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Davies, Jody Messler Ferenczi, Sandor Confusion of Tongues Between Adults and the Child. Freud, Sigmund A Developmental Lag in Technique. Self-Disclosure: Is It Psychoanalytic? Contemporary Psychoanalysis. The Working Alliance and the Transference Neurosis. Psychoanalytic Quarterly , Guntrip, Harry. My Experience of Analysis with Fairbairn and Winnicott. Why Not Long Term Therapy? In Zeig, J. Brief Therapy. Kohut, Heniz The Analyses of Mr. Lipton, S. International Journal of Psychoanalysis , Loewald, Hans On the Therapeutic Action of Psychoanalysis.
International Journal of Psychoanalysis , 41 Loewenstein, R. Meisels, Murray A History of Psychoanalysis in Michigan. What Is Psychoanalysis? How Does It Work? Nagera, Humberto International Review of Psychoanalysis , 2 1 : p. Rapaport, David Clinical Implications of Ego Psychology. In Collected Papers of David Rapaport. Rioch, Janet MacKenzie The Transference Phenomenon in Psychoanalytic Therapy. Illness in the Doctor: Implications for the Psychoanalytic Process.
Journal of the American Psychoanalytic Association , M. Nina Searl Some Queries on Principles of Technique. Smith, Sidney Stein, Martin H. The Un-Objectionable Part of the Transference. The Fate of the Ego in Analytic Therapy. James Strachey The Nature of the Therapeutic Action of Psychoanalysis.
International Journal of Psychoanalysis , Robert S. Wallerstein, Journal of The American Psychoanalytic Association , Articles: Smith, Sidney Child Analysis and Therapy - J. Trauma in the Lives of Children - Kendall Johnson. Click here to view article. A Hunger for Healing - J. Flores Click here for excerpt. Lowinson, Pedro Ruiz, Robert B. Alcoholism Treatment Quarterly , Vol. Against Depression - Peter D. Click here for exerpt.
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Big Deals Craft and Spirit: A Guide to the Exploratory Psychotherapies (Psychoanalytic Inquiry
I Am Also an Alcoholic. Click here for the article. What's Normal? Barrett and Bryan E. Holmes, R. Lieberman, Irvin Yalom, Matthew B. Keenan Group Techniques , 2nd Ed. Cobb, E. Better Him Than Me! Articles: Advances in neuropsychoanalysis, attachment theory, and trauma research- Schore, A. Psychoanalytic Inquiry Vol. Williams and J. Psychoanalytic Psychology Vol. Kluft, American Journal of Hypnosis, Vol. Restoring complexity to the subjective worlds of profound abuse survivors- Hirschman, L. Conversations in Self Psychology A. On the other hand, the interpersonal process group leader observes a variety of group dynamics, such as the stages of group development, how leadership is emerging in the group, the strengths each individual is bringing to the group as a whole, and how individual resistances to change are interacting with and influencing group functioning.
The interventions of the leader are dependent on his or her perceptions of this mix. Even so, leaders in this type of group are not fonts of information, skill builders, problemsolving directors, or client boosters. Yalom recommends an adaptable approach to group treatment, one that allows easily applied modifications across the continuum of the recovery needs of an individual who abuses substances. His model can be tightened to have more structure early in treatment and can subsequently be loosened to relax structure as more abstinent time passes, recovery is solidified, and the danger of relapse decreases.
In practice, group leaders may use different models at various times, and may simultaneously influence more than one focus level at a time. Groups will, however, have a general orientation that determines the focus the majority of the time. This focus is an entry point for the group leader, helping to provide direction when working with the group. Specific techniques of the process group leader will vary, not only with the type of process group, but also with the developmental stage of the group. Early on in group development, process group leaders might consciously decide to be more or less active in the group life.
Craft and Spirit: A Guide to the Exploratory Psychotherapies
They might also choose, based on the needs of the group, to make more or fewer interpretations of individual and group dynamics to the group as a whole. Likewise they might choose to show more warmth and supportiveness toward group members or take a more aloof position. For instance, in contrast to leading a support group, where the leader is likely to be unconditionally affirming, the process leader might make a conscious decision to allow clients to struggle to affirm themselves, rather than essentially doing it for them.
