Strategies for Working with Clients with Co-Occurring Disorders

DownloadStrategies for Working with Clients with Co-Occurring Disorders

Advertisement
Download Presentation
Comments
nam
From:
|  
(210) |   (0) |   (0)
Views: 218 | Added: 19-02-2012
Rate Presentation: 0 0
Description:
Learning Objectives. Learn the advantages of therapeutic group work in the treatment of co-occurring disordersExamine the modifications that will enhance effectiveness of group work with co-occurring disordersUnderstand the challenges of 12-Step program participation by clients with CODsLearn how to facilitate 12-Step participation by clients with CODs.
Strategies for Working with Clients with Co-Occurring Diso...

An Image/Link below is provided (as is) to

Download Policy: Content on the Website is provided to you AS IS for your information and personal use only and may not be sold or licensed nor shared on other sites. SlideServe reserves the right to change this policy at anytime. While downloading, If for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.











- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




1. Strategies for Working with Clients with Co-Occurring Disorders Trainer Notes: Group treatment of co-occurring disorders is considered standard practice. However, certain modifications are necessary to ensure the success of these groups. In addition, there are specific types of groups that are particularly effective in the treatment of CODS. This module is an overview of commonly used group approaches. A demonstration followed by role-play is recommended when teaching this module. Trainer Notes: Group treatment of co-occurring disorders is considered standard practice. However, certain modifications are necessary to ensure the success of these groups. In addition, there are specific types of groups that are particularly effective in the treatment of CODS. This module is an overview of commonly used group approaches. A demonstration followed by role-play is recommended when teaching this module.

2. Learning Objectives Learn the advantages of therapeutic group work in the treatment of co-occurring disorders Examine the modifications that will enhance effectiveness of group work with co-occurring disorders Understand the challenges of 12-Step program participation by clients with CODs Learn how to facilitate 12-Step participation by clients with CODs

3. Trainer Notes: Allow 10 minutes for the pre-test and: Have trainees set it aside for review at the end of the class, or Administer a post-test at the end of the class Trainer Notes: Allow 10 minutes for the pre-test and: Have trainees set it aside for review at the end of the class, or Administer a post-test at the end of the class

4. Advantages of Group Work Engenders social support among clients Provides opportunity for social skills acquisition Provides positive role models for clients at earlier stages of treatment Offers economy of teaching Teaching Points: Learning is enhanced by the presence of like individuals who support the overall goals of the group. The group offers a safe place for individuals to try out new social behaviors. Confidence is built when efforts are successful Members can accept other members as credible role models. The shared bond of experience increases the likelihood of ?buy-in? to recovery attitudes and behaviors. Individuals in early recovery are likely to need many hours of skills building. The group setting multiplies the clinician?s effortsTeaching Points: Learning is enhanced by the presence of like individuals who support the overall goals of the group. The group offers a safe place for individuals to try out new social behaviors. Confidence is built when efforts are successful Members can accept other members as credible role models. The shared bond of experience increases the likelihood of ?buy-in? to recovery attitudes and behaviors. Individuals in early recovery are likely to need many hours of skills building. The group setting multiplies the clinician?s efforts

5. Discussion: Modifications to Group Work With your partner or small group: List at least three important modifications you would advise a novice counselor to make when conducting group therapy with clients with CODs List in order of importance Discussion: Have the class participants to discuss the above question in groups of 3?5, depending upon the class setup. Allow 5 minutes to list the modifications and have each group report to the class the three listed and explain why they think they are important. Allow sufficient time to process Discussion: Have the class participants to discuss the above question in groups of 3?5, depending upon the class setup. Allow 5 minutes to list the modifications and have each group report to the class the three listed and explain why they think they are important. Allow sufficient time to process

