By Paul Casey
This paper will explore the positive outcomes that individuals with addictions experience when they engage in group therapy. These individuals can come into a safe environment where other group members are struggling with similar addictions and issues. With a leader facilitating the group and creating an open atmosphere, individuals can express what is truly going on inside of them. This type of intervention can start a person on a healing path and help him/herself to walk away from a destructive way of life.
An Inside Look
“The emergence of self-help groups may reflect a societal response to failures within the mental health community. Self-help groups have developed where society has fallen short in meeting the needs of its members.” (Reissman, Carroll, 1995) The fact that public health organizations face lack of funding with the overwhelming need for substance abuse treatment is all the more reason for group therapy, which is highly cost effective. Alcoholics and Narcotics Anonymous are great examples of places where an individual can walk into a group therapy environment and pay by donation. An individual can also receive free one-on-one counseling by a member of the group who has years of sobriety and takes the role of being a sponsor. “Providing help when one has felt helpless can increase self-worth, confidence and optimism. In turn passivity may be decreased as perceived control increases and ultimately less dependence on traditional mental health services may result.” (Reissman, 1965)
By the simple act of sitting in a room with a group of people, self-help groups can eliminate one major distress: that of feeling isolated. A new member who walks into a meeting for the first time and feels completely disconnected has the opportunity to hear someone else express exactly what s/he is going through. The individual experiences an instant shift from feeling disconnected to feeling connected. “Because of variability in group members’ skills some self-help groups might benefit from having a professional involved. A mental health professional’s assistance may further assure the group’s success by promoting group goal achievement and reinforcing the aims of group members’ treatment programs.” (Felix-Ortiz, et.al, 2000)
Unlike an Alcoholics Anonymous meeting where there can be large numbers of people in the room a group therapy session with a professional will most likely have a maximum of twelve people. The obvious benefit of this is having more attention and focus on each client. It also feels safer and is much easier for the clients to gain trust in a more intimate setting. Clients have a much better chance of sharing their deep issues and therefore enhancing the beginning of their healing process. That is why in Alcoholics and Narcotics Anonymous there is a strong push for new members to obtain a sponsor. The older members as well as professionals in the therapeutic community know that one-on-one session in the beginning of abstinence is crucial for an addict to break out of the cycle of self-destructive addictions. People who are shy in the small group setting are more likely to be drawn out in one-on-one sessions either with a sponsor or a professional group therapist who sees them one-on-one after the group. The combination of group and one-on-one counseling is ideal.
“There is ample evidence that a range of chemical dependency treatments lead to significant reductions in use, improved physical and mental health, and increased social productivity. Unfortunately the treatment field also continues to contend with the problems of poor patient retention and relapse. In both alcohol and drug populations an average of about one third of people who start an outpatient chemical dependency program will complete it.” (Pekarik, Zimmer, 1992) It seems that motivation becomes a giant factor whether or not a person breaks out of the destructive cycle. Individuals become very accustomed to the drinking and drugging life-style and although his/her behaviors have become self-destructive, it is still the only way that this person knows how to cope. S/he clings to addictions for survival.
“Miller and Sanchez (1994) reviewed interventions in the alcoholism field and derived six common motivational elements from empirically tested successful treatments which they described with the acronym ‘FRAMES’: feedback, responsibility, advice, menu of options, empathy, and self-efficacy.” (Foote, et al, 1999) Feedback with someone in the early stages of treatment is very effective because it challenges the individual to start taking an honest look at what is going on with him/herself and what is happening in his/her life. Responsibility is huge in recovery because one learns to finally take control of one’s own life. When an individual takes responsibility the blaming of others stops. The finger is pointed back at the person.
Advice and a menu of options go hand and hand. People in recovery can be shown alternative ways of dealing with stress and emotions. Counselors and sponsors can also ask them about what they truly enjoy and encourage them to engage in activities that bring fulfillment like meditation, exercise, music, art, child-rearing, etc. Empathy can be demonstrated by the heart connection the counselor brings to someone suffering painful addictions. The fact that someone sincerely cares and understands what the addict/alcoholic is going through can be very healing in itself. The clients slowly learn to care about themselves and then finally other people. Self-advocacy is truly about bringing empowerment back to the individual. The more a person learns about assertiveness, work, self-care and leisure skills the more s/he can go forward. Addictions start to lose their hold when a person begins to see a new light. The complete change in environment and the energy shift from alcohol and drugs to a sober atmosphere by itself is the beginning of awareness and a new life.
Some individuals have reached a point with their addictions where they have hit a bottom and want to change. They will be more likely to be honest with themselves, and will be ready to embrace feedback and assistance from others. In other cases individuals are still very attached to their addictions and are resistant to letting go of the drug or alcohol of choice.
There are many skills that a counselor uses including motivational interviewing, discussion group facilitating, and the structured exercises used in cognitive therapies. These skills all take effort, thought and time to learn. Even a fully trained counselor with all of these skills and knowledge realizes the natural course for most addicts will be relapse. “Reviews of substance abuse treatment outcome research have indicated that many positively evaluated treatments are not typically included in clinical practice, while many of the approaches used have little or no research basis. This continuing disconnect between research and practice has amplified the call for greater emphasis on (cognitive) technology transfer.” (Dansereau, Dees, 2002)
Dansereau describes a series of studies that were done to assess the impact of cognitive transfer, otherwise known as mapping. In mapping groups, one counselor writes down what is going on in the group while the other facilitates. In one study, a group of clients was randomly selected to be in either a traditional group therapy setting or one in which mapping was a part of the group. The results showed that the group that participated in mapping were more committed to treatment as measured by attendance at scheduled counseling sessions, more positive views of the therapist-client relationship, and fewer positive opiate and cocaine urinalysis results during the first three months as well as during later treatment stages. This study also showed mapping to be more effective with African- and Mexican-Americans than with Caucasians. They concluded that mapping helps reduce cultural, racial and class communication barriers by providing a visual supplement and common knowledge. It could be that for these racial groups this form of true acknowledgment breaks barriers and brings a person into recovery. They also found that mapping these sessions brought all clients into a deeper level of sharing and more trust of the counselors. Clients could see that what they were saying was being recorded and tracked and that they were being held accountable for what they were saying. This engagement seemed to give them courage to go deeper into core issues.
In summary drug and alcohol addiction is in many cases a group problem. Individuals connect with each other to drink and do drugs. The amazing paradox is that these same individuals come into a group situation to liberate themselves from this self-destructive way of life. Individuals with addictions can find trust, motivation, and healing in the presence of counselors and their many effective group therapy techniques. The interaction between counselors and the clients within the group setting, especially with effective techniques, leads to recovery and long term healing.
Dansereau, F., Dees, S., (2002). Mapping training; the transfer of a cognitive technology for improving counseling. Journal of substance abuse treatment, 22: 219-230.
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