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Group Therapy

Group Therapy For Addictions

Group psychotherapy is a treatment in which a professional applies psychological techniques to a group of patients with a common problem. In this type of psychotherapy, each patient benefits from the specific techniques and interventions of the therapist and the group itself. Group therapy covers many practices: it can be applied to many psychosocial problems, mental disorders and addictions.

Three characteristics define group therapies:

  • Stage
  • The objectives
  • the time frame
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About Therapy

The clinical scenarios

The clinical scenarios of psychotherapy groups can be very varied and will affect the structure and performance of the group.

type of resource

The clinical scenario is usually defined by the type of resource the patient attends.

outpatient clinic,

In an outpatient clinic, the clinical scenario is ambulatory, and the characteristics of the group are relatively homogeneous patients of stable composition who attend voluntarily and meet periodically in the same place.

the therapeutic groups

While on the contrary, the therapeutic groups in a residential setting would have other characteristics: heterogeneous patients, in different phases of treatment, of variable composition as they progress in their treatment and who meet daily in the treatment centre itself. There are also support groups.

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Goals of Treatment

The treatment goals are also variable and must be explicit for all group members. There are groups with various objectives: relapse prevention groups, groups whose objective is absolute abstinence, risk reduction groups, social skills training groups, foster groups, etc.

outpatient group treatments

The time frame is defined by the duration of the life of the group in several sessions and by the duration of the stay of the members of the group. Usually, outpatient group treatments are closed (group members are the same on the first and last day), with a defined objective and a defined duration in a specific number of sessions. In these ambulatory groups, the duration of the group’s life is equal to the expected stay of the members in the group. However, in treatment groups at residential treatment centres, groups tend to persist indefinitely, and group members come and go as they meet goals or progress through their days in the hospital. As with everything, there are exceptions, but this is the most frequent configuration.

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Group psychotherapy is at least as effective as individual psychotherapy in psychiatric disorders (Smith et al., cited from Vinogradov & Yalom, 2010) and in addictive disorders (Weiss et al., cited from Brook, 2011).

Group psychotherapy in public health, where financial cuts have reduced staff in recent years, has the interesting advantage over individual therapy of its magnificent cost-benefit ratio. If one or two therapists can direct a group of 15-20 patients and the benefit to the patient is equivalent to that of individual therapy, the return on the therapist’s time is much greater.

Besides the financial benefits, group psychotherapy has other advantages over individual psychotherapy. Group therapy is based on a powerful therapeutic tool: the group setting. Interpersonal relationships are of great importance in our psychological development and are put into play in this group setting. Treatment in the group therapy format is intended to offer the individual the possibility of collaborating with other patients and obtaining satisfaction from interacting with these people in a context of realistic and mutually rewarding interpersonal relationships. Although this process can also occur in individual therapy, it is in group therapy where it acquires more dynamism because the group setting provides its members with a larger and potentially more powerful interpersonal field. 

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Andre Burns
Group Therapy

How Does Group Psychotherapy Work?

Various authors have proposed a series of factors by which group therapy is therapeutic or curative. Irvin Yalom, emeritus professor of psychiatry at Stanford University and an international reference in group psychotherapy, developed an inventory made up of eleven factors that determine the main therapeutic mechanisms of group therapy.

Instill hope

Receiving a treatment with the hope that it will be effective increases the chances that it will be effective in what you want to treat, as is the case with the placebo effect. In group therapy, as in any treatment, some patients improve, and others do not. In this case, the advantage of group therapy is that patients who do not improve do see other patients improve. Witnessing his improvement favours the patient who has not improved to continue harbouring or hoping to recover as his partner. This effect is achieved in group therapies run by professionals and in support groups offered by associations.

Universality

By universality, we refer to the “universality of experience”; that is, in the group, patients can find other people who have had the same experiences. Commonly, the behaviours associated with the consumption of alcohol and other addictive substances can be shameful and marginal, favouring social isolation and an overwhelming feeling of loneliness. The group offers these people an opportunity for frank and candid social exchange. In addition, they can feel a significant relief when realizing that other people are in the same situation and are not the only ones suffering from the disease and its consequences.

Convey information

Therapeutic groups also allow didactic interventions by the therapist. For example, in relapse prevention groups, the therapist can give general guidelines on what a patient can do in a risky situation where the desire to use again arises. Therefore, therapists teach group members coping mechanisms and relaxation or stress reduction techniques. On the other hand, in the support groups of associations, such as Alcoholics Anonymous, the didactic part is established by reading the experiences of other alcoholics or addicts.

If the didactic interventions come from the therapist, the advice comes from the other group members. It is common that, during group sessions, group members give their opinion and share their experiences with other members who are raising a problem or a specific situation.

Altruism

The help that patients give to each other in group therapy is not possible in individual therapy. This altruistic help to others who need help allows the patient to feel she can give something to others. Moreover, it makes you realize that you have much to offer other people, unlike how you probably thought before joining the group. This altruistic help experience is gratifying for people and increases the self-esteem of those who help. In addition, it helps patients see that they are not alone in the world, that other people also have needs, and that they can help them meet them. This therapeutic factor of altruism is unique to group therapy since patients in individual therapy rarely feel useful to the therapist.