Such choices should be based on the needs of group members and the needs of the group as a whole, rather than the style that is most comfortable for the group leader. Obviously such tactical decisions require a high degree of understanding and insight about group dynamics and individual behavior. For this reason, almost all leaders of process groups will seek supervision and consultation to guide them in making the best tactical decisions in behalf of the group and its members.
When deciding on a model for a substance abuse treatment group, programs need to consider their resources, the training and theoretical orientation of group leaders, and the needs and desires of clients in order to determine what approaches are feasible. While it is beyond the scope of this TIP to provide detailed instruction on how to run each of the different models of groups, the following figures do illustrate the basic differences among the psychodynamic emphases. For additional information on this type of group, see the last section in this chapter.
The reader also may refer to appendix B of TIP 34, a Brief Interventions and Brief Therapies for Substance Abuse [CSAT a ], for a list of resources that can provide further training and information about the theoretical orientations that influence these groups. The individually focused group concentrates on individual members of the group and their distinctive internal cognitive and emotional processes. How the client interacts in the world at large is not on the agenda.
This model is used with a range of technical and theoretical approaches to group therapy, including cognitive therapy, expressive therapies, psychodrama, transactional analysis, redecision therapy, Gestalt, and reality therapy see section below for further discussion of expressive therapies and psychodrama as well as the glossary in appendix D. The group is conceived as an aggregate of individuals in which the group leader generally works sequentially with one group member at a time.
This model of group does not require a client to have insight into a problem but does require awareness of behavior and its immediate causes and consequences. In the more cognitively oriented approaches, clients will focus on their behaviors in relation to thoughts. The more expressive form of individually oriented groups is particularly beneficial for clients who need a structured environment or have so much contained, powerful emotion that they need some creative way of releasing it.
Individually focused groups are useful to identify the first concrete steps in coping with substance abuse. Figure describes how an individually focused group might respond to the conflict described in Figure Interpersonally focused groups generally work from a theory of interactional group therapy, most often associated with the work of Irving Yalom In groups that follow this model, emphasis is placed primarily on current interactions occurring between and among group members.
The group leader monitors the way clients relate to one another, and reinforces therapeutic group norms, such as members responding to each other in an emphatic way. The leader also steps in to extinguish contratherapeutic norms that might damage group cohesion or to point out behavior that could inhibit empathic relationships within the group. Figure describes how an interpersonally focused group might respond to the conflict described in Figure As the name suggests, in this model, the group leader focuses on the group as a single entity or system.
This model generally is inappropriate for clients with substance use disorders—at least as the sole approach to treatment.
It can be harmful, especially to clients new to recovery, and can add to their problems without helping them manage their substance abuse. Certain techniques taken from this approach, however, may be used productively in an eclectic treatment group. These vignettes illustrate the different interventions available. No single approach necessarily is more appropriate than any other. In addition to making the right strategic choice of approach, the interventions should be done at the right time.
Finally, what works for the client without addictions will not always work with a client with addictions. Consequently, the rest of this TIP will be dedicated to exploring the modifications in group technique that need to be made when treating people with substance use disorders. Some of these specialized groups are unique to substance abuse treatment like relapse prevention , and others are unique in format, group membership, or structure such as culturally specific groups and expressive therapy groups.
It would be impossible to describe all of the types of special groups that might be used in substance abuse treatment. Relapse prevention groups focus on helping a client maintain abstinence or recover from relapse. Relapse prevention also can be helpful for people in crisis or who are in some way susceptible to a return to substance use. They also may take the form of psychotherapy. For instance, Khantzian et al. Because relapse prevention groups may use techniques drawn from all of these types of groups, they are considered a special type of group in this TIP.
