1. UTILIZING GROUP THERAPY IN RELAPSE PREVENTION: An Interpersonal Approach
Dr. Ford Brooks, LPC, CADC, NCC
Professor and Chair: Department of Counseling and College Student Personnel
Shippensburg University

2. Humility
“We pass on what we learn because it’s not ours to keep. We learn to pass it on in order to keep it alive and in doing so, it can help others. I am only a conduit in this journey”

3. Wisdom Providers in my journey
Every client I’ve had/have the honor and privilege to work with… Father Joseph Martin Mickey Thomas Bill, Bob and Lois Dr. Marcia Lawton Terence Gorski Dr. Irvin Yalom And finally…all of my drug and alcohol counseling colleagues

4. Laughter is a symptom of Recovery

5. If you’re not moving forward, you’re going backwards

6. Look for the process of life unfolding

7. Trust God, Clean House, Help others

8. Without Lois, AA might not have happened…and because of lois, family and friends have a fellowship of support

9. Founder of ADERP-One of the first alcohol and drug educational training programs in the united states

10. Our journey today
An overview of group therapy-what it is and what it isn’t
Therapeutic Factors in group
Interpersonal vs. psychoeducational groups
Relapse Prevention Method
Utilizing relapse prevention in a group format

11. Interpersonal therapy Group basics
Is it an open vs. a closed group
8-10 members-ideal
A facilitator, if your lucky, a co-facilitator too!
60-90 minutes
Minimize interruptions and have chairs that fit all sizes and shapes of clients and are relatively comfortable.

12. Psychoeducational group
10-15 minutes of information presented
10-15 members
Perhaps an activity
Group discussion about the information and topic
60-90 min
A facilitator/co-facilitator

13. Group leader Tasks Ensure physical survival of group
Help to build a group culture and establish norms
Help group understand here and now work

14. Two significant concepts in group therapy and therapy in general
Process-story behind the story, what are the group members really saying to each other. What is the underlying process unfolding in the group.
Content-what is actually being said in the group. The data, the stories, the information
It’s the facilitators task to help illuminate the process unfolding within the group and thereby model/teach them to illuminate the process as a group. The facilitator is constantly examining the process as he/she is listening to the content and responding to that as well.

15. Process and content expanded
As a facilitator you are the process observer and you make comment on that throughout the group
As a facilitator you understand that content are the waves, the process is the current below.
If you are in content, time goes slower.
When you are in process, time moves quickly.
Group is a mixture of both; where you attend to the content and illuminate the process.

16. Group Leadership skills to facilitate group interaction
Opening and closing group
Drawing members out
Cutting off members and paradoxically having them talk more
Summarizing
Linking-one to two to three group members
Probing/open ended questioning
Challenging
Confronting
Empathizing/affirming
reflecting

17. Stages of group-Tuckman and Jensen
Forming
Storming
Norming
Performing
Adjourning

18. Technical expert
Believe in power of group therapy and trust the process
Convince the group to interact with each other and not you as the group leader
Interpersonal Honesty and Spontaneity by the leader
Help facilitate group development. This will vary depending on whether the groups are inpatient, intensive outpatient or partial

19. Group therapeutic factors-yalom
Instillation of Hope
Universality
Development of the social microcosm
Altruism
The recapitulation of the family unit
Interpersonal learning
Imitative behavior
Imparting information
Group cohesion
Existentiality
Catharsis

20. What interpersonal group therapy is not
It is not a lecture
It is not a “sage on the stage”
It is not “one-on-one” individual therapy in group
The best leadership is when the group doesn’t realize they are being led. It’s about the group, not the facilitator.
Sometimes facilitators need to sit on their wisdom and help the group come to their own awareness through group interaction.

