Theinterpersonalprocessgroupmodelfor substanceabusetreatmentisgroundedinan extensivebodyoftheory(Brown1985;Brown andYalom1977;Flores1988;Floresand Mahon1993;Khantzianetal.1990;Matano andYalom1991;Vannicelli1992;Washton 1992).Eventhissharplydefinedareaofpro- cess-orientedgrouptherapiesiswidelydiverse. Psychodynamicgrouptherapiescanbethought ofasagenericnameencompassingseveralways oflookingatthedynamicsthattakeplacein groups.Originally,thesedynamicswereconsid- eredinFreudianpsychoanalytictermsthat placedaheavyemphasisonsexualandaggres- sivedrives,andconflictsandattachments betweenparentsandchildren.Overthepast halfcenturymanyresearchers,suchasJung, Adler,Bion,Noreno,Rogers,Perls,Yalom, andothers,expandedorchangedtheFreudian emphasis.Asaresult,currentdynamicconcep- tualizationsincludeheavyemphasisonthe socialnatureofhumanattachment,rivalryand socialhierarchies,andculturalandspiritual concerns(i.e.,existentialissuesandquestions
Types of Groups Commonly Used in Substance Abuse Treatment 22
offaith).Thistherapeuticapproachfocuseson healingbychangingbasicintrapsychic(within aperson)orinterpersonal(betweenpeople) psychologicaldynamics.
Thus,astudentofprocess-orientedgroupther- apy,agrouptreatmentapproachthatusesthe processofthegroupastheprimarychange mechanism,soonlearnsthatthewayBion (1961)taughtgrouptherapywillbefardiffer- entfromthewayotherrecognizedauthorities, suchasWolfandSchwartz(1962),taught. Thesetheoristsinturndifferfromtheprocess- orientationexemplifiedbyDurkin(1964)or Glatzer(1969).Themanytheoreticalvariants differinwhattheypaymostoftheirattention toasgroupmembersinteract.
0URPOSEæInterpersonalprocessgroupsuse psychodynamics,orknowledgeofthewaypeo- plefunctionpsychologically,topromotechange andhealing.Thepsychodynamicapproachrec- ognizesthatconflictingforcesinthemind, someofwhichmaybeoutsideone’sawareness, determineaperson’sbehavior,whetherhealthy orunhealthy.Attachmenttoothersisoneof thecontendingforces.Fromapsychodynamic pointofview,startinginearlychildhood, developmentalissuesareakeyconcern,asare environmentalinfluences,towhichcertainpeo- pleareparticularlyvulnerablebecauseoftheir geneticandotherbiologicalcharacteristics.For thosepeoplewhohavebeendrawntosubstance abuse,theinterpersonalprocessgroupraises andre-examinesfundamentaldevelopmental issues.Asfaultyrelationshippatternsareper- ceivedandidentified,thegroupparticipant canbegintochangedysfunctional,destructive patterns.Thegroupmemberbecomesincreas- inglyabletoformmutuallysatisfyingrelation- shipswithotherpeople,soalcoholanddrugs losemuchoftheirpowerandappeal.
Basictenetsofthepsychodynamicapproach includethefollowing
•Earlyexperienceaffectslaterexperience. Individualsbringtheirhistories—personal, cultural,psychological,andspiritual—to therapy.
•Sometimesperceptionsdistortreality.People oftendrawgeneralizationsfromtheirlife experiencesandapplythegeneralizationsto thecurrentenvironment,evenwhendoingso isinappropriateorcounterproductive.These “cognitivedistortions”mayservetomaintain habitspeoplewouldotherwiseliketochange. •Psychologicalandcognitiveprocessesoutside
awarenessinfluencebehavior.Asclients becomeconsciousofsomeformerlysubcon- sciousprocessessupportingabehaviorthey wanttochange,thisinformationcanbeused toalterdysfunctionalrelationships.