6. Modifications to Group Teaching Points: Point out that individuals with serious mental illness may feel over stimulated by a very intense group. They may respond negatively or ?shut down? The clinician is responsible for maintaining structure. Cognitive deficits in the group can derail the logical progression of learning objectives. Co-leaders, when possible, enable one clinician to focus on the group objectives while the other clinician monitors individual responses to the proceedings Shorter attention span is a characteristic of CODs Regular schedules contributes to the structure and stability of the group. Predictability contributes to the sense of safety in a group Groups should not exceed 12 participants, and a smaller number is desirable. The leader is responsible for restraining any attempt to monopolize the group and for drawing out more reticent members Affirmation and strokes for participation are essential. Remember to adjust your expectations for each individual in the group. It is important that individuals do not leave feeling they have failed at the process. ?Start Low, Go Slow? is often a motto in COD treatment.Teaching Points: Point out that individuals with serious mental illness may feel over stimulated by a very intense group. They may respond negatively or ?shut down? The clinician is responsible for maintaining structure. Cognitive deficits in the group can derail the logical progression of learning objectives. Co-leaders, when possible, enable one clinician to focus on the group objectives while the other clinician monitors individual responses to the proceedings Shorter attention span is a characteristic of CODs Regular schedules contributes to the structure and stability of the group. Predictability contributes to the sense of safety in a group Groups should not exceed 12 participants, and a smaller number is desirable. The leader is responsible for restraining any attempt to monopolize the group and for drawing out more reticent members Affirmation and strokes for participation are essential. Remember to adjust your expectations for each individual in the group. It is important that individuals do not leave feeling they have failed at the process. ?Start Low, Go Slow? is often a motto in COD treatment.

7. Helpful Rules and Guidelines for Group Participation Group Confidentiality Members should not discuss members? personal info outside group Group leaders should discuss confidentiality limits (e.g., duty to report child abuse) Respect Listen attentively to others Disagreeing is okay, personal attacks are not Pay Attention Sharing is optional, paying attention is not Teaching Points: Confidentiality is a major issue. The rules of confidentiality should be repeated frequently. Often individuals in a group will share one or more overlapping circles of acquaintance outside the group, e.g., housing, support meetings, community services. Violations of confidentiality of material discussed in the group will seriously damage the perception of safety of the group. The showing of respect in group is an opportunity for active learning of social skills. Do not assume that all participants know what is acceptable behavior. For example, interrupting others may be an automatic learned behavior that needs modification. Individuals should not be forced to share. However, they must attend to the proceedings. Attending while someone is speaking is a show of respect and a social skill. Teaching Points: Confidentiality is a major issue. The rules of confidentiality should be repeated frequently. Often individuals in a group will share one or more overlapping circles of acquaintance outside the group, e.g., housing, support meetings, community services. Violations of confidentiality of material discussed in the group will seriously damage the perception of safety of the group. The showing of respect in group is an opportunity for active learning of social skills. Do not assume that all participants know what is acceptable behavior. For example, interrupting others may be an automatic learned behavior that needs modification. Individuals should not be forced to share. However, they must attend to the proceedings. Attending while someone is speaking is a show of respect and a social skill.

8. Different Models of Group Interventions for CODs Stage-wise Treatment Groups Psychoeducational Groups Social Skills Training Groups Multi-Family Groups Medication Support Groups 12-Step Self-Help Groups (e.g., Double Trouble, Dual Recovery Anonymous) Teaching Points: Stage-wise groups include Persuasion Groups, Active Treatment Groups, and Relapse Prevention Groups. Member of the group are at the same stage of treatment and have similar needs for skills building. Psychoeducational groups are a vital part of Active Treatment. Topics run the gamut from basic hygiene to money management, from learning about addiction to learning about medication management. Social skills training may teach the individual how to avoid social situations that encourage drug use and use social situations that support recovery. Multi-family groups provide the family with information about the disease of addiction, mental illness. They also offer support and valuable advice about how to deal with the challenges of CODs in the family. Medication support groups can be run by a medical professional or can be peer-led. See resource list for info on Peer Led Medication Support Groups. Consumer-run self-help groups (i.e., 12-Step programs such as Alcoholics Anonymous and other programs such as Rational Recovery, Dual Recovery Anonymous, and Double Trouble). See next section in this module. Teaching Points: Stage-wise groups include Persuasion Groups, Active Treatment Groups, and Relapse Prevention Groups. Member of the group are at the same stage of treatment and have similar needs for skills building. Psychoeducational groups are a vital part of Active Treatment. Topics run the gamut from basic hygiene to money management, from learning about addiction to learning about medication management. Social skills training may teach the individual how to avoid social situations that encourage drug use and use social situations that support recovery. Multi-family groups provide the family with information about the disease of addiction, mental illness. They also offer support and valuable advice about how to deal with the challenges of CODs in the family. Medication support groups can be run by a medical professional or can be peer-led. See resource list for info on Peer Led Medication Support Groups. Consumer-run self-help groups (i.e., 12-Step programs such as Alcoholics Anonymous and other programs such as Rational Recovery, Dual Recovery Anonymous, and Double Trouble). See next section in this module.