Development of socialization techniques

In all treatment groups, there is, to a greater or lesser extent, social learning in the form of acquiring basic social skills. Depending on the type of group and the group’s objectives, these social skills will be acquired by mere social interaction under the supervision of the therapist, or they will be objectives in themselves and worked on through didactic interventions. The group look can transmit sincere feedback that offers each patient information, allowing them to deepen their maladaptive behaviours and responses.

Imitative behaviour

Patients who attend group therapy can incorporate those behaviours, reasoning, or emotional responses that they see in the therapist or other patients. This is what is known in psychology as vicarious learning.

Catharsis

Catharsis, which expresses intense repressed emotion, is not therapeutic, although the classical Greek translation is purification. What can be therapeutic is sharing feelings, thoughts or opinions in a group where the subject feels accepted, not judged or questioned. Therefore, the mere act of expressing a strong negative emotion is not, in itself, therapeutic, but feeling accepted by others when expressing them is very useful to people.…

Andre Burns
Corrective Recapitulation

Corrective Recapitulation of the Primary Family Group

The relationships that the patients establish with the therapist and the other group members will recreate, in one way or another, the primitive relationships of the patient with his nuclear relative. For example, a male patient with an authoritarian father may view the therapist (a male of similar age to his father) as rigid and restricting the group’s freedom, as he thinks his father would. Or a female patient whose parents were negligent in caring for her in childhood may feel abandoned or rejected by the other group members when they do not ask her how she is after a day away sick. The therapist’s mission is to recapitulate these scenarios correctly, in addition to encouraging patients to experience new behaviours and find an explanation for the old ones.

Existential factors

In therapy groups geared towards helping people with chronic illnesses, such as cancer, or in bereavement groups, these existential factors (such as talking about death or the meaning of life) sometimes play a central role in therapy. In group therapy for addictions, it has been seen that the meaning of life is a very important factor to consider when working with addicts. Many patients have gone through very difficult situations, and the addiction has been able to truncate their plans and life expectations. Recovering or giving meaning to their lives can be very important in the face of their recovery.

Group cohesion

Group cohesion is for group therapy, as the therapist-patient relationship is for individual therapy. A cohesive group is one in which its members accept and support each other and form meaningful relationships among its participants. Cohesive groups achieve better therapeutic results than non-cohesive groups (Budman et al., cited in Vinogradov and Yalom, 2010). It is common for people who suffer from serious addictions to go years without feeling like a valued group member, so this group experience can be therapeutic. In addition, it lays the foundations for establishing similar relationships, of cohesion and integration, in other social groups outside of therapy and thus, expanding the social circles of the members of the therapeutic group.

Group cohesion favours acceptance and understanding among group members. This, in turn, facilitates emotional expression and candour among group members. Sincerity will be a source of feedback so that each member becomes aware of aspects of her personality that she may want to change.

Interpersonal learning

Interpersonal relationships contribute to personality development and are involved in the origin of psychopathology and current symptoms. Each group member’s current problems are greatly influenced by their interpersonal relationships. The same relationship problems that each individual has outside the group will begin to manifest, sooner or later, in the group. If the group offers its members a safe and sincere environment, this will help those interpersonal interactions that take place within the group become corrective emotional experiences.

So powerful is the interaction that can be observed between the members of the group that it is hardly necessary for the patients to report current difficulties or recount their past. The very interpersonal interaction observed in the therapeutic group can provide this information to therapists.

The corrective emotional experience within the group therapy allows us to take out of the therapy to the daily life what was learned in it. Putting these newly learned behaviours into practice favours the integration and assimilation of these experiences. Finally, the patient can realize her potential to change his way of being, behaving, reacting, etc and acquire, therefore, greater self-efficacy.

 The group psychotherapist

Usually, the therapeutic group is led by a main therapist who is assisted by a co-therapist. The therapist also has an active role in therapy. Both of you must be neutral, sincere, flexible and understanding; In addition, they must avoid situations during the sessions where there may be disqualifications among the group members. The fact that there are two therapists has great advantages compared to only one (Fernandez et al., 2007):

  • The continuity of the group if one of the two therapists cannot attend.
  • The possibility of one of the two dealing with an interpersonal conflict between two patients or taking care of a particular patient or group of patients who may engage in more hostile or disruptive behaviour.
  • At the end of the therapeutic session, both therapists can meet to discuss what happened that day in the group and plan the following sessions. “Four eyes see more than two”.

Therapists are responsible for favouring a group climate of respect, collaboration, understanding and active participation of everyone who makes it up. To achieve this climate, the therapist must have specific training in psychotherapy and, specifically, in group psychotherapy, must gather clinical experience and have a deep knowledge of the disease that the patients share (in this case, addiction).