•Behaviorsarechosentoadapttosituations andprotectpeoplefromharm.Aspecific behaviorisaperson’sbestefforttoadaptto aparticularsituationgivenindividualmake- up,environment,andpersonalhistory.Ina sense,peoplecometotherapybecauseof theirsolutions,nottheirproblems. Withintheinterpersonalprocessmodel,the objectsofinterestarethehere-and-nowinter- actionsamongmembers.Oflessimportanceis whathappensoutsidethegrouporinthepast. Alltherapistsusinga“process-orientedgroup therapy”modelcontinuallymonitorthree dynamics:
•Thepsychologicalfunctioningofeachgroup member(intrapsychicdynamics)
•Thewaypeoplearerelatingtooneanotherin thegroupsetting(interpersonaldynamics) •Howthegroupasawholeisfunctioning
(group-as-a-wholedynamics)
Agroupleaderconductinganinterpersonal processgroup,however,willtendtopaymore attentiontotheinterpersonaldynamicsand concentratelessoneachmember’sindividual psychologicaldynamicsandtheworkingsofthe groupasawhole.Thesectionthatfollows includesillustrations(Figures2-3to2-6)ofhow groupsmightdifferaccordingtotheirfocuson intrapsychic,interpersonal,andgroup-as-a- wholedynamics.
The experienced group leader knows that the intervention chosen at any moment in the group will have an impact on all three dynamics and
that a delicate balance must be struck in the attention given to each. A too-intense focus on group members’ interaction, to the exclusion of attention to individual psychological needs or the needs of the group as a whole, blunts the effectiveness and relevance of group develop- ment.
0RINCIPALæCHARACTERISTICSæInterpersonalpro- cessgrouptherapydelvesintomajordevelop- mentalissues,searchingforpatternsthatcon- tributetoaddictionorinterferewithrecovery. Thegroupbecomesamicrocosmoftheway groupmembersrelatetopeopleintheirdaily lives.
TheInterpersonalProcessGroupPsychothe- rapy(IPGP)modellinkstheabstinence-based treatmentapproachwithcurrentpsychological principlesoftreatment,whilestillremaining compatiblewith12-Steptheoryandpractice. IPGPandsubstanceabusetreatmentbothrec- ognizethataperson’scapacityforhealthy interpersonalrelationshipssupportssolid recoveryfromsubstanceabuse.IPGPiseasyto understandandadaptbecauseitis
•Pragmatic.IPGPisapractical,nutsand bolts,hands-ontypeofgrouptreatment.It focusesonresults,notabstractconceptsand all-encompassingtheories,anditsresults-ori- entednatureisespeciallysatisfyingtoapop- ulationthatneedssomeswift,positiveout- comes.Thisfeatureisespeciallyimportant duringtheearlyphasesoftreatment,when thewindowofopportunityforinfluencing clientsissmallandopenonlybriefly.
•Applicable.IPGPisaveryadaptablemodel. Becauseitcansoreadilybemodified,itcan beappliedindiversesetsofdifficultiesand undervariouscircumstances.IPGPfurnish- esthegroupleaderwithasetofstrategic toolsthatareeasytoacquireanduse.The IPGPmodelprovidesenoughstructureto preventunproductivediscussion.Thisis especiallydesirablebecausefewwilltoleratea passivegroupleaderwhowaitsforissuesto evolveoutoftheflowofthegroup.Onthe otherhand,manypeoplewhoabusesub- stanceswillreactnegativelytoadomineering
orauthoritarianleader.TheIPGPmodelper- mitsagroupexperiencethatisneitherleader- dependentnorleader-centered.Thisgeneral- lyegalitariansettinghelpstoreduceresis- tance.
