Group Treatment With Substance Abusing Clients: A Model of Treatment During the Early Phases of Outpatient Group Therapy (From Chemical Dependency Treatment: Innovative Group Approaches, P 67-80, 1997, L. Donald McVinney, ed. -- See NCJ-170450)

• NCJ Number: 170454
• Author(s): S L A Straussner
• Date Published: 1997
• Length: 14 pages
• Sale Source: Haworth Press, Inc
• Publication Type: Program/Project Description
• Language: English
• Country: United States of America
• Note: DCC. Based on a presentation at The Israeli Congress on Group Therapy, March 16, 1994, in Tel Aviv.

Annotation

This paper discusses the dynamics of substance abusers and presents a treatment model for use during the early phases of outpatient group therapy.

Abstract

Group therapists may find it useful to view substance abusers as individuals for whom drugs and alcohol become a substitute for other objects or people in addition to providing a temporary relief from psychic pain. At the same time, it is important to keep in mind that the chemical effect of drugs and alcohol leads to the use of more primitive defensive operations such as denial, splitting, projective identification, and grandiosity. These secondary defenses, although providing a protective shield, have the negative consequence of further impairing object relations and isolating the substance abuser from meaningful contact with others. Such impairment often leads to further feelings of distrust, anger, deprivation, emptiness, isolation, and susceptibility to narcissistic injury. Moreover, due to a combination of pathological development as well as the chemical effects of drugs and alcohol, the substance abuser may exhibit various defects in other ego functions, such as reality testing, judgment, stimulus barrier, and regulation and control of drives, affects, and impulses. Consequently, substance abusers often show disturbances in interpersonal relationships, as well as in their self care; they lack the ability to use signal anxiety and to protect themselves from internal chaos. The author has found it helpful to conceptualize the early phases of group treatment with substance-abusing clients by using Otto Kernberg's model of supportive therapy, which he developed for use with borderline patients. The components of their tripartite model consists of environmental intervention, clarification and confrontation, and support. The focus of environmental intervention is on curtailing the acting-out behaviors and decreasing anxiety by establishing a predictable structure and setting limits both inside and outside the group. Clarification and confrontation consist of pointing out and explaining the contradictions in behavior between what a person says and does. Support has three components: affective, cognitive, and behavioral. The leader's role is also explained. 23 references