The therapist is expected to have certain personal skills and aptitudes: to be trustworthy, even-tempered, empathetic to others, to have a good sense of humour (without going overboard), and to have a strong sense of self. His participation during group therapy sessions has to be active, helping group members to maintain the focus of treatment within a structure and norms established in the group’s therapeutic contract. In this way, the group therapist maintains the cohesion and stability of the group. The therapist often relies heavily on the “here and now” to help patients overcome the painful consequences of addictive disorders, such as psychosocial problems, medical illnesses, and associated mental disorders (Brook, 2011).

A group therapist has to pay particular attention to the following aspects of treatment (Brook, 2011):

  • The adequate selection of patients for each group.
  • The preparation of the group members before starting the group sessions.
  • The establishment and maintenance of a structure and security for the group.
  • The use of constructive confrontation during the therapeutic process of the group.
  • The specific intervention of the group therapist

.Group therapies for patients who are in different phases of their addiction

Patients in an active consumption phase would not benefit from a relapse prevention group. Other types of groups are recommended for these patients. Host groups or abstinence preparation groups are often offered. It has different objectives and different structures.

On the other hand, in some patients in whom absolute abstinence has not been possible, harm reduction group therapy may be offered. The main objective is not abstinence but reducing consumption to minimize or reduce the physical, social, family, personal and economic consequences of consumption on the patient. Once they have reduced consumption, are exposed to fewer risk situations and have seen their quality of life partially improve by reducing consumption, they decide to seek a more ambitious goal: absolute abstinence.

Group therapies for homogeneous populations

Certain populations, such as adolescents, the elderly, abused women, people from minority ethnic groups, and immigrants who speak other languages ​​or from other cultures, may benefit from specific groups. These groups with greater homogeneity among their members allow greater group cohesion and specific issues inherent to their particular situation. For example, adolescents have concerns related to the stage of life they are in, such as their sexual development, their academic future, and romantic relationships.…

Andre Burns
Group Therapy

Differences Between Group Therapy And Mutual Support And Self-Help Groups

Support groups, such as 12-step communities (Alcoholics et al., for example), take advantage of some of the healing potential of group therapy, but they do not take full advantage of it. A demanding educational background in group therapy and years of experience are necessary to take full advantage of the above benefits. Support groups offered by associations offer much to patients but cannot be matched or replaced by professional groups. Lack of experience and training can lead inexperienced therapists to react intuitively by adapting their poor knowledge or experience (not their professional experience).

There are indeed few psychotherapists with solid postgraduate training in group therapy and extensive addiction experience. Many therapists trained in group therapy have no addiction training, and vice versa. Group therapy is also used to treat other psychiatric disorders and symptoms; For example, there are groups on stress and anxiety reduction, obsessive-compulsive disorder, depression, grief, psychosis, anorexia nervosa, bulimia nervosa, binge eating disorder, etc. Each diagnostic category has some peculiarities and specific needs that are convenient. Group therapy for grieving people is different from those with psychosis or addictions. Therefore, addiction group therapists need to be specialized in group therapy and addiction.

Even within addictions, there are different stages. The needs of people thinking of giving up drinking differ from those of people who have been abstinent for more than six months. Therefore, the groups can be classified according to the phase of addiction in which the patients are. However, in mutual support and self-help groups, patients in different phases of their illness and recovery meet.

Likewise, there are differences between substances consumed. Generally, the needs of a person who uses intravenous heroin are different from those of a person who drinks alcohol or a person who is addicted to playing online poker. For this reason, and here it does coincide with mutual support and self-help groups, people are usually divided into groups by substance.

In group therapies, classifications are usually made according to age. For example, it is common for adolescents and young adults to be in a different group than middle-aged people. It is logical to think that the ideology of an adolescent, his sense of life, his concerns and his aspirations have little to do with those of a middle-aged person. On the contrary, no distinctions are usually made about the age of those attending the meetings in mutual support and self-help groups.

Finally, some populations may have specific needs, and making specific groups with people who belong to this population is required. For example, groups are made with people who have addiction and HIV, with people who have an addiction and a mental illness, with people who have an addiction and are homosexual, with people who have an addiction and are at risk of social exclusion, etc. However, associations’ self-help and mutual support groups rarely make these distinctions. This is good on the one hand because it does not exclude anyone and accepts everyone equally. However, on the other hand, it may not cover the special needs of these populations that may require addressing certain issues more specifically.

Multifamily group therapies

Multifamily therapy is halfway between family therapy and group therapy. It means bringing patients with the same condition and their families together in the same space. These groups have very complex interactions and are difficult to manage, but they can be very useful for patients and their relatives who suffer from the disease in the background. These groups aim to improve family dynamics, especially about the patient’s main problem: addiction.

Patients with addictions to alcohol or other drugs tend to externalize their discomfort with actions (acting out) precisely with their consumption that everyone sees. However, family members who are not users tend to go unnoticed, hiding their pathology from others and not externalizing it (acting in). Non-consuming family members learn that it is preferable to go unnoticed in a dysfunctional family environment without provoking the consuming family member, who usually acts by consuming more or presenting behaviour problems. Family group therapists must be alert to identify these family members because they can also suffer from many discomforts and, sometimes, mental disorders such as depression or anxiety.

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Andre Burns

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