•Synergistic.IPGPandsubstanceabusetreat- mentcomplementeachother,reciprocally settingthescenefortheestablishmentofthe crucialcomponentsofeffectivetreatment. ThecombinationofIPGPandsubstance abusetreatmentallowstheclienttoexperi- encetreatmentasemotionallysupportive. Thissparingoftheclient’sself-imageenables theclienttoidentifypositivelywithtreatment andmutesanystrongreactionstothecoun- selor.Further,thecombinationofthesetwo treatmentapproachescaneasetheclient’s handlingofshame,theneedtochange aspectsofself,theuncomfortablenewnessof therecoveryperiod,andthetherapeutic experienceitself.Recoverycanproceedas clientsexperienceandre-experiencedeep attachmentdynamicsandusetheexperience tocraftmajorchangesincharacterand behavior.
,EADERSHIPæSKILLSæANDæSTYLESæIninterpersonal processgroups,contentisasecondarycon- cern.Instead,leadersfocusonthepresent, noticingsignsofpeoplerecreatingtheirpastin whatisgoingonbetweenandamongmembers ofthegroup.If,forexample,apersonhasa problemwithanger,thisproblemeventually willbere-enactedinthegroup.Whenanangry groupmember,“George,”explodesat
“Charlie,”thetherapistmightsay,“George, youseemtobehavingastrongresponseto Charlierightnow.WhodoesCharlieremind youof?Doesthisfeelfamiliar?Hasanything likethishappenedtoyoubefore?”
Ononehand,theinterpersonalprocessgroup leadermonitorshowgroupmembersarerelat- ing,howeachmemberisfunctioningpsycholog- icallyoremotionally,andhowthegroupasa wholeisfunctioning.Ontheotherhand,the interpersonalprocessgroupleaderobservesa varietyofgroupdynamics,suchasthestagesof groupdevelopment,howleadershipisemerging inthegroup,thestrengthseachindividualis
Types of Groups Commonly Used in Substance Abuse Treatment 24
bringingtothegroupasawhole,andhowindi- vidualresistancestochangeareinteracting withandinfluencinggroupfunctioning.The interventionsoftheleaderaredependenton hisorherperceptionsofthismix.
Sincethegroupleader’stheoreticalpersuasion, training,experience,andpersonalitydetermine thelevelofinterventionthattakespriorityata particulartime,itisraretofindtwointerper- sonalprocessgroupleaderswhowillconducta groupinexactlythesamemanner.Evenso, leadersinthistypeofgrouparenotfontsof information,skillbuilders,problemsolving directors,orclientboosters.Ininterpersonal processgrouptherapy,theleader’sjobisto promoteandprobeinteractionsthatcarry apoint.
Mostgroupleaderswhoapplyaprocess-orient- edapproachtogrouptherapywithpeoplewho abusesubstancesrecognizethetheoretical influenceoftheInteractionalModel(Yalom 1975).Yalomrecommendsanadaptable approachtogrouptreatment,onethatallows easilyappliedmodificationsacrossthecontinu- umoftherecoveryneedsofanindividualwho abusessubstances.Hismodelcanbetightened (tohavemorestructure)earlyintreatmentand cansubsequentlybeloosened(torelaxstruc- ture)asmoreabstinenttimepasses,recoveryis solidified,andthedangerofrelapsedecreases.
4ECHNIQUESæInpractice,groupleadersmayuse differentmodelsatvarioustimes,andmay simultaneouslyinfluencemorethanonefocus levelatatime.Forexample,agroupthat focusesonchangingtheindividualwillalso haveanimpactonthegroup’sinterpersonal relationsandthegroup-as-a-whole.Groups will,however,haveageneralorientationthat determinesthefocusthemajorityofthetime. Thisfocusisanentrypointforthegrouplead- er,helpingtoprovidedirectionwhenworking withthegroup.
Specifictechniquesoftheprocessgroupleader willvary,notonlywiththetypeofprocess group,butalsowiththedevelopmentalstageof thegroup.Earlyoningroupdevelopment, processgroupleadersmightconsciouslydecide
tobemoreorless activeinthegroup life.Theymightalso
choose,basedonthe