9. Stage-wise Treatment Groups for Clients with CODs These groups focus on helping clients progress from one stage of treatment to the next Use therapeutic group process as the primary vehicle for change Three types: Persuasion Groups Active Treatment Groups Relapse Prevention Groups Teaching Points: Stage-wise groups focus on helping members achieve the goals for their level of treatment and move to the next higher level. Goals for the stages of treatment are covered in treatment planning. Progress in these groups moves the individual toward accomplishing these goals and objectives. For example, completion of a decisional balance worksheet in a persuasion group is a legitimate intervention for increasing motivation. Handout: See IDDT Stage-Wise Groups Handout Teaching Points: Stage-wise groups focus on helping members achieve the goals for their level of treatment and move to the next higher level. Goals for the stages of treatment are covered in treatment planning. Progress in these groups moves the individual toward accomplishing these goals and objectives. For example, completion of a decisional balance worksheet in a persuasion group is a legitimate intervention for increasing motivation. Handout: See IDDT Stage-Wise Groups Handout

10. Persuasion Groups Focus on clients at the beginning of treatment who do not yet see their substance abuse as a problem Primary goals are to: Explore the interaction between substance use and mental illness Help clients understand the impact of substance abuse on their lives Motivate client to address substance use problems Clients at later stages can be included to serve as role models Teaching Points: Clients are in the late engagement and persuasion stages of treatment. The goals are accomplished by creating an accepting group environment in which clients are free to discuss their experiences with drugs and alcohol without fear of judgment, social censure, or confrontation. Although confrontation is not a goal, members of the group will recognize denial and defenses in others and point it out. The clinician is responsible for seeing that this process is gentle and not harsh. Members who have been exposed to previous treatment experiences that did encourage harsh confrontation will need to be re-educated by the clinician on the acceptable way to give feedback. Handouts: See Persuasion Groups Promote Recovery Handout and Conducting the First Persuasion Group Session Handout Teaching Points: Clients are in the late engagement and persuasion stages of treatment. The goals are accomplished by creating an accepting group environment in which clients are free to discuss their experiences with drugs and alcohol without fear of judgment, social censure, or confrontation. Although confrontation is not a goal, members of the group will recognize denial and defenses in others and point it out. The clinician is responsible for seeing that this process is gentle and not harsh. Members who have been exposed to previous treatment experiences that did encourage harsh confrontation will need to be re-educated by the clinician on the acceptable way to give feedback. Handouts: See Persuasion Groups Promote Recovery Handout and Conducting the First Persuasion Group Session Handout

11. Characteristics of Persuasion Groups Supportive Nonjudgmental Peer interaction is facilitated Education is provided Motivation interviewing techniques are used Often long-term Attendance is supported Teaching Points: The key word for Persuasion Groups is Supportive. Group members are at the ?Contemplation? Stage of Change. The are ambivalent and not ready to take set concrete goals for change. They are exploring the possibility as well as desirability of change. It follows that judgment is not passed on behavior. This is not to say that concern cannot be expressed. Peer interaction is facilitated by the leader. The goal is to have individuals share directly with each other, not with or through the leader as can sometimes happen in lower functioning groups. Education of a practical nature is provided. It is especially effective when group members can be the source of useful information. Motivational Enhancement techniques that demonstrate empathy and use reflection to draw out sharing by members is the practice. Open-ended questions that lead the member to share thoughts, feelings, and beliefs about their experiences are helpful. The group should be open and allow members to return as long as there is persuasion work to be done. Members should not move on to active treatment groups until they have made a decision to change. The goal is retention. There is no punishment for missing group; rather, there is affirmation for attending.Teaching Points: The key word for Persuasion Groups is Supportive. Group members are at the ?Contemplation? Stage of Change. The are ambivalent and not ready to take set concrete goals for change. They are exploring the possibility as well as desirability of change. It follows that judgment is not passed on behavior. This is not to say that concern cannot be expressed. Peer interaction is facilitated by the leader. The goal is to have individuals share directly with each other, not with or through the leader as can sometimes happen in lower functioning groups. Education of a practical nature is provided. It is especially effective when group members can be the source of useful information. Motivational Enhancement techniques that demonstrate empathy and use reflection to draw out sharing by members is the practice. Open-ended questions that lead the member to share thoughts, feelings, and beliefs about their experiences are helpful. The group should be open and allow members to return as long as there is persuasion work to be done. Members should not move on to active treatment groups until they have made a decision to change. The goal is retention. There is no punishment for missing group; rather, there is affirmation for attending.

