1. Early Stage of Group Treatment getting the client to recognize, admit and move past their high levels of ambivalence and denial.

2. Early Stage of Group Treatment understand the relationship between their addiction and their present difficult in life.

3. Early Stage of Group Treatment rebellious, suspicious and manipulative behaviour

4. Early Stage of Group Treatment During the early stages of treatment the goal of the therapist is to: 1) to discover themselves and others as feeling people 2) identify their defenses

5. Early Stage of Group Treatment Ego Defenses: denial rationalization

6. Early Stage of Group Treatment The art of treating addiction is to overcome the enormous denial and resistance that most addicts possess.

7. Confrontation How confrontation is used is critical ~ there can be constructive and destructive

8. Early Stage of Group Treatment Washton (1992) Guidelines for Effective Confrontation giving feedback as you see it most useful when spoken with empathy, concern, and respectful voice be descriptive (what you observed, give examples) expressing concern about the person’s dangerous and self-defeating behaviour

9. Leaders Responsibility Assessing when to/ not to intervene Allowing some tension for group to grow Helping members assume responsibility for their own drug related problems Modulating anxiety in intense situations Dealing with destructive resistance: fleeing Treating the group as a mirror, microcosm

10. Reinforcing Group Norms Feedback Risk-taking Openness Acceptance Confidentially

11. Impulse Control & Self-Disclosure Manage members difficulties with impulse control Members inexperience in regulating closeness and intimacy Appropriate/inappropriate self disclosure Risk of self-disclosure ~ vulnerability Too little, too much: indiscriminate self- disclosure Tolerance and readiness of the group/individual

12. Integrating New Members in the Open Group Introduce how the group works to new comers No set ways or rituals for integrating new members Impact of new members on group development Impact of relapse and returning members on group process

13. Middle Stage of Treatment Action stage of treatment Awareness of the stages of change for individual members and the group as a whole

14. Middle Stage of Treatment Group leader should consider: Equal distribution of time in group Activity focuses and invites group members to participate Focus on topics that are meaningful Prevents rambling patient from derailing the group Provides a clear direction for the group

15. Corrective Emotional Experience Strong expression of emotion Group supportive enough to permit risk Reality testing of the incident Inappropriateness of certain feelings Inappropriateness of avoiding behaviour Facilitation to interact with others more deeply and honestly (Yalom, 2005)

16. Late Stage Change Emphasis will focus on addressing characterological makeup of the client Helping the person become aware That’s who I am I wnt ot cange but can’t Here I go again Whey change? What is in it for me?