“These basic principles – the importance of the emotional experience in therapy and the client’s discovery, through reality testing, of the inappropriateness of his or her interpersonal reactions – are as crucial in group therapy as in individual therapy, and possibly more so because the group offers far more opportunities for the generation of corrective emotional experiences.” Irvin D. Yalom, The Theory and Practice of Group Psychotherapy, 5th Ed.

W HAT THE G ROUP C AN D O Reduce shame: Group speaks from lived experience. Therapist is paid to be empathetic. Intervene in transference and projection: Effectiveness of peers at interrupting transference and projection processes Increase motivation for change: “What the group thinks of me” more motivating than what the therapist may think Offer feedback: Clients get to explore the effectiveness of their communication and how they impact others Increase accountability: Group holds client to treatment goals -- “You paid for this”

W HAT THE G ROUP C AN D O Offer 24/7 support: Group members move out of isolation and learn to ask for help Highlight defensive structure: Group interaction gives therapist a much clearer picture of defenses in action Expand problem-solving abilities: More psychologically-minded clients work with more concrete thinkers and at different paces Reality Testing: Group process offers continuous reality testing Modeling: Less defensive group members model vulnerability and emotional risk taking for more defensive

ITC’ S P RIMARY T REATMENT : G ROUP T HERAPY Assessment and Preparation Usually done in three individual sessions When characterological issues emerge  Increased preparation time  Concurrent individual therapy mandated Other issues that alter the three session A&P  Client in crisis  Legal issues  Appropriate group availability

S TAGES OF G ROUP D EVELOPMENT Initial stage:  Members get to know each other  Begin defining goals, both personal and group  Roles, norms, and responsibility begin to be defined  Group depends on the leader for direction Working stage:  Members start defining/attempting to solve problems  Communication of feelings begins  Differences become apparent  Conflict and cooperation develop

S TAGES OF G ROUP D EVELOPMENT Mature:  Development of a group culture  Conflicts able to be resolved  Differences accepted without judgment  Personal responsibility increases Termination Stage:  Evaluation of group experience  Exploration of feelings about group experience

P RINCIPLES OF G ROUP T HERAPY Universality Instillation of hope Imparting information Altruism Imitative behavior Group cohesion Interpersonal learning Development of socializing techniques Recapitulation of the family Catharsis Existential Factors Irvin D. Yalom, The Theory and Practice of Group Psychotherapy, 5th Ed.

G UIDELINES FOR H EALTHY G ROUPS (S EX A DDICTS ) The Four Circles (three from SAA) Group feedback system Group as antidote to isolation; the sharing of fantasy and acting out Facilitation of group disclosures: setting tone, empathy, providing an “open mike” Reality testing and containment of projections

G UIDELINES FOR H EALTHY G ROUPS (P ARTNERS ) Boundaries, boundaries, boundaries Identification of feelings; separating feelings from thoughts Direct versus indirect communication Personal experience, not intellectual ideas or advice Body sensations and present awareness Limit interruptions to process Notice incongruence

ITC G ROUP R ULES Three month commitment required Regular attendance and punctuality necessary Four weeks notice is required on leaving the group Payment requested at beginning of the month No reimbursement for missed sessions Confidentiality: All personal information disclosed in group stays in group Advice among group members is discouraged, unless specifically requested No recreational drugs/alcohol use 24 hours before sessions

C ONTACT O UTSIDE OF G ROUP Connection outside of group for personal support only. Clients agree to no talking about group (including feelings about what goes on in group), other group members and/or group leader If something comes up outside of group that is actually "group business," it is brought back to the group. This keeps the group free of secrets and/or triangulation

D IFFERENCES BETWEEN SA & P ARTNER G ROUPS C ENTRAL C HARACTERISTICS OF A DDICTS C ENTRAL C HARACTERISTICS OF P ARTNERS shame impulsive behavior lack of empathy denial of consequences loss of self ineffective boundaries lack of voice denial of feelings and/or needs

D IFFERENCES BETWEEN SA & P ARTNER G ROUPS A DDICT ’ S G ROUP P ROCESS P ARTNER ’ S G ROUP P ROCESS generally confrontational in style aids in reducing denial increases accountability heightens awareness of consequences identifies triggers encourages use of sober resources generally supportive in style increases self-awareness heightens understanding of feelings and needs models direct communication encourages use of self-care resources

G ROWTH IN THE G ROUP Absenteeism, lateness, termination Preparing a member for group, selecting out Confrontation and avoidance Confidentiality as a matter of group ethics

ITC: A C OLLABORATIVE M ODEL Addict Partner’s Individual Therapist Partner Couples Therapist Partner’s Group Therapist Addict’s Group Therapist Addict’s Individual Therapist

R ESOURCES Bion, Wilfred (1961) “Experiences in groups and other papers” New York: Basic books. Disorders of Self, New Therapeutic Horizons (1995) Edited by James F. Masterson, MD, and Ralph Klein, MD. Brunner/Mazel, Inc. Fischer, R.E (1995). “Group Psychotherapy and Disorders of the Self”. Disorders Of The Self: New Therapeutic Horizons. Edited by James Masterson, M.D. and Ralph Klein, M.D. Brunner/Mazel, Inc. Science and Services Task Force (2007) “Practice Guidelines for Group Psychotherapy”. American Group Psychotherapy Association. Edited by Robert H. Klein, Ph.D.

R ESOURCES Yalom, Irvin (2005) The Theory and Practice of Group Psychotherapy. Fifth Edition. Basic books International Journal of Group Psychotherapy, N.Y: The Guilford Press, published by The American Group Psychotherapy Association The Association for Specialists in Group Work: The International Association for Group Psychotherapy and Group Processes: