Substance abuse treatment Group therapy

208 Pages·2005·0.78 MB·English

Substance Abuse Treatment:
Group Therapy
A Treatment
Improvement
Protocol
TIP
41
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov GROUP
THERAPY
Substance Abuse Treatment:
Group Therapy
This TIP, Substance Abuse Treatment: Group Therapy, presents an
overview of the role and efficacy of group therapy in substance
abuse treatment planning. This TIP offers research and clinical find-
ings and distills them into practical guidelines for practitioners of
group therapy modalities in the field of substance abuse treatment.
The TIP describes effective types of group therapy and offers a theo-
retical basis for group therapy’s effectiveness in the treatment of sub-
stance use disorders. This work also will be a useful guide to supervi-
sors and trainers of beginning counselors, as well as to experienced
counselors. Finally, the TIP is meant to provide researchers and clini-
cians with a guide to sources of information and topics for further
inquiry.
Collateral Products
Based on TIP 41
Quick Guide for Clinicians
DHHS Publication No. (SMA) 05-3991
Printed 2005
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
GROUP
THERAPY
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1
Substance Abuse Treatment:
Group Therapy
Philip J. Flores, Ph.D.
Consensus Panel Chair
Jeffrey M. Georgi, M.Div., CGP, CSAC, LPC, CCS
Consensus Panel Co-Chair
A Treatment
Improvement
Protocol
TIP
41
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857
Acknowledgments Public Domain Notice
Numerous people contributed to the develop- All materials appearing in this volume except
ment of this TIP (see pp. ix, xi, and appendices those taken directly from copyrighted sources
F, G, and H). This publication was are in the public domain and may be repro-
produced by The CDM Group, Inc. (CDM) duced or copied without permission from
under the Knowledge Application Program SAMHSA/CSAT or the authors. Do not repro-
(KAP) contract number 270-99-7072 with the duce or distribute this publication for a fee
Substance Abuse and Mental Health Services without specific, written authorization from
Administration (SAMHSA), U.S. Department SAMHSA’s Office of Communications.
of Health and Human Services (DHHS). Karl
D. White, Ed.D., and Andrea Kopstein,
Electronic Access and Copies
Ph.D., M.P.H., served as the Center for
Substance Abuse Treatment (CSAT) Govern- of Publication
ment Project Officers. Christina Currier
Copies may be obtained free of charge from
served as the CSAT TIPs Task Leader. Rose M.
SAMHSA’s National Clearinghouse for Alcohol
Urban, M.S.W., J.D., LCSW, CCAC, CSAC,
and Drug Information (NCADI), (800) 729-
served as the CDM KAP Executive Deputy
6686 or [phone]; TDD (for hearing
Project Director. Shel Weinberg, Ph.D., served
impaired), [phone], or electronically
as the CDM KAP Senior Research/Applied
through the following Internet World Wide
Psychologist. Other CDM KAP personnel
Web site: www.ncadi.samhsa.gov.
included Raquel Witkin, M.S., Deputy Project
Manager; Susan Kimner, Managing Editor;
James Girsch, Ph.D., Editor/Writer; Michelle Recommended Citation
Myers, Quality Assurance Editor; and Sonja
Center for Substance Abuse Treatment.
Easley, Editorial Assistant. In addition, Sandra
Substance Abuse Treatment: Group Therapy.
Clunies, M.S., I.C.A.D.C., served as Content
Treatment Improvement Protocol (TIP) Series
Advisor. Jonathan Max Gilbert, M.A., Susan
41. DHHS Publication No. (SMA) 05-3991.
Hills, Ph.D., and Mary Lou Rife, Ph.D.,
Rockville, MD: Substance Abuse and Mental
were writers.
Health Services Administration, 2005.
Disclaimer
Originating Office
The opinions expressed herein are the views of
Practice Improvement Branch, Division of
the Consensus Panel members and do not nec-
Services Improvement, Center for Substance
essarily reflect the official position of CSAT,
Abuse Treatment, Substance Abuse and Mental
SAMHSA, or DHHS. No official support of or
Health Services Administration, 1 Choke
endorsement by CSAT, SAMHSA, or DHHS
Cherry Road, Rockville, MD 20857.
for these opinions or for particular instru-
ments, software, or resources described in this DHHS Publication No. (SMA) 05-3991
document are intended or should be inferred.
The guidelines in this document should not be Printed 2005
considered substitutes for individualized client
care and treatment decisions.
ii Acknowledgments
Contents
What Is a TIP?............................................................................................................vii
Consensus Panel ..........................................................................................................ix
KAP Expert Panel and Federal Government Participants....................................................xi
Foreword..................................................................................................................xiii
Executive Summary.....................................................................................................xv
Chapter 1—Groups and Substance Abuse Treatment...........................................................1
Overview......................................................................................................................1
Introduction.................................................................................................................1
Defining Therapeutic Groups in Substance Abuse Treatment....................................................2
Advantages of Group Treatment ........................................................................................3
Modifying Group Therapy To Treat Substance Abuse .............................................................6
Approach of This TIP.....................................................................................................8
Chapter 2—Types of Groups Commonly Used in Substance Abuse Treatment..........................9
Overview......................................................................................................................9
Introduction.................................................................................................................9
Five Group Models .......................................................................................................12
Specialized Groups in Substance Abuse Treatment................................................................29
Chapter 3—Criteria for the Placement of Clients in Groups................................................37
Overview....................................................................................................................37
Matching Clients With Groups.........................................................................................37
Assessing Client Readiness for Group................................................................................38
Primary Placement Considerations...................................................................................40
Stages of Recovery........................................................................................................43
Placing Clients From Racial or Ethnic Minorities .................................................................44
Diversity and Placement.................................................................................................52
Chapter 4—Group Development and Phase-Specific Tasks .................................................59
Overview....................................................................................................................59
Fixed and Revolving Membership Groups...........................................................................59
Preparing for Client Participation in Groups.......................................................................61
Phase-Specific Group Tasks............................................................................................72
Chapter 5—Stages of Treatment....................................................................................79
Overview....................................................................................................................79
Adjustments To Make Treatment Appropriate .....................................................................79
The Early Stage of Treatment..........................................................................................80
The Middle Stage of Treatment ........................................................................................85
The Late Stage of Treatment............................................................................................88
iii
Chapter 6—Group Leadership, Concepts, and Techniques..................................................91
Overview....................................................................................................................91
The Group Leader........................................................................................................92
Concepts, Techniques, and Considerations........................................................................105
Chapter 7—Training and Supervision............................................................................123
Overview...................................................................................................................123
Training....................................................................................................................123
Supervision................................................................................................................131
Appendix A: Bibliography ..........................................................................................137
Appendix B: Adult Patient Placement Criteria................................................................149
Appendix C: Sample Group Agreement.........................................................................151
Appendix D: Glossary................................................................................................153
Appendix E: Association for Specialists in Group Work Best Practice Guidelines..................159
Appendix F: Resource Panel.......................................................................................165
Appendix G: Cultural Competency and Diversity Network Participants...............................167
Appendix H: Field Reviewers ......................................................................................169
Index......................................................................................................................175
CSAT TIPs and Publications........................................................................................181
iv Contents
Figures
1-1 Differences Between 12-Step Self-Help Groups and Interpersonal Process Groups ...................4
2-1 Groups Used in Substance Abuse Treatment and Their Relation to Six Group Models .............11
2-2 Characteristics of Five Group Models Used in Substance Abuse Treatment ...........................13
2-3 Group Vignette: Joe’s Argument With His Roommate.......................................................26
2-4 Joe’s Case in an Individually Focused Group.................................................................27
2-5 Joe’s Case in an Interpersonally Focused Group.............................................................28
2-6 Joe’s Case in a Group-As-A-Whole Focused Group..........................................................29
2-7 The SageWind Model for Group Therapy......................................................................33
3-1 Eco-Map...............................................................................................................38
3-2 Client Placement by Stage of Recovery.........................................................................43
3-3 Client Placement Based on Readiness for Change............................................................44
3-4 What Is Culture? ....................................................................................................45
3-5 Diversity Wheel......................................................................................................46
3-6 When Group Norms and Cultural Values Conflict...........................................................48
3-7 Three Resources on Culture and Ethnicity....................................................................48
3-8 Guidelines for Clinicians on Evaluating Bias and Prejudice...............................................49
3-9 Self-Assessment Guide..............................................................................................50
3-10 Preparing the Group for a New Member From a Racial/Ethnic Minority..............................54
3-11 Culture and the Perception of Conflict........................................................................57
4-1 Characteristics of Fixed and Revolving Membership Groups..............................................62
4-2 The Family Care Program of the Duke Addictions Program..............................................66
4-3 SageWind..............................................................................................................67
4-4 Examples of Agreements About Time and Attendance ......................................................69
4-5 Examples of Agreements About Group Participation........................................................71
4-6 Reminders for Each Group Session .............................................................................74
6-1 Shame..................................................................................................................95
6-2 Confidentiality and 42 C.F.R., Part 2.........................................................................110
6-3 Jody’s Arm ..........................................................................................................121
7-1 How Important Is It for a Substance Abuse Group Leader To Be in Recovery?.....................126
7-2 Does Online Communication Impede Attachment?.........................................................132
7-3 Group Experiential Training....................................................................................133
Contents v