12. Active Treatment Groups For individuals who have decided that substance use is a problem they want to change Primary goals are to: Focus on supporting members? goals of reducing substance use Teach coping skills that facilitate recovery Not appropriate for individuals still in the Persuasion stage of treatment Teaching Points: Active Treatment Groups are for individuals who are in the Active Stage of Change. They have completed the work of Contemplation and Preparation during the Persuasion Stage of Treatment. They are now ready to take action. They will, however, still need reinforcement for the decisions made earlier in treatment. Remember that co-occurring treatment often involves taking steps backward as well as forward. Interventions at this stage of treatment should focus on behavior change. Earlier interventions focused on attitudinal change. For behavioral change, the client will need to learn new skills. The first set of skills to be tackled includes ?staying sober? skills and tools. A primary ?staying sober? skill involves seeking and accepting support. Interpersonal skills are more easily learned in a nonthreatening group setting.Teaching Points: Active Treatment Groups are for individuals who are in the Active Stage of Change. They have completed the work of Contemplation and Preparation during the Persuasion Stage of Treatment. They are now ready to take action. They will, however, still need reinforcement for the decisions made earlier in treatment. Remember that co-occurring treatment often involves taking steps backward as well as forward. Interventions at this stage of treatment should focus on behavior change. Earlier interventions focused on attitudinal change. For behavioral change, the client will need to learn new skills. The first set of skills to be tackled includes ?staying sober? skills and tools. A primary ?staying sober? skill involves seeking and accepting support. Interpersonal skills are more easily learned in a nonthreatening group setting.

13. Characteristics of Active Treatment Groups Some confrontation is allowed Educational Skills building Skills for decreasing substance use or maintaining abstinence Identifying triggers to use substances Social skills Coping skills Self-care skills Expect sobriety Teaching Points: In the active treatment group, respectful confrontation from other group members is an important instrument of change. Peers can give feedback that is considerably more credible than that provided by professionals. It is the professional?s responsibility to see that the feedback is given in a tone and form that can be readily received. As mentioned before, continuing education and skills building in a group setting is economical as well as effective ?Staying Sober? skills acquisition is facilitated when group members can share their own experience with a particular behavior. Trigger identification is a relapse prevention skill. It is appropriate at all stages of treatment. In early treatment, avoidance is a primary tool. Later, in active treatment, deactivation of the trigger may be undertaken. Social Skills of all types are taught to meet the individual needs of the group. These skills include work-related behaviors as well. Improved self-care does not happen automatically. Good habits of daily living either have not been learned or have been forgotten during times of low functioning. Self-care skills start with personal hygiene and extend through boundary setting. Active Treatment Groups expect sobriety. It is considered a safety issue in the group. Sober group members will be negatively affected by a lack of commitment to sobriety. Individuals may not attend the group while ?under the influence.?Teaching Points: In the active treatment group, respectful confrontation from other group members is an important instrument of change. Peers can give feedback that is considerably more credible than that provided by professionals. It is the professional?s responsibility to see that the feedback is given in a tone and form that can be readily received. As mentioned before, continuing education and skills building in a group setting is economical as well as effective ?Staying Sober? skills acquisition is facilitated when group members can share their own experience with a particular behavior. Trigger identification is a relapse prevention skill. It is appropriate at all stages of treatment. In early treatment, avoidance is a primary tool. Later, in active treatment, deactivation of the trigger may be undertaken. Social Skills of all types are taught to meet the individual needs of the group. These skills include work-related behaviors as well. Improved self-care does not happen automatically. Good habits of daily living either have not been learned or have been forgotten during times of low functioning. Self-care skills start with personal hygiene and extend through boundary setting. Active Treatment Groups expect sobriety. It is considered a safety issue in the group. Sober group members will be negatively affected by a lack of commitment to sobriety. Individuals may not attend the group while ?under the influence.?

