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Effective Group Approaches for Co-Occurring Clients

Effective Group Approaches for Co-Occurring Clients. Presented by Jill S. Perry, MS, NCC, LPC, CAADC, SAP March 8, 2019. JP Counseling & Associates, LLC Healing for Adults, Youth and Families. JP Counseling Healing for Adults, Youth and Families. What does COD Look Like?.

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Effective Group Approaches for Co-Occurring Clients

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  1. Effective Group Approaches for Co-Occurring Clients Presented by Jill S. Perry, MS, NCC, LPC, CAADC, SAP March 8, 2019 JP Counseling & Associates, LLCHealing for Adults, Youth and Families

  2. JP CounselingHealing for Adults, Youth and Families

  3. What does COD Look Like? JP CounselingHealing for Adults, Youth and Families

  4. Stigma JP Counseling & Associates, LLCHealing for Adults, Youth and Families

  5. Quick Review

  6. In the past, the attitude was that the client with COD was the exception. • Today, we recognize that COD is common among our populations and that clinicians should be prepared to demonstrate responsiveness to the requirements clients with COD present. JP CounselingHealing for Adults, Youth and Families

  7. Most Common Drugs of Abuse

  8. Today’s Plan of Action

  9. Group Therapy • Studies over the last 30 years have shown the growing benefits of group psychotherapy in a number of areas of life challenges.  • Through groups, individuals find a forum of peer support, gaining strength as they share their feelings and experiences with others who are facing the same obstacles as themselves.  • Some gain strength in seeing the resourcefulness of those in the same situation, while others renew their feelings of self-worth through assisting others.

  10. Group Therapy • During the group process, people develop a support network through each other—no longer feeling isolated by their condition and gaining a greater sense of normalcy. • Group is more cost-effective compared to individual therapy. When a therapist’s time is spent with a whole group instead of one person, the expense for individuals is significantly reduced while the benefits remain and, in some cases, prove to be even greater.

  11. Group Therapy • Substance Use Disorders • Mental Health Diagnoses • Co-occurring Disorders JP CounselingHealing for Adults, Youth and Families

  12. Group Therapy • Cancer Patients • HIV/AIDS Patients • Youth Violence JP CounselingHealing for Adults, Youth and Families

  13. Group Therapy • National Institute of Drug Abuse (NIDA) • National Institute of Alcoholism and Alcohol Abuse (NIAAA) • Both require that group therapy be a part of SU Treatment JP CounselingHealing for Adults, Youth and Families

  14. Advantages of Group Therapy • Mutual identification with and acceptance from others going through similar problems as they learn they are not alone or unique as they struggle with their symptoms, moods, cravings and behaviors • Positive peer support regarding the abstinence or reduction of substance use or behavior changes to improve mental health JP CounselingHealing for Adults, Youth and Families

  15. Advantages of Group Therapy • Role modeling for abstinence or reduction of substance use is enhanced because the substance abuser has the opportunity to better understand their own attitudes about substance use and their defenses against giving up or reducing substance use by confronting similar attitudes and defenses in others • Affiliation, cohesiveness, social support while learning to identify and communicate feelings more directly JP CounselingHealing for Adults, Youth and Families

  16. Advantages of Group Therapy • Structures, discipline and limit setting while permitting experiential learning and exchange of factual information about recovery and drug use • Installation of hope, inspiration for the future and the pursuit of shared goals and ideas JP CounselingHealing for Adults, Youth and Families

  17. Clench & Release

  18. Basic Principles of Effective Group Therapy • Welcoming clients with co-occurring disorders into substance abuse group instead of excluding them because of a psychiatric condition • Giving the addictive disorder and the co-occurring psychiatric disorder the same level of attention and care during the group process

  19. Basic Principles of Effective Group Therapy • Addressing both the mental illness and the substance use disorder as chronic, relapsing conditions that require long-term support • Ensuring that care is provided by a treatment team that’s trained in addressing co-occurring disorders • Treating all clients with dignity and respect, even if they are in the midst of a mental health or substance use crisis

  20. Therapeutic Factors in Group Therapy (Yalom) • Installation of Hope • Universality • Imparting Information • Altruism (story of heaven & hell) • The Corrective Recapitulation of the Primary Family Group • Developing of Socializing Techniques • Imitative Behavior

  21. How do you know when you have a cohesive group?

  22. Signs of Group Cohesiveness • Try harder to influence other group members • More open to influence by the other members • More wiling to listen to others and more accepting of others • Experience greater security and relief from tension in the group • Participate more readily in meetings • Self-disclose more • Protect the group norms and, for example, exert more pressure on individuals deviating from the norms • Less susceptible to disruption as a group when a member terminates

