Stages of Treatment and Process Issues
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC
Executive Director, AllCEUs
Module 3 Goal and Objectives
Provide an overview of how to match clients with groups, depending on clients’ readiness to change and their ethnic and cultural experiences.
~ Match clients with substance abuse treatment groups.
~ Assess clients’ readiness to participate in group therapy.
~ Determine clients’ needs for specialized groups.
Matching Clients With Groups
~ The client’s characteristics, needs, preferences, and stage of recovery
~ The program’s resources
~ The client’s ethnic and cultural experiences
Clients Who May Be Inappropriate
~ Clients who refuse to participate
~ Clients who cannot honor group agreements
~ Clients in the throes of a life crisis
~ Clients who cannot control impulses
~ Clients whose defenses would clash with the dynamics of the group
~ Clients who experience severe internal discomfort in groups
Primary Placement Considerations
~ Level of interpersonal functioning
~ Motivation to abstain (if an addiction group)
~ Stage of recovery
~ Expectation of success
Preparing the Group for New
~ Integrate new clients into the group slowly, letting them set their own pace.
~ Be aware of signs of transference and countertransference between
◦ Clinician and clients
◦ Clients and other clients
~ Watch for signs of increased participation and comfort
~ Distinguish the differences between fixed and revolving membership groups.
~ Prepare clients for groups.
~ Describe the tasks for each of the three phases of group development.
Fixed Membership Groups
~ Members are prepared and stay together for a long time.
~ Membership is stable.
~ Groups are either:
◦ Time limited. Members participate in a specified number of sessions and start and finish together.
◦ Ongoing. New members fill vacancies in a group that continues over a long period.
Revolving Membership Groups
~ New members enter a group when they become ready for its services.
~ Groups must adjust to frequent, unpredictable changes.
~ Groups are either:
◦ Time limited. Member attends a specified number of sessions, starting and finishing at his or her own pace.
◦ Ongoing. Member remains until he or she has accomplished his or her specified goals.
~ Begin as early as the initial contact between the client and the program.
~ Strive to:
•Form a therapeutic alliance between the leader and the client.
•Reach consensus on what is to be accomplished in therapy.
•Educate the client about group therapy.
•Allay anxiety related to joining a group.
•Explain the group agreement.
~ Emphasize that each person may be at a slightly different place in recovery
~ Let new members know they may be tempted to leave the group at times.
~ Recognize and address clients’ therapeutic hopes.
~ Establish the expectations that group members have for one another, the leader, and the group.
~ Require that group members entering a long-term fixed membership group commit to the group.
~ Inspire clients to accept the basic rules and increase their determination and ability to succeed.
Elements in a Group Agreement
~ Communicating grounds for exclusion
~ Physical contact
~ Use of mood-altering substances
~ Contact outside the group
~ Participation in the group
~ Financial responsibility
Preparing the Group To Begin
~ Group agreement review
~ Providing a safe, cohesive environment
~ Establishment of norms
~ Initiation of group work
~ Clients receive feedback that helps them rethink their behaviors and move toward productive changes.
~ Leaders allocate time to address issues, pay attention to relations among group members, and model healthful interactions that combine honesty with compassion.
End Phase of Group: Reaching Closure
~ Putting closure on the experience
~ Examining the impact of the group on each person
~ Acknowledging the feelings triggered by departure
~ Giving and receiving feedback about the group experience and each member’s role in it
~ Completing any unfinished business
~ Exploring ways to continue learning about topics discussed in the group
Module 5 Objectives
~ Discuss the importance of making adjustments.
~ Describe the conditions of the early, middle, and late stages of treatment and possible types of effective groups.
~ Identify leadership characteristics in the early, middle, and late stages of treatment.
Three Stages of Treatment
~ In the early stage of treatment, strategies focus on immediate concerns.
~ In the middle stage of treatment, clients recognize that their problem causes many problems and blocks them from getting the things they want.
~ In the last stage of treatment, clients identify the treatment gains to be maintained and risks that remain.
Condition of Clients in Early Stage
~ Some enter treatment because of health problems.
~ Others begin treatment because they are referred or mandated by the criminal justice system or others.
~ Group members are often in extreme emotional turmoil.
~ Imparting information
~ Corrective recapitulation of the primary family group
~ Imitative behavior
~ Interpersonal learning
~ Group cohesiveness
~ Existential factors
~ Stress that clients have some things in common.
~ Are spontaneous and engaging.
~ Are not overly charismatic.
~ Focus on helping clients:
•Learn ways to manage cravings.
~ Clients experience some stability.
~ Self-knowledge and altruism can be emphasized.
~ Emotions of anger, sadness, terror, and grief may be expressed more appropriately.
~ Clients use the group to explore their emotional and interpersonal world.
Therapeutic Strategies in Middle Stage
~ Cognitive-behavioral interventions provide tools to modulate feelings and to express and explore them.
~ Interpersonal groups are helpful.
~ Help members see how continued drug or alcohol use interferes with what they want out of life.
~ Help clients join the culture of recovery.
~ Support the process of change by drawing attention to positive developments.
~ Assess the degree of structure and connection clients need as recovery progresses.
Condition of Clients in Late Stages
~ Clients work to sustain the achievements of previous stages.
~ Clients may discover and acknowledge that some goals are unrealistic, certain strategies are ineffective, and environments deemed safe are not conducive to recovery.
~ Significant underlying issues emerge (e.g., poor self-image, relationship problems, shame, past trauma).
Therapeutic Strategies in Late Stages
~ The focus of group interaction broadens.
~ A process-oriented group may become appropriate for some clients who can confront painful realities.
~ The group can be used to settle difficult and painful old business.
~ The leader shifts toward interventions that call on clients to take a clear-headed look at their inner world and system of defenses.
~ Late-stage interventions permit more intense exchanges.
~ The leader allows clients to experience enough anxiety and frustration to identify destructive and maladaptive patterns.