The different models for relapse prevention groups Donovan and Chaney include those developed by Annis and Davis , Daley , Gorski and Miller , and Marlatt All of these models are derived from principles of cognitive therapy. Some, such as that of Marlatt, classify relapse prevention as a form of skills development; other models tend to emphasize support.
Research has demonstrated that relapse is common and to be expected during the process of recovery Project MATCH Carroll also notes that relapse prevention groups seem to reduce the intensity of relapse when it occurs. Schmitz and colleagues compared relapse prevention for cocaine abuse delivered in group and individual formats. Both demonstrated favorable outcomes; no significant difference was detected in cocaine use as measured by urine tests. Further, McKay et al. Relapse prevention carried out in group settings enables clients to explore the problems of daily life and recovery together and to work collaboratively to isolate and overcome problems.
However, as Schmitz and colleagues note, it may also be the case that the group experience makes members less willing to report the severity of their problems or cause them to feel that their problems are less severe by comparison to those of others Schmitz et al. Leaders of relapse prevention groups need to have a set of skills similar to those needed for a skills development group. However, they also need experience working in relapse prevention, which requires specialized training, perhaps in a particular model of relapse prevention.
Group leaders need to be able to monitor client participation to determine risk for relapse, to perceive signs of environmental stress, and to know when a client needs a particular intervention. Above all, group leaders should know how to handle relapse and help the group process such an event in a nonjudgmental, nonpunitive way—clients, after all, need to feel safe in the group and in their recovery. Leaders should know how to help the group manage the abstinence violation effect, in which a single lapse leads to a major recurrence of the addiction.
Additionally, the leader of a relapse prevention group should understand the range of consequences a client faces because of relapse. The group leader, like any counselor, should know the confidentiality rules 42 C.
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Part 2 and the legal reporting requirements relating to client relapse. Because the purpose of a relapse prevention group is to help members develop new ways of living and relating to others, thereby undercutting the need to return to substance use or abuse, potential group members need to achieve a period of abstinence before joining a relapse prevention group.
Restoring lost cultural ties or providing a sense of cultural belonging can be a powerful therapeutic force in substance abuse treatment, and in important ways, substance abuse is intimately intertwined with the cultural context in which it occurs. Cultural prohibitions against substance use and cultural patterns of permissible use define, in part, what is reasonable use and what is abuse of substances Westermeyer Risk factors such as cultural displacement or discrimination can cause substance abuse rates to rise drastically for a given population.
Problems that pervade particular cultures, such as racism, poverty, and unemployment, have an impact on the incidence of substance abuse and are appropriate focuses for intervention in substance abuse treatment Taylor and Jackson ; Thornton and Carter Effective substance abuse treatment providers thus build personal relationships with clients before turning to the tasks of treatment. Also, at the outset of treatment, personal relationships do not yet exist. Many have commented on the usefulness of these types of groups Trepper et al.
Research is needed to evaluate the effectiveness of culturally specific groups and ascertain the primary indications for their use. Different cultures have developed their own views of what constitutes a healthy and happy life. These ideas may prove more relevant and understandable to members of a minority culture than do the values of the dominant culture, which sometimes can alienate rather than heal. All cultures also have specific processes for promoting wellness among their members.
As long as respect and awareness are evident, the use of such practices will not harm the members of a particular culture. Leadership characteristics and style. Group leaders always need to strive to be culturally competent with members of the various populations who enter their programs.
Clients should be asked what it means to them to belong to a particular group. When in doubt, clinicians should discuss the issue privately with the client. A group leader for a culturally specific group will need to be sensitive and creative. How much authority leaders will exercise and how interactive they will be depends on the values and practices of the cultural group. The group leader should pay attention to a number of factors, all of which should be considered in any group but which will be particularly important in culturally specific groups.
Clinicians should. The SageWind Model for group therapy, discussed in Figure , provides individually tailored interventions for its clients. Different cultures have specific activities that can be used in a treatment setting. Some common elements in treatment include storytelling, rituals and religious practices, holiday celebrations, retreats, and rites of passage practice these may be particularly useful for adolescent clients.