14. Active Treatment Groups: Common Topics Teaching social skills Sleep hygiene instruction Teaching skills for coping with unpleasant feelings Managing cravings Dealing with relapses Developing a relapse prevention plan Practicing relaxation skills Increasing pleasant activities Examining self-help programs Teaching Points: There are many manualized workbooks available for teaching the above skills. A few are cited in the References and Additional Resources Handout. If possible, examples of such workbooks should be available to show the class. It is also a good idea to ask the class what methods are used in their work settings to address these topics. An effective group can be accomplished by combining discussion, workbook exercises, demonstration of the behavior by the leader, and role-play by group members. Handout: Handouts and lists of suggestions are also a good idea. An example is the Suggested Techniques for Coping with Persistent Symptoms Handout from the Skills Training Class.Teaching Points: There are many manualized workbooks available for teaching the above skills. A few are cited in the References and Additional Resources Handout. If possible, examples of such workbooks should be available to show the class. It is also a good idea to ask the class what methods are used in their work settings to address these topics. An effective group can be accomplished by combining discussion, workbook exercises, demonstration of the behavior by the leader, and role-play by group members. Handout: Handouts and lists of suggestions are also a good idea. An example is the Suggested Techniques for Coping with Persistent Symptoms Handout from the Skills Training Class.

15. Topics for Psychoeducational Groups Causes, symptoms, and treatment for substance use and CODs Medical and mental effects of CODs Psychosocial effects of CODs The recovery process for CODs Medications to treat CODs, their side-effects, and medication management Coping with cravings, anger, anxiety, boredom, and depression Changing negative or maladaptive thinking Teaching Points: When conducting psychoeducational groups it is a good idea to use a variety of teaching methods. As mentioned before, employing a variety of teaching methods will improve the outcome of teaching efforts. It is a good idea to use as many different methods of teaching as possible. These include: Videos Handouts Discussion Role-play Homework Art work Movement Psychodrama Although some methods of teaching require special training (psychodrama, for example), there are often counselor aids available from publishers of treatment materials that incorporate these elements into a format that is appropriate for most clinicians.Teaching Points: When conducting psychoeducational groups it is a good idea to use a variety of teaching methods. As mentioned before, employing a variety of teaching methods will improve the outcome of teaching efforts. It is a good idea to use as many different methods of teaching as possible. These include: Videos Handouts Discussion Role-play Homework Art work Movement Psychodrama Although some methods of teaching require special training (psychodrama, for example), there are often counselor aids available from publishers of treatment materials that incorporate these elements into a format that is appropriate for most clinicians.

16. More Psychoeducational Topics Developing a sober support system Addressing family issues Learning to use leisure time constructively Spirituality in recovery Joining 12-Step and COD recovery mutual-help groups Risk factors in ongoing recovery Understanding and getting maximum benefits from psychotherapy and counseling Trainer Notes: Again, this is a good opportunity to ask the class to share methods of teaching that have been proven successful in their work setting. For example, ask the class, ?How have you or your agency been able to successfully address ?Spirituality in Recovery??? Trainer Notes: Again, this is a good opportunity to ask the class to share methods of teaching that have been proven successful in their work setting. For example, ask the class, ?How have you or your agency been able to successfully address ?Spirituality in Recovery???