  23. Group Cohesion • Those who improved significantly reported: • They felt accepted by the other members • Perceived similarity of some kind among group patients • Made specific references to particular individuals when queried about their group experience

  24. Goals for Constantly Changing Groups • Engaging the patient in the Therapeutic Process • Talking Helps • Problem Spotting • Decreasing Isolation • Being Helpful to Others • Alleviation of Treatment-Related Anxiety

  25. Some Topics may be Too Difficult for Group Therapy • Culture • Cohesion • Dynamics JP CounselingHealing for Adults, Youth and Families

  26. Some Clients are Less Able to Benefit from Group Therapy • Clients with cognitive problems that interfere with problem solving, social skills, or managing multiple sources of stimulation • Clients with active psychosis whose delusions or hallucinations interfere with their ability to tolerate the stimulation of multiple others, or whose unusual behavior would frighten group members • Clients who are very angry or who have impulse control problems and cannot manage their emotions well enough to tolerate the presence of others without becoming hostile or aggressive

  27. Some Clients are Less Able to Benefit from Group Therapy • Clients with severe social phobia who have not been prepared for participation in group through a period of individual treatment • Clients experiencing significant withdrawal symptoms or on medications that produce an inability to maintain alertness during group • Clients with medical problems who cannot remain seated for the required time due to fatigue, pain, or other issues

  28. Problem Patients

  29. The Monopolist • Compulsive speech is often a way to deal with anxiety or control conversation in order to avoid certain topics • Some Monopolists are aware and some are not • Initially may be welcome and even encouraged by others • Eventually turns to frustration and anger for other group members • Detrimental impact on group cohesion JP CounselingHealing for Adults, Youth and Families

  30. The Monopolist • Therapeutic Considerations: • Initially wait for a group member to confront the person • Eventually therapist must address the issues considering both the monopolizing patient and the group • Remember that no monopolistic patient exists in a vacuum • Your goal is not to silence the monopolist rather to hear less from them • Enlist the patient as an ally in the therapeutic work • Help the monopolist generalize beyond the group

  31. The Silent Patient • Opposite of the monopolist • Less disruptive but equally as challenging • Minimal, if any, benefit to the silent patient • Possible dread of self-disclosure, conflict about aggression, perfectionism, superiority to maintain distance JP CounselingHealing for Adults, Youth and Families

  32. The Silent Patient • Therapeutic Considerations: • Comment on nonverbal behavior • Encourage others to reflect on their perception of the silent patient • Utilize individual sessions to address behavior and build skills for group

  33. The Help Rejecting Complainer • Pervasive for some; reaction to particular stress for others • Requests help from the group by presenting a problem or complaint then rejecting any help offered • Seems to take pride in insolubility of the problems • Seems self-centered and superficial

  34. The Help Rejecting Complainer • Group members become bored and irritated then frustrated and confused • Conflict between dependency and distrust toward authority JP CounselingHealing for Adults, Youth and Families

  35. The Help Rejecting Complainer • Therapeutic Considerations: • Don’t confuse the help requested for the help required • Do not show frustration; this continues the cycle • Provide empathy without nurturing or offering resolution JP CounselingHealing for Adults, Youth and Families

  36. The Self-Righteous Moralist • Priority is to be right and to demonstrate that others are wrong • Not usually concerned about being liked or respected • Group members become resentful quickly • Therapeutic Considerations: • Address underlying shame and feelings of failure

  37. The Narcissistic Patient • Loving oneself to the exclusion of others • Soloists who experience the world and others in it existing solely for them • Lack awareness or empathy for others • Therapeutic Considerations • Do not focus on how he got to be this way; instead focus on the current forces that influence how he relates to others • Helpful to others to work on confronting his behaviors • Good role modeling for non-assertive people

  38. The Boring Patient • Often subjective • Extremely inhibited, lacks spontaneity, never takes risks • Participation is always “safe” and predictable • Usually tolerated by the group • Core dependent personality fearing rejection and abandonment • Confuses healthy self-assertion with aggression

  39. The Boring Patient • Therapeutic Considerations • Encourage group cohesiveness allowing the boring patient to reveal more about himself • Remember that your task is to explore with the patient why he has squelched his creative, vital and spontaneous parts as opposed to injecting those traits into him

  40. The Borderline Patient • Self-destructive impulsivity • Unstable and intense interpersonal relationships • Instability of mood • Chronic feelings of emptiness or boredom • Often easier to deal with in group then in individual therapy (*)

  41. The Borderline Patient • Therapeutic Considerations: • Primary advantage to group is powerful reality testing provided by ongoing feedback and observations from others • Potential for nontherapeutic transference distortions are minimized by other members participation • Recognizing positive aspects of self in others

  42. Group Rules

  43. Group Rules 1

  44. Group Rules (2)

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