Culturally specific groups work best if all members of the population become involved in the activity, even the clients who are not familiar with their cultural heritage. In fact, the reasons for that lack of familiarity can become a topic of discussion. Helping clients understand what they have lost by being separated from their cultural heritage, whether because of substance abuse or societal forces, can provide one more reason to continue in sobriety.
This category includes a range of therapeutic activities that allow clients to express feelings and thoughts—conscious or unconscious—that they might have difficulty communicating with spoken words alone. Expressive therapy groups generally foster social interaction among group members as they engage either together or independently in a creative activity. These groups therefore can improve socialization and the development of creative interests. Further, by enabling clients to express themselves in ways they might not be able to in traditional talking therapies, expressive therapies can help clients explore their substance abuse, its origins, the effect it has had on their lives, and new options for coping.
These groups can also help clients resolve trauma like child abuse or domestic violence that may have been a progenitor of their substance abuse. For example, Glover states that play therapy and art therapy are particularly useful for substance abuse treatment clients who have been incest victims. Play and art therapies enable these clients to work through their trauma and substance abuse issues using alternatives to verbal communication Glover Although a number of articles have theorized about the usefulness of various types of expressive therapy for clients with substance use disorders, little study on the subject has used rigorous research methods.
Clinical observation, however, has suggested benefits for female clients involved in dance therapy Goodison and Schafer The actual characteristics of an expressive therapy group will depend on the form of expression clients are asked to use. Expressive therapy may use art, music, drama, psychodrama, Gestalt, bioenergetics, psychomotor, games, dance, free movement, or poetry. Expressive group leaders generally will have a highly interactive style in group. The leader of an expressive group will need to be trained in the particular modality to be used for example, art therapy.
Expressive therapies can require highly skilled staff, and, if a program does not have a trained staff person, it may need to hire an outside consultant to provide these services. Any consultant working with the group should be in regular communication with other staff, since expressive activities need to be integrated into the overall program, and group leaders need to know about each client if they are to understand their work in the group.
Expressive therapies can stir up very powerful feelings and memories. Group leaders need to know as well how to help clients obtain the resources they need to work though their powerful emotions. The techniques used in expressive groups depend on the type of expressive therapy being conducted.
Generally, however, these groups set clients to work on an activity. Sometimes clients may work individually, as in the case of painting or drawing. At other times, they may work as a group to perform music. After clients have spent some time working on this activity, the group comes together to discuss the experience and receive feedback from the group leader and each other.
In all expressive therapy groups, client participation is a paramount goal. All clients need to be involved in the group activity if the therapy is to exert its full effect. In addition to the five models of therapeutic groups and three specialized types of groups discussed above, groups can be classified by purpose. In sheer numbers, these groups are the most widespread.
Additionally, problemsolving groups are directed from a cognitive—behavioral framework. They focus on problems of daily life for people in early and middle recovery, helping group members learn problemsolving skills, cope with everyday difficulties, and develop the ability to give and receive support in a group setting.
As clients discuss problems they face, these problems are generalized to the experience of group members, who offer support and insight. Instead, the group helps clients develop effective coping mechanisms to enable them to meet social obligations and to initiate recovery from substance abuse. This kind of group is helpful particularly for new clients; its homogeneity and simple focus help to allay feelings of vulnerability and anxiety.
Leadership characteristics and styles. The group leader usually is active and directive. Other examples are groups that help support people with a specific problem or loss such as breast cancer or suicide in the family , help people alter a particular behavior or trait like overeating or shyness , or learn a new skill or behavior for instance, conflict resolution or assertiveness training. When deciding on a model for a substance abuse treatment group, programs will need to consider their resources, the training and theoretical orientation of group leaders, and the needs and desires of clients in order to determine what approaches are feasible.
The reader may also refer to appendix B of TIP 34, Brief Interventions and Brief Therapies for Substance Abuse CSAT a , for a list of resources that can provide further training and information about the theoretical orientations that influence these groups. Turn recording back on. National Center for Biotechnology Information , U. Search term. Introduction Substance abuse treatment professionals employ a variety of group treatment models to meet client needs during the multiphase process of recovery. This TIP describes five group therapy models that are effective for substance abuse treatment: Psychoeducational groups.
