 topic cession pre-selected and pre-scheduled for a complete cycle. Each cession will take 1 hour and 30 minutes and will be thoroughly structured as followed: a) b) c) d) 25 minutes review of the week 10 minutes introduction and information on the topic 10 minutes break 45 minutes topic processing

a) 25 minutes review of the week: During the first 30 minutes the patients will be invited to summarize the week emphasizing on the occurrence of cravings, urges and/or relapses. In addition, the attendant will be asked to talk about the goals he had achieved during the week and/or discuss the homework on which the group has agreed the previous week. Question to pose intervention:

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The therapist will ask the following questions in order to help the client review the events of the previous week: How was your last week? What are the positives and the negatives about last week? Did you have any cravings? When, where and with whom? Did you act upon it? If yes, what were the consequences (long term and short term).What could you have done in order to prevent the relapse? If not, what did you do in order to prevent the relapse? What were the consequences (short term and long term)?

To go through the previous week’s achievements and homework the therapist will summarize the previous cession and ask the following questions: - Did you do the task assigned for this week? - If yes, did you have a positive outcome? If not, why and how can you do in order to improve the outcome? - If not, why didn’t you do the assigned task? What were the consequences? Can you schedule a day for the task to be done? And/or Did you achieve any of your goals last week? If yes what was it and how did you achieve it? What were the consequences? If not, why didn’t you attain any of your goals? How could you have done in order to reach it?

b) 10 minutes introduction and information on the topic: During this part of the cession, the therapist will introduce the topic to be discussed. He or she will emphasize on the relevance of the topic in the recovery process and will expose the relation between the topic selected and addiction.  Example: Anger management and the recovery process The therapist will first introduce the topic by defining anger and by describing its components and mechanisms. Then, he or she will explain how anger leads to using and how anger management would prevent farther escalation in drug taking.

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Example of intervention: “Anger is an emotion that can be problematic for many people. You may or you may not express anger but you probably have experience an upheaval of anger at times. When we are angry our body mobilizes for defense or attack, and our thoughts are often filled with plans for retaliation. As with all moods anger is accompanied by changes in thinking, behavior and physical functioning. How angry we become in a given situation in influenced by our interpretation of the meaning of the event. When intoxicated we have a tendency to experience aggressive outburst that leads to destructive and or assaultive acts. Angry reactions tend to be exaggerated by the chemical dissemblance due to drugs. When using drugs, what seems to be a rather frustrating event can be perceived as disapproval, rejection and/or criticism. Upon these interpretations we tend to overreact aggressively which in turn leads to using more drugs in order to overcome our anger” In order to illustrate what has just been said, the therapist gives an example of anger issues and drug using: “I will give you now, an example in order for you to understand more about the relation between addiction and drug use” (See anger management section and handouts in this manual p.X). “By learning anger management skills, we can decrease the frequency of occurrence of angry thoughts, feelings and behaviors and consequently reduce the likelihood of using drugs in order to calm ourselves” c) 10 minutes break: Before allowing the clients to take a break, the therapist must be sure that the topic and its relevance have been well understood. He or she will remind the attendants that the cession will be resumed after 10 minutes and that nobody is allowed to leave during the break. During the break the leader and the co-leader will get together in order to gather impressions and information on the progress of the group and on issues related to the participants. d) 45 minutes topic processing:

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In the last part of the cession, the topic will be processed in a pragmatic way in order for the clients to relate to it. After the break, the leader will first ask one of the clients to summarize the theme and its relation to addiction. Then, the therapist will expose the goals of the cession and according to the method used for the topic (paper and pen, role playing, brainstorming), he or she will give the instruction before asking the participant to begin processing by themselves (individually or in group).  Example: Anger management and the recovery process Material: paper and pen Example of intervention: “We will now try to understand more about our angry behavior, what triggers them and how we can implement skills that help us deal with destructive thoughts and actions. By the end of this cession you will be able to decrease your self defeating angry thoughts, feelings and behavior thus enhancing your recovery program. • • • You will learn how to implement realistic thoughts that will lead to adapted behavior in anger-producing situations. You will learn how to implement an assertive attitude necessary to solve problem in a less aggressive and more constructive manner. You will learn a relaxation technique that will help you reduce the level of stress and irritability lessening thus the likelihood of getting anger outburst.

