Critical Analysis of Group Therapies in Addiction Counseling and Treatment

Critical Analysis of Group Therapies in Addiction Counseling and Treatment

Due to the wide range of characteristics associated with substance addiction, group therapy is the most preferred psychotherapy approach in addiction counseling and treatment (Khantzian et al., 2004). The preference for group therapy is based on cost-effectiveness while also providing clients with valuable life and interpersonal skills that are essential in the recovery process. Despite the importance of group therapy in addiction counseling and treatment, little research has been conducted on the various groups used, with a focus on specific features of each group therapy approach and its benefit in comparison to individual psychotherapy (Washington, 2005). Various groups are essential in the counseling and treatment of substance abuse addiction for the success of group therapy. The current study critically examines the group therapy approach in psychotherapy, taking into account multiple groups applicable to addiction counseling and therapy, as well as their relative advantages and limitations.

Recognizing Group Therapy

According to Khantzian et al. (2004), there are numerous psychotherapeutic counseling and treatment approaches for addiction that employ various groups to achieve specific outcomes. Psycho-educational groups, skills development groups, cognitive-behavioral (CBT) groups, support groups, and interpersonal process groups are the standard groups used in psychotherapy for substance addiction counseling and treatment (CSAT, 2005). There are numerous advantages to using group therapy in addiction counseling and treatment. One of the most significant advantages of group therapy over individual therapy is its lower cost because one therapist can provide counseling and treatment to multiple clients at the same time (Washington, 2005). Previous research found that group therapy was just as effective as individual therapy for addiction counseling and treatment (Marques & Formigoni, 2001; Schmitz et al., 1997; Weiss et al., 2004).

Scheidlinger (2000) discovered that group therapy was more effective than individual treatment in addiction counseling and treatment. However, Tucker and Oei (2007) discovered that group therapy was less cost-effective in CBT, despite the fact that both group and individual therapies had comparable efficacies. Group therapy is also useful for modeling adaptive behavior (Oei, 2007). When a client observes the recovery process of others in a group, they can gain motivation to continue with the hope of improving their life free of addiction. Clients with similar addiction challenges can encourage one another, leading to a successful recovery. Clients can learn maladaptive strategies from one another while also honing their social skills to alleviate anxiety through healthy social interactions, which are critical in reducing emotional distress (Rohsenow et al., 2004). After identifying the potential advantages of group therapy over individual treatment, the research now focuses on the discussion of each group in the group therapy model.

Five Different Group Models

Groups for Psychoeducation

The client seeking addiction counseling and treatment is educated on substance abuse, the related behavior, and its consequences in the psychoeducation therapy group. Lectures, as well as visual and audio methods, are used to teach (Weiss et al., 2004). The information provided during psychoeducation is geared toward self-awareness, options for change and growth, community resource identification, understanding the recovery process, and enrollment in a treatment program (Washington, 2005). Although intrapsychic change occurs, the primary goal of psychoeducation is not to address psychological issues. Psychoeducation aims to increase understanding of behavior as well as the psychological and medical consequences of addiction and substance abuse (Najavits, 2002). The other function of psychoeducation is to prepare clients to enter the recovery-ready stage.

Psychoeducation groups can help patients recover from addiction by combating denial about their addiction, causing maladaptive changes in behavior, increasing their commitment to treatment, and providing supportive behaviors for active addiction recovery. Psychoeducation is used to assist clients in making behavioral changes for adequate improvement, enhancing early recovery, identifying barriers to recovery, and improving their understanding of the condition (Mueller, Petitjean, Boening & Wiesbeck, 2007). Furthermore, the approach assists families in providing the necessary care and management of the addiction required in recovery, and it assists clients in understanding the resources available to them for supporting their recovery in a community setting (Messina, Farabee & Rawson, 2003).

Groups for Skill Development

Although most counselors and therapists use skill development techniques, there is a cognitive-behavioral orientation in the skill development groups. The goal of skill development is to train groups in the skills that people in recovery from addiction need to successfully maintain abstinence (McGovern et al., 2005). The skills can be directly related to substance use or to assisting victims of addiction in maintaining their sobriety (problem-solving, relaxation, or reducing anger or anxiety) (Marques & Formigoni, 2001). Coping skills training is derived from a cognitive theoretical approach to provide clients with life skills that promote successful recovery from addiction. Clients in addiction counseling and treatment require a wide range of interpersonal coping skills, making group therapy an effective natural treatment option (Magura et al., 2002). Due to the wide range of client needs, the skills taught are based on an individual assessment of each client’s characteristics, background, and abilities. The unique skills required for active coping with clients determine an individual’s suitability for skill development.

Because the skills development process is brief, each group should have 8-10 participants to ensure that the counselor can meet the needs of each member. Support and psychoeducation are typically included in skill development sessions, with the primary goal of strengthening and building positive reinforcement of behavior or cognitive ability to address addiction problems (Daley et al. 2002). Psychoeducation focuses on acquiring information relevant to improving coping, whereas support includes elements of both internal and external assistance to sustain change. Leadership skills and styles are required in skill development groups to effectively lead participants to full recovery. The techniques used differ from one member to the next (CSAT 1999). Leisure activities such as biking, swimming, and hiking are important during and after treatment and could be taught as part of skill development. Assertiveness skills, for example, aid in the removal of feelings and perceptions of shame, unworthiness, inadequacy, and low self-esteem.