Figure Clients are not thinking about changing substance abuse behavior and may not consider their substance abuse to be a problem. Clients still use substances, but they begin to think about cutting back or quitting substance use. Clients still use substances, but intend to stop since they have recognized the advantages of quitting and the undesirable consequences of continued use. Planning for change begins. Clients choose a strategy for discontinuing substance use and begin to make the changes needed to carry out their plan.
This period generally lasts 3—6 months. Clients work to sustain abstinence and evade relapse. From this stage, some clients may exit substance use permanently. Many clients will relapse and return to an earlier stage, but they may move quickly through the stages of change and may have gained new insights into problems that defeated their former attempts to quit substance abuse such as unrealistic goals or frequenting places that trigger relapse.
Five Group Models Figure summarizes the characteristics of five therapeutic group models used in substance abuse treatment. Psychoeducational Groups Psychoeducational groups are designed to educate clients about substance abuse, and related behaviors and consequences. Some of the contexts in which psychoeducational groups may be most useful are Helping clients in the precontemplative or contemplative level of change to reframe the impact of drug use on their lives, develop an internal need to seek help, and discover avenues for change.
Helping clients in early recovery learn more about their disorders, recognize roadblocks to recovery, and deepen understanding of the path they will follow toward recovery. Helping families understand the behavior of a person with substance use disorder in a way that allows them to support the individual in recovery and learn about their own needs for change. Helping clients learn about other resources that can be helpful in recovery, such as meditation, relaxation training, anger management, spiritual development, and nutrition.
Skills Development Groups Most skills development groups operate from a cognitive—behavioral orientation, although counselors and therapists from a variety of orientations apply skills development techniques in their practice. Provide relapse prevention training Najavits et al. Uses educational devices to promote rapid and sustained learning of material, such as visual aids, role preparation, memory improvement techniques, written summaries, review sessions, homework, and audiotapes of each session.
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Focuses on both disorders, with instruction on stages of recovery to motivate members to achieve abstinence and control over PTSD symptoms Najavits et al. Interpersonal Process Group Psychotherapy The interpersonal process group model for substance abuse treatment is grounded in an extensive body of theory Brown ; Brown and Yalom ; Flores ; Flores and Mahon ; Khantzian et al. Basic tenets of the psychodynamic approach include the following Early experience affects later experience.
Individuals bring their histories—personal, cultural, psychological, and spiritual—to therapy. Sometimes perceptions distort reality. People often draw generalizations from their life experiences and apply the generalizations to the current environment, even when doing so is inappropriate or counterproductive. Psychological and cognitive processes outside awareness influence behavior. As clients become conscious of some formerly subconscious processes supporting a behavior they want to change, this information can be used to alter dysfunctional relationships.
Behaviors are chosen to adapt to situations and protect people from harm. In a sense, people come to therapy because of their solutions, not their problems. This feature is especially important during the early phases of treatment, when the window of opportunity for influencing clients is small and open only briefly.
IPGP is a very adaptable model. Because it can so readily be modified, it can be applied in diverse sets of difficulties and under various circumstances. IPGP furnishes the group leader with a set of strategic tools that are easy to acquire and use. The IPGP model provides enough structure to prevent unproductive discussion. This is especially desirable because few will tolerate a passive group leader who waits for issues to evolve out of the flow of the group.
On the other hand, many people who abuse substances will react negatively to a domineering or authoritarian leader. This generally egalitarian setting helps to reduce resistance. IPGP and substance abuse treatment complement each other, reciprocally setting the scene for the establishment of the crucial components of effective treatment.
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The combination of IPGP and substance abuse treatment allows the client to experience treatment as emotionally supportive. Three group dynamics in practice When deciding on a model for a substance abuse treatment group, programs need to consider their resources, the training and theoretical orientation of group leaders, and the needs and desires of clients in order to determine what approaches are feasible. Joe tells the group that he wants to talk about his distrust of his roommate. Joe is not currently using drugs, but he is still struggling with attempts to control his drinking.
