Rehab 4 Addiction

Alongside individual therapy and a full detox, group therapy is one of the most important parts of addiction treatment. It has the capacity to kickstart positive change in those who are in recovery.

In this informational page, we go through what exactly group therapy is (and isn’t), its aims, the structure of a typical group therapy session, advantages and disadvantages of group therapy, and five different kinds of group therapy.

What is group therapy? (A short history)

Group therapy originated in the early 20th century, with an American physician named Dr J. H. Pratt. Pratt held group sessions for patients with tuberculosis, in which he instructed them on how to care for themselves at home.

Pratt found that his sessions were very beneficial for his patients, giving them a sense of community, a supportive environment, and a feeling of identification with others who were going through the same thing.

In the 1950s, he began referring to these sessions as ‘group psychotherapy’.

Over the course of the 20th century, group therapy grew in popularity, eventually entering the mainstream. [1]

It found its way to the UK, where Wilfred Bion and S. H. Foulkes were some of its first practitioners. They used it on soldiers who were suffering from trauma and fatigue due to WWII.

In fact, group therapy owed much of its newfound popularity to the two world wars, which left large swathes of the male population in need of therapy.

What is group therapy? (Definitions)

Group therapy is a form of therapy in which a group of clients are led by a trained therapist in a course of therapy sessions.

These sessions happen regularly: either weekly, or, on a residential treatment programme, they may happen every day.

The number of clients in the group is usually between 6-12. In substance abuse groups, there tend to be between 10 and 12 clients.

The purpose of group therapy is to help clients combat their problems. In the case of substance use disorders, group therapy sessions are intended to provide support, encouragement and sometimes confrontation, in order to overcome denial and to aid the recovery process.

It is important to note that, strictly speaking, 12-step programmes do not qualify as ‘group therapy’. In fact, they differ from group therapy in a number of ways.

For instance, they are not led by a qualified therapist, do not have a limit on attendees, do not typically cost money to attend, do not have as strict an attendance policy as group therapy sessions, and are not designed as therapy so much as ‘support’. [1]

Group therapy can come in various forms. There are five main kinds of group therapy, including skills development groups, interpersonal process groups, cognitive-behavioural groups, support groups and psychoeducational groups.

These will be discussed later on in this article.

Why is there a need for group therapy?

Whilst individual therapy is important for unearthing past traumas and giving those in recovery the kind of intense therapeutic attention which they need, group therapy also serves a number of important roles.

Firstly, it is very important that those in recovery interact with people who are going through the same experience. When managed correctly, this can create a bond which is very powerful in maintaining abstinence and inspiring optimism for the future.

Those in recovery often suffer from isolation – indeed, isolation goes hand-in-hand with addiction – and being part of group is a good way to counteract that.

Second, groups act as microcosms for the wider world.

Those in recovery are not just learning how to overcome their addiction; they are learning how to reassimilate into the world as a member of society.

In some cases, addiction can cause sufferers to withdraw from the world; groups help to reengineer those in recovery so that they can relearn important social skills.

Third, groups combat some of the things that go hand-in-hand with addiction, such as shame and depression. Membership of a group can provide a strong sense of belonging which is often lacking in the lives of those in recovery.

This can improve people’s outlook on the world, which in turn will make them less likely to relapse.

Finally, it is important for those in recovery to have people to inspire them in their struggle against substance abuse.

Being part of a group, some of whose members may have succeeded in being clean for a little while, gives people a sense of hope and solidarity. These are important emotions to foster in those who are going through addiction treatment.

Aims of group therapy

Broadly speaking, these are the aims of group therapy:

  • To provide those in recovery with examples of good and bad behaviours regarding addiction. In a group setting, it is likely that there will be instances of group members sharing things they are doing wrong, such as putting themselves in situations that may cause them to relapse. The hope is that when the therapist or another group member challenges these behaviours, it will cause other members of the group to reflect on their own behaviours and whether they are acting in their own best interests. Conversely, there may also be examples of positive behaviours, such as reconnecting with family or cutting off an abusive relationship, which could inspire group members to make a positive change
  • To provide emotional support. Though emotional support can be given during individual therapy, the presence of a group, all of whom want the best for each other, can make this emotional support much more effective
  • To teach valuable communication skills and social skills. As mentioned above, those in recovery may need to relearn some skills that are associated with being a member of society. Group therapy can play a big part in that learning process

How does group therapy work?

As mentioned above, group therapy sessions are typically comprised of around 6-12 clients and a therapist, and take place fairly regularly, either once a week or daily.

Some therapy groups are open, meaning that new members are welcome to join at any point in the course. Others are closed, which means that only those who began the course can take part.

In a small group, the room will normally be set up with the chairs in a circle. In a bigger group, the chairs may be facing a platform at the front.

At the beginning of a typical session, participants give their names and explain their reasons for coming to group therapy.

The therapist will then determine how the rest of the session plays out. This will depend largely on what kind of group therapy session it is, for example, a cognitive-behavioural group, a support group etc.

A typical activity would be for the members of the group to each share their recent experiences and how they have been coping with their substance abuse disorder. Other activities include problem-solving and trust-building.