17. Facilitating Self-Help Participation

18. Self-Help Groups Are nonprofessional Focus on a common problem shared by the members of the group Most frequently follow a 12-Step approach Are not for profit and are usually supported by small donations from members Teaching Points: Self-Help groups for individuals in recovery are usually based on the 12-Steps and the 12 Traditions of Alcoholics Anonymous. Narcotics Anonymous is the most closely related and the first spinoff group from Alcoholics Anonymous, which began in the 1930s and grew to become a worldwide organization in the 1950s. The 12-Steps were first written in 1938. They provided a step-wise program for recovery. They remain the primary feature of the program today. Individuals ?work the steps? to repair the damage brought to their lives by addiction. The Twelve Traditions were written and adopted in 1946. They are rigorously observed and help ensure the preservation of the most important principles of the program. These principles include anonymity (often cited as the most important principle), independence, and adherence to a ?primary purpose.? A careful reading of the Traditions reveals well-thought-out guidelines that protect the integrity of the program from attempts to bend the program to any other purpose other than that for which it was created. Handout: See handout 12 Steps and 12 Traditions HandoutTeaching Points: Self-Help groups for individuals in recovery are usually based on the 12-Steps and the 12 Traditions of Alcoholics Anonymous. Narcotics Anonymous is the most closely related and the first spinoff group from Alcoholics Anonymous, which began in the 1930s and grew to become a worldwide organization in the 1950s. The 12-Steps were first written in 1938. They provided a step-wise program for recovery. They remain the primary feature of the program today. Individuals ?work the steps? to repair the damage brought to their lives by addiction. The Twelve Traditions were written and adopted in 1946. They are rigorously observed and help ensure the preservation of the most important principles of the program. These principles include anonymity (often cited as the most important principle), independence, and adherence to a ?primary purpose.? A careful reading of the Traditions reveals well-thought-out guidelines that protect the integrity of the program from attempts to bend the program to any other purpose other than that for which it was created. Handout: See handout 12 Steps and 12 Traditions Handout

19. Benefits of a Self-Help Group Provides a social network Offers the opportunity to become both a recipient and giver of help Coping strategies and personal experiences are shared Individuals who are coping successfully serve as role models Provides meaningful structure that is self generated Teaching Points: It has been noted that the primary need in early recovery is for social support. Both addiction and mental illness tend to isolate the individual and put him or her on the outside of social institutions. People can find immediate acceptance in a self-help group at a time when they may not be able to find it anywhere else. In self-help groups, sharing one?s experience is seen as not only helping oneself but also helping others. Newcomers immediately see how this works and can begin to feel useful from the very beginning. The accumulated wisdom of the group provides a treasure trove of coping strategies that have been tried and tested and proven to work. Role models who are actively recovering and moving ahead with their lives are hard to come by outside of recovery groups. The presence of these role models provides an essential ingredient to change: hope, the belief that change is possible. The structure of the group that is maintained by members, not by professional staff, builds self esteem and empowers individuals to attempt other constructive activities.Teaching Points: It has been noted that the primary need in early recovery is for social support. Both addiction and mental illness tend to isolate the individual and put him or her on the outside of social institutions. People can find immediate acceptance in a self-help group at a time when they may not be able to find it anywhere else. In self-help groups, sharing one?s experience is seen as not only helping oneself but also helping others. Newcomers immediately see how this works and can begin to feel useful from the very beginning. The accumulated wisdom of the group provides a treasure trove of coping strategies that have been tried and tested and proven to work. Role models who are actively recovering and moving ahead with their lives are hard to come by outside of recovery groups. The presence of these role models provides an essential ingredient to change: hope, the belief that change is possible. The structure of the group that is maintained by members, not by professional staff, builds self esteem and empowers individuals to attempt other constructive activities.