To understand what happens when you are angry I will give you handouts on which each you will write a recent situation in which you felt angry or irritated. You will than probe what went through your mind at that time (thoughts, images and memories) and write it down… (See anger management section and handouts in this manual p.X) The therapist will make sure everybody has participated before giving a task (related to the theme) to complete during the following week. Before wrapping up the facilitator will make sure that no one leaves the facility while craving. In case of a craving client, the therapist will invite him or her to stay after the cession in order to work craving out. The therapist then thanks the attendants for coming to group and remind them of the next cession.

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2. Closed group a) Configuration of the group: In order to increase cohesiveness between the clients and consequently enhancing the compliance to treatment, the groups conducted at Skoun are fixed membership groups. A fixed number of patients are to attend a set of 13 cessions (including the introductory cession). A total of 8 patients form 1 group that goes through a cycle of 3 months. If a group has not yet reached his maximum size, new participants can still join before the end of the third cession. No new entries are to be allowed after the third cession. All new entry then might disrupt the consolidation of the clients’ sense of belonging to the group. A chart containing the dates and the themes of all the group cessions will be given during the introductory cession. Each time the client attendant a group he or she will mark it on the chart (see chart in appendix). A total of 3 cessions can be missed. Each cession missed will be rescheduled with a different group. Should a client miss more than 3 cessions with no valid reasons, he or she will be considered non compliant to group treatment and thus be discharged from group therapy.

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IV- Placement consideration:
1. General consideration A formal selection is essential if the therapists are to match clients with the group. The evaluation should be based on the primary assessments (psychology and psychiatry), on the therapist’s following appraisal of the patient’s mental functioning (especially if the patient went through detox after assessment) and finally on the clients hopes, fear and expectations. This is why a delay of one month after the first interview must be respected before admitting a client to group. During the first month of treatment and before admitting someone into a new cycle, the therapist must consider the following points bearing in mind the interest of both the client and the group: Does the patient pose a threat to others? Is the patient prepared to engage in the give and take of group dynamics? What is his or her motivation to work on his addiction (even though he might not be always sober)? Is his or her psychological functioning compatible with the type of group running

Taking in consideration the previous points, exclusion criteria are: 2. Exclusion criteria: All clients who seek treatment can be eligible to participate in group therapy, nevertheless there are some contraindications. Since some unstable mental functioning can be aggravated by the interactions in group disrupting the group dynamic, it would be better for this type of clients either to be more prepared than others to group or to get extra therapy cessions instead of group cessions. The exclusion of a client from group treatment should be decided upon the psychiatrist’s and the therapist’s assessment and the decision should be submitted to the approval of Skoun’s team.

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Psychiatric exclusion criteria are based on the diagnosis inventoried in the manual for mental disorders: DSMIV–R. Mental disorders that disable the client from interacting with others should be considered upon their severity before allowing the client to join a group. Here are some mental disorders that ought to be evaluated for admission to group: - Severe Social Phobia - Severe Paranoia traits (unshakable paranoid delusions) - Severe schizophrenia symptoms such as hallucination and delusions not yet treated. Furthermore people with significant character pathology such as personality disorders place in a group of people who do not have similar disorder almost certainly would violate the boundaries of the group and its participants. As a result, both parties would have a negative group experience and limited opportunity for growth and improvement. Since our groups at Skoun are not specially designed for population with sever personality disorder and since most of our clients do not suffer, it will be counterproductive to place clients with sever personality issues. Consequently it would be more appropriate for these clients to get extra one on one therapy in order to reduce the unadapted features before reconsidering group therapy. The following personality disorder traits should be assessed thoroughly before allowing them to join a group: Antisocial personality disorder with impulsivity and aggressive behavior Borderline personality disorder with impulsivity and sexual promiscuous behavior Paranoid personality disorder with unshakable paranoid thoughts

Not all clients are equally equipped and suited for all kinds of groups, nor is any group approach suitable for all clients with history of substance abuse. For instance a person who relapses frequently and is not motivated to stop his or her using would be dangerous in groups where there is a major effort put in the recovery process. Since most of the clients are sober during group cessions or have reached significant abstinence it would be disadvantageous to place a person high on drugs in the middle of people trying to get over their cravings. Therefore clients who are highly at risk to be using drugs at any time and consequently who might come to group under the influence, should not be admitted unless they are sober again for several days or went through detox.