What Is a TIP?
Treatment Improvement Protocols (TIPs), developed by the Center for
Substance Abuse Treatment (CSAT), part of the Substance Abuse and
Mental Health Services Administration (SAMHSA) within the U.S.
Department of Health and Human Services (DHHS), are best-practice
guidelines for the treatment of substance use disorders. CSAT draws on
the experience and knowledge of clinical, research, and administrative
experts to produce the TIPs, which are distributed to a growing number
of facilities and individuals across the country. The audience for the
TIPs is expanding beyond public and private treatment facilities as alco-
hol and other drug disorders are increasingly recognized as a major
problem.
CSAT’s Knowledge Application Program (KAP) Expert Panel, a distin-
guished group of experts on substance use disorders and professionals in
such related fields as primary care, mental health, and social services,
works with the State Alcohol and Drug Abuse Directors to generate top-
ics for the TIPs. Topics are based on the field’s current needs for infor-
mation and guidance.
After selecting a topic, CSAT invites staff from pertinent Federal agen-
cies and national organizations to a Resource Panel that recommends
specific areas of focus as well as resources that should be considered in
developing the content for the TIP. Then recommendations are commu-
nicated to a Consensus Panel composed of experts on the topic who have
been nominated by their peers. This Panel participates in a series of dis-
cussions; the information and recommendations on which they reach
consensus form the foundation of the TIP. The members of each
Consensus Panel represent substance abuse treatment programs, hospi-
tals, community health centers, counseling programs, criminal justice
and child welfare agencies, and private practitioners. A Panel Chair (or
Co-Chairs) ensures that the guidelines mirror the results of the group’s
collaboration.
A large and diverse group of experts closely reviews the draft document.
Once the changes recommended by these field reviewers have been
incorporated, the TIP is prepared for publication, in print and online.
vii