Group members are generally supportive of Joe in his argument with his roommate. They express concern that he is living with someone who is actively using marijuana and other drugs. Jane is struggling with her own abuse of prescription tranquilizers, and she is typically rather quiet and anxious in group. Nonetheless, she attacks Joe verbally with uncharacteristic vehemence. Source : Adapted from Flores Individually focused groups The individually focused group concentrates on individual members of the group and their distinctive internal cognitive and emotional processes.
The group leader might ask Joe to tell the group more about his anger and how he experiences it and might ask him to say why he has difficulty trusting his roommate. The group leader could try to help her see if Joe reminded her of anyone and whether she identified with the roommate because she too had been judged.
Her fears of being judged might be related to her own substance abuse, and the group could explore that possibility. Interpersonally focused groups Interpersonally focused groups generally work from a theory of interactional group therapy, most often associated with the work of Irving Yalom The leader might ask Jane if she can tell Joe directly how his statements have made her feel, and then ask Joe to say how he feels about what she said.
The group leader might also ask Joe if he sees any parallel in his response to both his roommate and Jane. The leader might ask him if Jane could have reported what she felt in a way that would make him feel less defensive. Jane might tell Joe that she is reacting to his judgmental behavior toward his roommate and his evasiveness about his own drinking.
If Jane discloses the reasons behind her response to Joe, namely that her husband distrusts her in a similar manner, the group leader would turn the issue over to the group, perhaps asking Jane how she thinks Joe feels about her. Another group member who has worked on issues concerning trust may interpret what is really going on between Joe and Jane. The goal is to help Joe and Jane deal authentically and realistically with one another, and strengthen the attachment between them.
The leader might note that the group has become very involved in this discussion as a way of evading issues of trust common to the whole group. Is the group perhaps fleeing from dealing directly with trust? The discussion might be redirected toward how the group is coping with feelings of uncertainty about continued substance use. Three cautionary notes These vignettes illustrate the different interventions available.
Relapse Prevention Relapse prevention groups focus on helping a client maintain abstinence or recover from relapse.
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Communal and Culturally Specific Groups Restoring lost cultural ties or providing a sense of cultural belonging can be a powerful therapeutic force in substance abuse treatment, and in important ways, substance abuse is intimately intertwined with the cultural context in which it occurs. Culturally specific practices or concepts can be integrated into a therapeutic group to instruct clients or assist them in some aspect of recovery.
For example, a psychoeducational group formed to help clients develop a balance in their lives might use an American Indian medicine wheel diagram or the seven principles of Kwanzaa. The medicine wheel represents four dimensions of wellness: belonging, independence, mastery, and generosity.
Kwanzaa is based on a value system of seven principles called the Nguzo Saba. Examples might include a group for people with cognitive disabilities, or a bilingual group for recent immigrants. The groups help minority group members understand their own background, cope with prejudice, and resolve other problems related to minority status. Groups described in this TIP fall into this category. Be able to validate and acknowledge past and current oppression, with a goal of helping to empower group members.
The SageWind Model for Group Therapy View in own window In programs that have the resources, the capacity to offer a variety of types of groups addressing a range of client needs is preferred. SageWind in Reno, Nevada, offers more than groups each week. In addition, the clinical team, the client, and any others concerned such as probation or parole officers, parents or legal guardians, or social workers determine the best course of group therapy formats.
Group intervention ranges in intensity from one group per week to more than In a structured program similar to that of a university, where fundamental courses are required before more advanced ones may be taken, clients attend the groups they need, then change to others and progress through the program. Expressive Groups This category includes a range of therapeutic activities that allow clients to express feelings and thoughts—conscious or unconscious—that they might have difficulty communicating with spoken words alone.
Skills Development. Cognitive—Behavioral Therapy. Interpersonal Process. Specialized Group.