20. AA and Similar 12-Step Groups Advantages include no cost, accessibility that is welcoming, and consistency from group to group Lists of meetings and locations are usually easy to obtain Emphasis on personal responsibility Accumulated shared wisdom on how to stay clean and sober is provided by members who have shared experience Teaching Points: AA, NA, and other similar 12-Step groups are usually available and can be accessed at no cost. Members are usually helpful in providing additional information about the availability of support and resources in the community. Although groups follow the same guidelines and principles, there is often considerable variation from group to group as far as attitudes towards other lifestyles and disorders is concerned. In large metropolitan areas, there are many ?specialized? groups. There are gender-specific groups, gay and lesbian groups, HIV groups, and even some groups that cater to a particular occupation, such as doctors and nurses. For individuals who are uncomfortable with the spiritual or religious aspect of 12-Step groups, there are even groups for agnostics. It is also possible to find ?dual diagnosis-friendly? groups. Teaching Points: AA, NA, and other similar 12-Step groups are usually available and can be accessed at no cost. Members are usually helpful in providing additional information about the availability of support and resources in the community. Although groups follow the same guidelines and principles, there is often considerable variation from group to group as far as attitudes towards other lifestyles and disorders is concerned. In large metropolitan areas, there are many ?specialized? groups. There are gender-specific groups, gay and lesbian groups, HIV groups, and even some groups that cater to a particular occupation, such as doctors and nurses. For individuals who are uncomfortable with the spiritual or religious aspect of 12-Step groups, there are even groups for agnostics. It is also possible to find ?dual diagnosis-friendly? groups.

21. Disadvantages of Traditional 12-Step Groups Focus on abstinence from the start Have a strong spiritual orientation Co-occurring clients may have very different histories from higher functioning members Some members may be hostile to the idea of psychiatric medications Groups may be large and intimidating Co-occurring clients with social skills deficits may have trouble assimilating Teaching Points: Given the fact that there is variation from group to group, it is not surprising that some groups are more welcoming to the issues of co-occurring disorders than others. Issues that may not be met with acceptance include harm reduction, psychiatric medication, and some symptoms of mental illness. Some groups are very large and can be quite boisterous. While some see this energy as uplifting, individuals with co-occurring disorders may find such meetings intimidating and over-stimulating. Lower functioning individuals with poor social skills may find it hard to enter into an established social order leading to feelings of ?difference? and exclusion. It is a good idea to provide coaching and advance preparation to an individual with CODs who is planning to attend a 12-Step group for the first time. Teaching Points: Given the fact that there is variation from group to group, it is not surprising that some groups are more welcoming to the issues of co-occurring disorders than others. Issues that may not be met with acceptance include harm reduction, psychiatric medication, and some symptoms of mental illness. Some groups are very large and can be quite boisterous. While some see this energy as uplifting, individuals with co-occurring disorders may find such meetings intimidating and over-stimulating. Lower functioning individuals with poor social skills may find it hard to enter into an established social order leading to feelings of ?difference? and exclusion. It is a good idea to provide coaching and advance preparation to an individual with CODs who is planning to attend a 12-Step group for the first time.

22. Preparing Your Client for Self-Help Participation Talk with your client about the pros and cons of self-help groups. Try to recommend the most appropriate meeting for your client. Provide coaching on what to expect and general rules of group etiquette. Attend the meeting with the client, if possible, or partner your client with a more experienced group member. Teaching Points: It is a good idea to review the things about the meeting that the client might like as well as the things he or she might not like before the experience. This will prepare the client and make it easier to process the experience after the fact. Make yourself aware of the different meetings in your area. Use this knowledge to guide your client to the best experience. Remember to update your information from time to time. The more information you give your client before the meeting, the less likely he or she is to have a negative experience. You will be able to do this if you have reviewed the 12-Steps and Traditions yourself and become familiar with the unwritten rules of etiquette. If you are unfamiliar with meeting protocol, you can attend a meeting yourself as long as that meeting is designated as ?Open.? Any interested party can attend an open meeting of AA or NA, but only individuals who have a problem with substances can attend a ?Closed? meeting. Co-occurring clients often require some ?handholding? for their first meeting attendance. A clinician can attend open meetings with the client or escort him or her there and back. It is always good if a self-help meeting is held on site. Although the group must be independent of the treatment program, it will benefit from the sense of familiarity and safety engendered by being in a familiar place.Teaching Points: It is a good idea to review the things about the meeting that the client might like as well as the things he or she might not like before the experience. This will prepare the client and make it easier to process the experience after the fact. Make yourself aware of the different meetings in your area. Use this knowledge to guide your client to the best experience. Remember to update your information from time to time. The more information you give your client before the meeting, the less likely he or she is to have a negative experience. You will be able to do this if you have reviewed the 12-Steps and Traditions yourself and become familiar with the unwritten rules of etiquette. If you are unfamiliar with meeting protocol, you can attend a meeting yourself as long as that meeting is designated as ?Open.? Any interested party can attend an open meeting of AA or NA, but only individuals who have a problem with substances can attend a ?Closed? meeting. Co-occurring clients often require some ?handholding? for their first meeting attendance. A clinician can attend open meetings with the client or escort him or her there and back. It is always good if a self-help meeting is held on site. Although the group must be independent of the treatment program, it will benefit from the sense of familiarity and safety engendered by being in a familiar place.