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Other types of clients who may not be appropriate for group therapy include: Clients who refuse to participate to group for no particular reason. No one should be forced to Clients who cannot attend for logistical reasons, such as work schedule that conflict with that of regular group meetings Clients who cannot attend group for privacy reasons such as highly ranked political personality or well known artist Clients who have already attended several groups during rehab or other drug treatment and to whom group therapy would be redundant

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V- Rules and regulations:

Regulations:

1. Members are required to make an initial 3-month commitment in order to benefit from all the topics that will be developed in group therapy. Payments are to be done at the beginning of each group cycle unless other arrangements are discussed and worked out in session with the therapist or with the administration.

2. In order to benefit from group, members will have a commitment to go through all the scheduled topics of the cycle. In the event of an unexpected absence, group members are expected to notify the group at least 24 hours in advance. If a client misses one cession he or she is requested to reschedule the topic missed with the next group. Furthermore, members are to be punctual at each attendance. In event of client’s inability to attend a session, a telephone call to this effect is expected.

3. Members will have a commitment to treat matters that occur in the group with utmost confidentiality consequently they are expected not to discuss what happens in the sessions with people who aren't part of the group.

4. Members will have a commitment to discuss during group only about important issues related to the group itself or interfering with its normal functioning. Since all issues related to group must be dealt within its premises, clients are requested not to discuss about other members in their individual therapy. Clients are also committed to disclose information if it is an emergency or if it’s considered crucial to the life of the group or any of its participants.

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5. Rules: • Even though Skoun is a none-abstinence-based-treatment center, using in-group and or coming high to group is prohibited. In order to guarantee a therapeutic safe environment to all members, clients who are under the influence of any drug are requested not to attend the running session. In order to guarantee a therapeutic drug-free environment to all Skoun clients, it is highly prohibited to deal in-group or within Skoun premises. Any dealing within the center will lead to the suspension of group treatment immediately. Since most participants are trying to maintain abstinence, it’s not allowed for any purpose to trigger voluntarily any member of the group. In event of a client deliberately triggering others, he or she will be suspended from group therapy and re-assessed in order to re-evaluate his or her readiness to change. In order to maintain a coherent flow of information, it is not allowed to leave group before the session has ended. Client who wishes to leave is requested to notify the therapist prior to the beginning of the session and inform the other members. In order to ensure a secure environment, it is prohibited to use any threatening behavior in the group and within the premises of the institution. Verbal and physical aggressiveness will lead to the exclusion of the person responsible for the said behavior. In case of hostile conduct the client case would be submitted to Skoun’s therapeutic team. A thorough evaluation of the case per-se will be made; it may lead to the re-admission of the violent client under conditions or may lead to his total discharge of group and/or the institution. Furthermore it is forbidden to display in-group any explicit or implicit promiscuous behavior since it may generate discomfort amongst the participants and consequently defeat the purposes of the group therapy. However it is allowed to put in words any of these feelings and discuss it openly it in a productive and respectful way within the group session. Since the aim of group therapy is to help clients recover from their drug use and learn skills to achieve their goals, it is not allowed to use the sessions for other purposes than the ones agreed on initially (example: recruiting, dating, selling, political activities…). Should this rule be 13

breached, participants are expected to reveal the occurring activity to the leader of the group.

In a group of people it’s somehow normal to feel more comfortable with some individuals than with others. Relationships built in group therapy are often beneficial yet some of them may lead to drug use or any other counterproductive activity. Therefore any alliance, between two or more individuals of a group, contradicting the aim of the group therapy is considered harmful to the participants and is forbidden. Group therapy is the ideal setting for drug users to deal with their issues in a secure and respectful environment. Consequently any disruptive behavior such as: constant joking, cross talking, interrupting others continuously, will lead to the suspension of the session for the disruptive member. In order to ensure an efficient environment free from all disruptions, it is not allowed to eat or smoke during group sessions. However these activities are permitted before and after the group sessions or during the break.