Members are allowed to sit out of these activities if they do not feel ready to participate. Some participants may simply want to sit and listen for the first few sessions before they get involved with the activities.

The therapist may also decide to use learning aids such as homework – this is common in cognitive-behavioural sessions – role-playing, visual aids and so on.

Unlike in 12-step programmes, those attending group therapy sessions will be asked to attend a certain number of sessions. This provides a greater level of commitment and ensures a bit more continuity in terms of those who attend the sessions.

Advantages

There are several advantages to group therapy. Here is a list of some of them:

  • Group therapy shows those in recovery that others are going through the same experiences. This gives them a sense of community. Dr Irvin Yalom, one of the most well-respected proponents of group therapy, has termed this effect the ‘principle of universality’ [3]
  • Group therapy gives attendees a network of supportive peers who are encouraging them not to use substances. It also creates a responsibility for them to attend the sessions. Failure to participate makes the therapeutic aspect of the group less successful. Therefore, there is a motivation to continue to attend
  • Those in recovery have an opportunity both to support and be supported in group sessions. The reciprocal nature of relationships in group therapy sessions strengthens bonds between attendees. These bonds help those in recovery not to relapse
  • Groups combat feelings of loneliness among recovering addicts. Loneliness breeds addiction. By reducing loneliness, you help to keep addiction at bay
  • Groups feature a diverse set of people. This allows for a broader set of viewpoints than in one-to-one sessions
  • Groups can be important sites for learning, especially for those who have only recently started the recovery process. Those in recovery may learn faster in group therapy, since the learning points may feel more relatable when applied to others in recovery
  • Groups can resemble families. Those in recovery may not have close relationships with their biological families. Though not a replacement for these relationships, groups can offer something similar
  • Groups are efficient. This may seem counterintuitive: after all, in a group setting each person in recovery gets significantly less of the therapist’s time. However, when managed correctly, group members can act as an extension of the therapist. This means that several people can be receiving therapy at the same time
  • Groups offer confrontation. Sometimes confrontation is useful. Denial goes hand-in-hand with addiction, and groups can combat this
  • Groups provide structure. Addiction thrives on chaos; a weekly or daily therapy session gives attendees a sense of routine which can be very helpful in combating cravings
  • Some find it easier to open up in a group setting. Individual sessions can be intense, whereas a supportive group can help those in recovery to share
  • Group therapy is often cheaper than individual therapy. This can be important for those on a budget, although we would still recommend doing both group therapy and individual therapy if possible, as the two complement each other

Disadvantages

There are also a few disadvantages to be aware of. We go through a few of them here:

  • In group therapy, those in recovery do not get as much focused attention as they would get in individual sessions. This means that group sessions may not be the best setting for going through individual trauma or triggers
  • Some attendees may not actually make changes in their lives. It is possible for group members to either refuse to make any changes or even lie about their progress. This can derail their recovery and that of others’
  • Those in recovery may have personality disorders or mental health problems. This can make for a difficult group dynamic, depending on how it is handled by the therapist
  • It is harder to guarantee confidentiality in a group setting. While a therapist would never reveal something confided to them during therapy (apart from under very specific circumstances), a person in recovery might do so. This is impossible to avoid

Five different kinds of group therapy

In this section, we give a brief summary of the five main kinds of group therapy.

1. Cognitive-behavioural groups

CBT focuses on identifying and modifying negative thoughts. By changing the way those in recovery think, CBT promises to help them avoid relapsing.

It is one of the most common and statistically-supported forms of therapy.

2. Psychoeducational groups

These are all about teaching attendees about addiction, and related topics such as mental health. Rather than members talking about their problems, these sessions offer more of a classroom-style experience.

They can also provide information about how to stay sober, maintaining a healthy lifestyle, avoiding triggers, and techniques such as mindfulness and relaxation.

3. Skill development groups

As the name suggests, skill development groups focus on improving skills required for living a normal, substance-free life.

These can include avoiding triggers, making good decisions about money, controlling anger and social skills. All of these skills are crucial in the real world and their absence can lead those in recovery to relapse.

4. Interpersonal process groups

Interpersonal process groups are one of the most difficult sorts of groups to run, but can also be one of the most effective.

They aid recovery by trying to resolve childhood issues, fostering a good group environment, and drawing lines of connection between past trauma and present substance abuse.

5. Support groups

Support groups foster a supportive atmosphere. Attendees are encouraged to share their experiences and discuss any challenges they may be facing.

The role of the therapist in these groups is simply to listen and to give a good example of supportiveness for other group members to follow.

Final thoughts

In this informational page, we’ve looked at what group therapy is, how it is applied, some advantages and disadvantages, and some of the most common types.

We hope that you’ve learnt something from reading all this, and are better equipped to make a decision regarding treatment for yourself or your loved one.

References

[1] http://americanmentalhealthfoundation.org/books/the-foundations-of-psychodynamic-group-therapy-part-1/

[2] https://www.theriversource.org/aa-12-step-meetings-group-therapy/

[3] https://www.rebelliouswellnesstherapy.com/yalom-s-11-curative-factors