Groups for Cognitive-Behavioral Studies

Cognitive-behavioral groups, which are essential in the treatment of addiction, are one of the most active types of group therapy. The goal of cognitive-behavioral groups is to conceptualize addiction as a learned behavior by identifying historical experiences that may have encouraged dependence, stimuli linked to addiction, stimuli avoidance, contingency management plans, and response desensitization (Zlotnick et al., 2003). Cognitive-behavioral groups address learned behavior effectively by changing cognitive or thinking patterns, beliefs, and perceptions that aid in the development of social networks for long-term abstinence from addiction. Cognitive processes use a psychological approach that includes thoughts, feelings, assumptions, and decisions (Waldron & Kaminer, 2004). Changing these beliefs is critical for maintaining sobriety and being more productive in eradicating negative thoughts. The counselors’ primary goal is to provide a structured environment for reflecting on historical experiences that may have led to substance abuse or addiction, as well as a useful treatment manual outlining intervention protocols (Vaughn & Howard, 2004). Clients recovering from addiction whose root cause was traumatic experiences such as posttraumatic stress disorder, for example, are likely to benefit from CBT groups by bringing suppressed thoughts and negative feelings to the conscious elements, as well as acquiring self-control skills, functional behaviors, and relapse prevention training (Tucker & Oei, 2007).

There are several important characteristics of cognitive-behavioral groups. To begin, the model is intended to accommodate 24 sessions, with each group consisting of 3-10 members and meeting twice a week for three months, with each session lasting 90 minutes (Tucker & Oei, 2007). Second, it is an early recovery program where the emphasis is on coping skills to control addiction withdrawal symptoms. The approach also employs educational tools and focuses on treating the underlying causes of drug use, substance abuse, and addiction symptoms. The cognitive-behavioral model can also be used to decrease anger, which is a learned behavior (Tiet & Mausbach, 2007). The model is essential for changing cognition (perceptions, thoughts, beliefs, and judgments). The techniques used differ depending on the therapist’s orientation. However, general methods include identifying self-destructive behavior and thoughts that may lead to maladaptive behavior, problem-solving skills, and short-to-long-term goal setting and assisting group members in monitoring addiction-related behavior and feelings (Stephens et al., 2000). Cognitive-behavioral groups aid in the identification of behavioral changes and intellectual insights that are beneficial in the development of self-esteem, confidence, interpersonal relationships, and emotional adequacy.

Groups of Support

Support groups in addiction counseling and treatment stem from the self-help tradition. The ultimate goal of addiction counseling and treatment is an overall lifestyle change. The support groups assist clients in sustaining abstinence by providing unconditional acceptance, open and honest interpersonal interaction, inward reflection, and commitment to change. Smith and colleagues, 2006). Support groups can be directed by a strong leader or problem-focused groups that aid in early recovery through methods such as abstinence, group-directed, or emotional and interpersonal groups (Shearer, 2007). Support groups assist members in developing the necessary strength to overcome addiction symptoms by altering their thoughts and emotions in order to improve interpersonal skills while recovering from substance abuse. These groups are also beneficial in assisting members with their day-to-day living and maintaining abstinence with the goal of improving general self-esteem and self-confidence (Shearer, 2007).

Support groups may be considered process (therapy) groups in some programs, but their primary interest is not in the intrapsychic world, and the goal is not character change. Although process issues may be present, support groups are less complicated, more direct, and have a narrower focus than process groups (Scheidlinger, 2000). Because of the anxiety that may arise, most victims of substance abuse do not seek treatment intervention. Support groups are essential not only during counseling but also in various treatment settings such as inpatient, continuing care, and outpatient. Support groups are founded on various theoretical frameworks, with the 12-step model dominating as a relapse prevention and recovery tool (Sandahl et al., 2004). The group leader’s role is primarily one of reinforcement through a less directive approach. Group leaders employ techniques such as facilitating discussions, maintaining group boundaries, identifying obstacles or conflicts, and offering acceptance to members.

Group Interpersonal Process Psychotherapy

The group process is used as the primary change mechanism in the interpersonal process of group therapy. The interpersonal process of group therapy focuses on the use of psychodynamics to promote addiction victims’ healing and recovery (Winters et al., 2002). A psychodynamic approach is used in interpersonal group therapy to recognize the conflict within a client’s mind that is outside of their awareness and influences behavior positively or negatively (Weiss et al., 2002). Attachment to others is one of the contending forces in addiction counseling and treatment from a psychodynamic perspective by evaluating early childhood developmental issues. The approach assists therapists in re-examining and raising the fundamental developmental issues that members of a group may be experiencing (Rosenblum et al., 2005). A therapist can help addicts by changing dysfunctional destructive patterns with these interventions.

The basic tenets of the psychodynamic approach used in interpersonal process group therapy are based on the assumptions that early (childhood) experiences influence adulthood experiences and behavior, that perceptions destroy reality through generalization, which leads to cognitive distortions, that cognitive and psychological processes outside of a client’s awareness can influence behavior, and that behavior is chosen to adapt to the situation (Rosenblum et al., 2005). Interactions among group members in the present are the focus of the interpersonal process model. This model’s therapists focus on psychological functioning for each group (intrapsychic dynamics), relationships between group members (interpersonal dynamics), and group operation as a whole (group-as-a-whole dynamics) (Rohsenow et al., 2004). Interpersonal process groups aid in the connection of abstinence-based treatment to psychological principles while operating within the framework of the 12-step theory. The method assists addiction victims in the group in recognizing their capacity for developing healthy interpersonal relationships that provide support for recovery.

Conclusion

Addiction counseling and treatment have identified group therapies as critical. Psycho-educational groups, skill development groups, cognitive-behavioral (CBT) groups, support groups, and interpersonal process groups were identified as the primary group therapies. Each of these methods is applied to a specific case based on the therapist’s intentions, interpersonal skills requirements, cognitive elements of thoughts and perception, and specific needs. Group therapies are effective and provide valuable support to addiction clients seeking counseling and treatment, according to the analysis and consideration of techniques used in the study.

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