21. Interactional vs. one-on-one group

22. Relapse prevention in groups
Relapse focused groups and treatment vs. first time treatment clients
Individuals who have attempted sobriety/recovery/abstinence multiple times and not clients who’ve never been in treatment or who have not attempted abstinence or recovery efforts.
The focus with relapsing clients is to help them understand their unique process of relapse warning signs, triggers and potential concomitant mental health issues that impact recovery.

23. Relapse Prevention-gorski
Assessment
Warning sign identification
Warning sign management
Recovery planning

24. Grid
Stages of Recovery-where did the person relapse? Is there a pattern?
Avoid/evade or move forward in recovery
High stress behaviors, triggers, internal triggers, external triggers

25. assessment Developmental assessment on PDF
Relapse calendar and identification of patterns and other mental health disorders
What was significant in stopping and from their perspective what sparked the relapse
What happened during abstinence and how did you accomplish this
What happened when you relapsed?

26. 4 important questions What do alcohol/drugs allow you to do or become?
What do alcohol/drugs allow you to avoid or escape?
On a scale of 1-10, how important to you is it to be sober/clean?
On a scale of 1-10, how confident do you feel in becoming abstinent?

27. Warning sign identification
At your seats, read over the warning signs and check off those which you can relate to when you are in the process of burning out.
Go back after you’ve checked them off and narrow that list to 6 significant warning signs and write them on six slips of paper

28. Relapse Card creation
On the front write a word or words that describe the warning sign
At the bottom write, “I know I’m in trouble with my recovery when…” and complete the sentence
On the back write: think, feel, act and respond based on the warning sign

29. Ordering warning signs
Start with the client telling you how they perceived their last relapse occurring
Begin to create/order their relapse cards
Help them with ordering, double check, you are working together
Back track from the first card, “how did you get to the first card?” and continue to back track
This usually leads to pre-using issues and core irrational thoughts and emotions
Review the list

30. Presenting in group
Clients will have the opportunity to present their cards in group
The group member will sit on the floor if they are able and describe his/her relapse to the group.
The group facilitator will then ask the group to give feedback/questions
Starting with that groups and subsequent groups, members will ask for feedback and suggestion to mitigate and manage warning signs.

31. Recovery planning Cards are shared with recovery support people
Sponsor, group members, significant other, friends in recovery and those supportive of recovery, faith support, counselor
Client works with counselor and group on matching recovery planning with relapse warning signs.
Ex: if client indicates idle time on weekends is a warning sign, structured time hour by hour is needed for weekends.

32. Facilitator skills in a relapse prevention group
Helping client to present warning sign cards
Drawing out other group members for feedback
Helping group members who have presented their cards before, help to support and validate the process.
Help group members explore their own emotions as the cards are presented
Facilitate honest feedback that may be in contrast to what is being presented. Help the group effectively confront each other in a respectful but helpful manner.

33. comments
Helping relapsing clients share their relapse pattern and story helps with healing and the shame associated with relapse
Not only it is unified as a homogeneous addiction group, it is relapse group which brings about a unique and powerful unification.
Clients learn about patterns as others in the group present their relapse stories
The hope is in the awareness…the hope is, “Now I can see and do what I couldn’t see before”.

34. Final thoughts Make this your own
Bill’s spiritual experience supports the light in all of us helping and connecting to others. Group is effective in that way
The steps don’t say “I” they say “we” and “our”
We are social creatures and need each other through group and the fellowship.

35. References
Brooks, F., & McHenry, B. (2015). A contemporary approach to substance use disorders and addiction counseling (2nd ed.). Alexandria, VA: American Counseling Association.
Flores, P. I. (1997). Group psychotherapy with addicted populations: An integration of twelve-step and psychodynamic theory (2nd ed.). New York, NY: Haworth Press.
Gorski, T. (1989). Passages through recovery: An action plan for preventing relapse. Center City, MN: Hazelden Press.
Tuckman, B. W., & Jensen, M.A.C. (1977). Stages of small group development revisited. Group and Organizational Studies, 2,
Yalom, I. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.