23. Facilitating Successful Self-Help Participation Process the client?s experience after the meeting. Affirm the client for positive participation. Encourage the client to attend a different meeting next time for comparison?s sake. Continue to inquire about your client?s experiences at meetings. Teaching Points: Processing the client?s experience after the meeting will provide an opportunity to give affirmation as well as a chance to get a clear understanding of the client?s level of social skills. Processing can turn a less-than-positive experience into a learning opportunity It is usually a good idea for the new member to attend a variety of meetings in order to match personal preferences to existing resources. Remember to go slow for the lower functioning client. Ongoing encouragement as well as problem solving as the need arises will help assure continued meeting attendance. Teaching Points: Processing the client?s experience after the meeting will provide an opportunity to give affirmation as well as a chance to get a clear understanding of the client?s level of social skills. Processing can turn a less-than-positive experience into a learning opportunity It is usually a good idea for the new member to attend a variety of meetings in order to match personal preferences to existing resources. Remember to go slow for the lower functioning client. Ongoing encouragement as well as problem solving as the need arises will help assure continued meeting attendance.

24. Dual Recovery 12-Step Fellowships Incorporate recovery from mental health disorders into the 12-Step framework, allowing participants to realize the unique benefits of 12-Step groups at the same time they are learning to manage symptoms of both mental illness and substance abuse Teaching Points: Dual Recovery Groups incorporate all of the good points of a self-help group and provide for the needs of the co-occurring client. The expectation is that the individual will have both a mental health issue as well as a substance problem. A person can address both problems openly and receive acceptance and support. Members have experience dealing with the same issues caused by co-occurring disorders. This is an ideal kind of self-help meeting for a treatment program to sponsor. The safety of being in a familiar environment and the feeling that help is available if needed is conducive to attendance and participation.Teaching Points: Dual Recovery Groups incorporate all of the good points of a self-help group and provide for the needs of the co-occurring client. The expectation is that the individual will have both a mental health issue as well as a substance problem. A person can address both problems openly and receive acceptance and support. Members have experience dealing with the same issues caused by co-occurring disorders. This is an ideal kind of self-help meeting for a treatment program to sponsor. The safety of being in a familiar environment and the feeling that help is available if needed is conducive to attendance and participation.

25. Dual Recovery Self-Help Groups Double Trouble in Recovery (DTR): Provides 12-Steps based on a traditional adaptation of the original 12-Steps Dual Disorders Anonymous: Follows format similar to DTR Dual Recovery Anonymous: Provides 12-Steps that are an adapted and expanded version of the traditional 12-Steps, similar to those used by DTR and Dual Disorders Anon. Dual Diagnosis Anonymous: Provides a hybrid approach that uses five additional steps in conjunction with the traditional 12-steps Trainer Note: The Additional Resources Handout tells students how to access a podcast interview with Howie Vogel, the founder of Double Trouble In Recovery. The DTR Web site is also listed in that Handout. Trainer Note: The Additional Resources Handout tells students how to access a podcast interview with Howie Vogel, the founder of Double Trouble In Recovery. The DTR Web site is also listed in that Handout.

26. Trainers Note: Review the pre-test answers (see answer sheet provided at the end of this module) or administer the post-test and collect quizzes. Summarize what was covered in today?s class. Trainers Note: Review the pre-test answers (see answer sheet provided at the end of this module) or administer the post-test and collect quizzes. Summarize what was covered in today?s class.


Other Related Presentations

Copyright © 2014 SlideServe. All rights reserved | Powered By DigitalOfficePro