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VI - Specific interventions

In the following section we will address some common issues that the therapist or the leader might face in a group session. For each issue an adapted attitude will be suggested. Remember these are general guidelines they cannot embrace all the possible issues that may occur during group therapy.

1) Dealing with promiscuous behavior: When physical boundaries are breached in a group and if no one raises the issues amongst the participants, the leader should call the behavior to the group's attention. Recommended intervention After reminding the group of the terms of agreement, the leader encourages the participants to give their input on the said behavior: - "Before we go further into the group session I would like to discuss an issue with you all. But first I would like to remind you of the rule we agreed on at the beginning of this group: it is forbidden to display any explicit or implicit promiscuous behavior since it may generate discomfort amongst the participants and consequently defeat the purposes of the group therapy. However it is allowed to put in words any of these feelings and discuss it openly it in a productive and respectful way within the group session" - "X, you appear to be communicating something nonverbally by constantly touching Y's . According to the rule I've reminded you off; can you please put in words your action?" If some participants raise the issue in group, the therapist acknowledges it and cools down any emotional outburst coming from the two parties (the participants and the person who is acting on).The leader than reminds the 15

participants of the rule they agreed on and invites the patient to put in words his or her promiscuous action.

2) Solving conflicts and dealing with violent behavior: Conflict is a normal healthy and unavoidable component of the group’s life. It helps the group mature by communicating constructively and solving issues without needing to use drugs in order to cope with the conflict. It is as unhelpful for clients to shut down a conflict before it gets worked through than to let it go too far. Conflicts within a group can be overt or covert. In case of a covert conflict, group leader should be able to bring it into the open for acknowledging the presence of a conflict makes group members feel safer. Recommended intervention: If the group leader notices a covert conflict amongst two or more participant he or she may bring to attention the signs of tension in the group and use it to speak openly about the conflict per se: - “I’ve been noticing since the beginning of this session that some of you are showing some signs of disagreement when X is talking about Y. as you know keeping the problem hidden wont solve it in anyway. Can we speak openly about what is making you react like that to that particular issue? Let’s beginning with you B why do you frown when X is talking about Y…? The leader may also convert the conflict into a learning experience by turning the disagreement into a problem to be solved by the group. The leader may begin by reformulating the conflicting subject than asks each member to give his/her point of view and a possible alternative to the issue: - ”I’ve noticed some tension going on since the beginning of the session and I’ve noticed that some of you do not agree with X when he speaks about Y. According to X, Y is still using this is why he is not coming to group. B, what do you think of this? Do you have an alternative explanation? What do you think should be made in order to bring Y back to the group?” At times some clients may get stuck in a distorted thinking about certain arguments. In this particular case the conflict may escalate and urge a member to show violent conduct towards others. In groups, threatening behaviors should be intercepted decisively. If necessary the leader may have to stand in front of the participant being violent or the member being threatened. For this reason, a group leader should never conduct a group session alone. Client showing violent conduct must than be accompanied by the co-leader out of he session.

