UTILIZING GROUP THERAPY IN RELAPSE PREVENTION: An Interpersonal Approach Dr. Ford Brooks, LPC, CADC, NCC Professor and Chair: Department of Counseling and College Student Personnel Shippensburg University
Humility “We pass on what we learn because it’s not ours to keep. We learn to pass it on in order to keep it alive and in doing so, it can help others. I am only a conduit in this journey”
Wisdom Providers in my journey Every client I’ve had/have the honor and privilege to work with… Father Joseph Martin Mickey Thomas Bill, Bob and Lois Dr. Marcia Lawton Terence Gorski Dr. Irvin Yalom And finally…all of my drug and alcohol counseling colleagues
Without Lois, AA might not have happened…and because of lois, family and friends have a fellowship of support
Founder of ADERP-One of the first alcohol and drug educational training programs in the united states
Our journey today • An overview of group therapy-what it is and what it isn’t • Therapeutic Factors in group • Interpersonal vs. psychoeducational groups • Relapse Prevention Method • Utilizing relapse prevention in a group format
Interpersonal therapy Group basics • Is it an open vs. a closed group • 8-10 members-ideal • A facilitator, if your lucky, a co-facilitator too! • 60-90 minutes • Minimize interruptions and have chairs that fit all sizes and shapes of clients and are relatively comfortable.
Psychoeducational group • 10-15 minutes of information presented • 10-15 members • Perhaps an activity • Group discussion about the information and topic • 60-90 min • A facilitator/co-facilitator
Group leader Tasks • Ensure physical survival of group • Help to build a group culture and establish norms • Help group understand here and now work
Two significant concepts in group therapy and therapy in general • Process-story behind the story, what are the group members really saying to each other. What is the underlying process unfolding in the group. • Content-what is actually being said in the group. The data, the stories, the information • It’s the facilitators task to help illuminate the process unfolding within the group and thereby model/teach them to illuminate the process as a group. The facilitator is constantly examining the process as he/she is listening to the content and responding to that as well.
Process and content expanded • As a facilitator you are the process observer and you make comment on that throughout the group • As a facilitator you understand that content are the waves, the process is the current below. • If you are in content, time goes slower. • When you are in process, time moves quickly. • Group is a mixture of both; where you attend to the content and illuminate the process.
Group Leadership skills to facilitate group interaction • Opening and closing group • Drawing members out • Cutting off members and paradoxically having them talk more • Summarizing • Linking-one to two to three group members • Probing/open ended questioning • Challenging • Confronting • Empathizing/affirming • reflecting
Stages of group-Tuckman and Jensen • Forming • Storming • Norming • Performing • Adjourning
Technical expert • Believe in power of group therapy and trust the process • Convince the group to interact with each other and not you as the group leader • Interpersonal Honesty and Spontaneity by the leader • Help facilitate group development. This will vary depending on whether the groups are inpatient, intensive outpatient or partial
Group therapeutic factors-yalom • Instillation of Hope • Universality • Development of the social microcosm • Altruism • The recapitulation of the family unit • Interpersonal learning • Imitative behavior • Imparting information • Group cohesion • Existentiality • Catharsis
What interpersonal group therapy is not • It is not a lecture • It is not a “sage on the stage” • It is not “one-on-one” individual therapy in group • The best leadership is when the group doesn’t realize they are being led. It’s about the group, not the facilitator. • Sometimes facilitators need to sit on their wisdom and help the group come to their own awareness through group interaction.
Relapse prevention in groups • Relapse focused groups and treatment vs. first time treatment clients • Individuals who have attempted sobriety/recovery/abstinence multiple times and not clients who’ve never been in treatment or who have not attempted abstinence or recovery efforts. • The focus with relapsing clients is to help them understand their unique process of relapse warning signs, triggers and potential concomitant mental health issues that impact recovery.
Relapse Prevention-gorski • Assessment • Warning sign identification • Warning sign management • Recovery planning
Grid • Stages of Recovery-where did the person relapse?Is there a pattern? • Avoid/evade or move forward in recovery • High stress behaviors, triggers, internal triggers, external triggers
assessment • Developmental assessment on PDF • Relapse calendar and identification of patterns and other mental health disorders • What was significant in stopping and from their perspective what sparked the relapse • What happened during abstinence and how did you accomplish this • What happened when you relapsed?
4 important questions • What do alcohol/drugs allow you to do or become? • What do alcohol/drugs allow you to avoid or escape? • On a scale of 1-10, how important to you is it to be sober/clean? • On a scale of 1-10, how confident do you feel in becoming abstinent?
Warning sign identification • At your seats, read over the warning signs and check off those which you can relate to when you are in the process of burning out. • Go back after you’ve checked them off and narrow that list to 6 significant warning signs and write them on six slips of paper
Relapse Card creation • On the front write a word or words that describe the warning sign • At the bottom write, “I know I’m in trouble with my recovery when…” and complete the sentence • On the back write: think, feel, act and respond based on the warning sign
Ordering warning signs • Start with the client telling you how they perceived their last relapse occurring • Begin to create/order their relapse cards • Help them with ordering, double check, you are working together • Back track from the first card, “how did you get to the first card?” and continue to back track • This usually leads to pre-using issues and core irrational thoughts and emotions • Review the list
Presenting in group • Clients will have the opportunity to present their cards in group • The group member will sit on the floor if they are able and describe his/her relapse to the group. • The group facilitator will then ask the group to give feedback/questions • Starting with that groups and subsequent groups, members will ask for feedback and suggestion to mitigate and manage warning signs.
Recovery planning • Cards are shared with recovery support people • Sponsor, group members, significant other, friends in recovery and those supportive of recovery, faith support, counselor • Client works with counselor and group on matching recovery planning with relapse warning signs. • Ex: if client indicates idle time on weekends is a warning sign, structured time hour by hour is needed for weekends.
Facilitator skills in a relapse prevention group • Helping client to present warning sign cards • Drawing out other group members for feedback • Helping group members who have presented their cards before, help to support and validate the process. • Help group members explore their own emotions as the cards are presented • Facilitate honest feedback that may be in contrast to what is being presented. Help the group effectively confront each other in a respectful but helpful manner.
comments • Helping relapsing clients share their relapse pattern and story helps with healing and the shame associated with relapse • Not only it is unified as a homogeneous addiction group, it is relapse group which brings about a unique and powerful unification. • Clients learn about patterns as others in the group present their relapse stories • The hope is in the awareness…the hope is, “Now I can see and do what I couldn’t see before”.
Final thoughts • Make this your own • Bill’s spiritual experience supports the light in all of us helping and connecting to others. Group is effective in that way • The steps don’t say “I” they say “we” and “our” • We are social creatures and need each other through group and the fellowship.
References • Brooks, F., & McHenry, B. (2015). A contemporary approach to substance use disorders and addiction counseling (2nd ed.). Alexandria, VA: American Counseling Association. • Flores, P. I. (1997). Group psychotherapy with addicted populations: An integration of twelve-step and psychodynamic theory (2nd ed.). New York, NY: Haworth Press. • Gorski, T. (1989). Passages through recovery: An action plan for preventing relapse. Center City, MN: Hazelden Press. • Tuckman, B. W., & Jensen, M.A.C. (1977). Stages of small group development revisited. Group and Organizational Studies, 2, 419-427. • Yalom, I. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.