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In case of violent behavior the group might be highly disrupted and might loose faith in the therapist and/or the institution therapeutic capability. Therefore a concise debriefing must follow the clash. First, the leader starts by containing any exceeding emotional outburst by acknowledging the unpleasant feeling members might have while experiencing a violent behavior. Than the therapist invites the remaining participants to describe briefly what they felt about the event (emotion), than to give their opinion on the event (thoughts) and to finish with a possible solution to the conflict encountered (resolution). This fast debriefing might be used as a closure to the session itself. But the leader must be cautious not to let any of the participant leave the institution anxious, triggered and/or confused by what had happened. A simple question such as: - ”Who, amongst us is feeling confused about what had happened?” or - “We might feel anxious after going through this kind of incident. If someone is experiencing any feeling of discomfort please stay after the session in order for me to help you deal with your feelings and help you understand what had happened for you”. The group leader may simply say: - ”Strong experiences such as these might generate feelings such as anxiety and anger and therefore triggers our cravings to use drugs as a relief strategy. Please do report to me if you feel triggered to use in order to help you deal with your cravings”. Aggressive behavior can be an easy road towards relapse thus it’s advisable to calm the violent client down before dismissing him. The participant that has been expelled from the group might be in such an emotional turmoil that he might act upon his anger by resuming his violent behavior and/or be craving for drugs and urges for it. After escorting the aggressive patient out of the group room, the co-leader makes sure that the patient is isolated from the others. A one to one session is necessary in order not to over stimulate the client and in order to help him focus more on his thoughts. The co-therapist may invite the client to sit and defocus from what had happened. The client must be granted enough time to calm down before helping him process what had happened. A breathing technique may be very helpful to sooth the client emotions. After the client had calmed down the co-leader may invite him to talk about what had happened and try to help him have a different perspective of the incident. The co-leader may equally release the client after making sure that his or her anger and/or craving (if he’s experiencing some) faded away.

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In both case the co-therapist is requested to contact the client’s therapist and give him an urgent appointment in order to work-through this experience. It’s recommended not to tackle deep psychological issues related to the violent behavior of the client at that point of the intervention but stay focused on the incident itself. An immediate disclosure after the incident might lead to bigger emotional outburst hard to contain. It is however beneficial to discuss with the patient the meaning and the implication of the limit-breaking behavior as they see it. Finally, in any case should the therapists act upon their anger towards the disruptive patient. It is prohibited to use any aggressive talk or threat while trying to stop the client’s violent behavior. The consequences of the aggressive act have to be evaluated by the therapeutic team and disclosed to the patient by his therapist only. 3) Substance use in-group: In a group of patient working actively on their recovery, the presence of an intoxicated client is a powerful trigger that might generate discomfort and aggressiveness. If the therapist does not handle this issue in a firm way, a considerable amount of problem might emerge: relapses, anger manifestations creation of rival subgroups... As a result, clients might loose confidence in the leader's ability to deal with drug problems, which would lead to massive dropouts. Recommended intervention: Denial of the group: In case members of a group do not confront a client who is using during session, the leader should raise the issue in a manner designed to encourage honesty and prevent any hostile reaction from abstinent participants: “ It must be hard for you X to find yourself in a group in which you don’t feel at ease enough to talk about your using. I’ve noticed you’ve been closing your eyes every now and than during group. Don’t you think it would be more helpful for you to come sober to group in order to make the best of the session? ” “ I know how difficult it is to admit using drugs in front of the group but we have agreed upon not taking in session or coming high at it since it would make the others feel uncomfortable. I would like you to sit in the waiting room and wait till the effect of the drug weans down before going home”.

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The therapist may also help the group understand why the using was kept secret. This intervention may reveal the existence of other concealed active users, sub-groups and/or secret alliances between the members:

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- “It is somehow interesting to see that none of you had noticed that X was intoxicated since the beginning of the session. It’s normal sometimes to feel the need to cover up other’s behavior but in this case withholding the information will impede your progress and interfere with your recovery. Can we take a moment to understand why no one brought to notice the intoxication of X knowing that according to group regulations it’s requested from each one of us to disclose this kind of information.” In case of client coming constantly intoxicated to group (more than two time in a month): In this case, the therapist should intervene decisively to protect the other members of the group. The leader is expected to be confrontational and make it clear to the user that he or she hasn’t been complying with the rule of abstinence during group and thus will be discharged: - “X, it’s the third time you come to group high in one month. You know that it is prohibited to use in-group. Since your behavior isn’t supporting the group norm I’m re-questioning your motivation to work with us. I’m asking you to leave the group now and sit in the waiting room until the effect of the drug decreases. You’ll join another group when you are ready to stop using or when you are able to control your taking. In case members of the group confront the intoxicated patient: Coming intoxicated to group is seldom left unknown by the other users who may try to protect themselves by reacting aggressively towards the active user. In this case, the therapist may let the group deal with this issue while intervening only if the tension gets out of control. He may equally take an active part in the process by acknowledging what’s going on in the session and invite the participants to find a solution to the issue encountered: - “I know how difficult it is to be trapped in a room with someone involuntarily triggering us. Condemning aggressively X is like avoiding to deal with our own issues. Can we brainstorm together in order to help X reach abstinence? Remember by helping other participants you are helping yourself deal with similar situation that may occur to you. X, In the meantime, can you go to the waiting room and wait until the effect of the drug decreases we will brief you on the solutions we found by the end of the session” 4) Dealing with negative subgroups: In an active group, subunits may appear inevitably. They are not always negative and in this case, they tend to facilitate the integration of patients with social issues to the larger group. The interaction of different subgroups can foster

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equally a big amount of material that would help the group increase the outcome of its therapeutic experience. But the leaders should not forget that group members might have used together thus may be drawn to build alliances within the group on the same previous pattern. Such connections might be highly disruptive for the members of the subgroups itself and anxiety triggering for the other participants. If the therapist is noticing a tension growing around a certain subunit of patients he or she may dispatch the members of the subgroup and reconfigure undesirable combinations. On occasion however subtle interventions may fail. In this case the leader should not hesitate to confront the subgroup - “X and Y I’ve noticed you get along pretty well together. It’s normal to have affinities with some clients and not with others but the alliance existing between you two is highly connected to drug since you use to take Heroine together. Don’t you think re-immersing in this type of relation might be prejudicial for both of you?” Following this intervention, the therapist may separate the two members of a subunit and may invite the whole group to reflect on the impact of the subunit on the larger group. 5) Dealing with disruptive behavior: When a client talks on and on he or she may not know what is expected in a therapy group, in this case, the therapist may help the patient clarify how he perceives his role in the group therapy: -"X, what are you hoping the group will learn from what you have been saying?" Following this question, the client will explain the aim of his interventions in group and the leader will explain how the group really functions or will ask another member of the group to do this.

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VII -Topics
Please note that each topic, (except topics followed by *) will need a whole session to be developed and worked on thoroughly. There are three types of themes: a) Skills building topics: Identifying triggers and cravings Coping skills Anger management Effective Communication Assertiveness (refusal and criticism) Cognitive restructuring* Modifying thoughts and emotions

b) Processing: Family issues Relation Closure

c) Informational: Introduction to group therapy Harm reduction: Safe use, first aid Sleep disturbance* (include Skills building) HEP C / HIV

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VIII – Scheduling:
a) 6 month schedule:

January Groups A1 B2 A3 B4 E5 F6 E7 F8 10 A1 B2

February

March

April

May

June

July

August

September

November

A1 B2 A3 B4

A1 B2 20 A3 B4 E5 F6

A1 B2 A3 B4 40 E5 F6 E7 F8

A1 B2 A3 B4 E5 F6 60 E7 F8

A1 B2 20 A3 B4 E5 F6 E7 F8 80

A3 B4 40 E5 F6 E7 F8

E5 F6 60 E7 F8

E7 F8 80

Letter = Therapist Number = Group

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b) 2 week's schedule:

Hours 9h00 9h30 10h00 10h30 11h00 11h30 12h00 12h30 01h00 01h30 02h00 02h30 03h00 03h30 04h00 04h30 05h00 05h30 06h00 06h30 07h00 07h30 08h00 08h30

Monday

Tuesday

Wednesday

Thursday

Friday

Month 2 Introductor Introductory y group* group*

Month4 Introductor Introductory y group* group*

Month 1 Introductory Introductor group* y group*

Month 3 Introductory Introductory group* group*

Hours 9h00 9h30 10h00 10h30 11h00 11h30 12h00 12h30 01h00 01h30 02h00 02h30 03h00 03h30 04h00 04h30 05h00 05h30 06h00 06h30 07h00 07h30 08h00 08h30

Monday

Tuesday

Wednesday

Thursday

Friday

Month 2 Triggers & Triggers & Cravings* Cravings* Month 3 Triggers & Cravings* Triggers & Cravings* Triggers & Cravings* Triggers & Cravings*

Month4 Triggers & Cravings* Triggers & Cravings*

Month 1

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