Counselor's Manual for Relapse Prevention With Chemically ...

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e assertive in setting limitsprovide appropriate rewards (activities, trips, etc.) to the group.Planning for Group WorkLogisticsAll logistical arrangements should be planned well in advance of beginning the group. In orderfor the preplanning to go smoothly, group counselors should seek the support of appropriateadministrative and support staff. Establish the following before getting started.Group SizeGroups typically range in size from 6 to 12 people. The size should be determined by suchfactors as the type of group and the capacity of the patients. "Capacity" refers to the level ofindividual functioning. Can the patient concentrate, focus, and pay attention? Some substanceabusers, particularly those in the early stages of recovery, cannot make use of all their mentalfunctions. Others may have mental/emotional problems that interfere with these abilities. Lowfunctioningindividuals will need a smaller group. Educational groups can handle more members,whereas process oriented-groups should be smaller.TimeTime is an important boundary. The length of group sessions should be preplanned if the groupis to be time limited. A schedule of sessions should be established that considers holidays andother commitments.Sessions should be of equal length. The ideal length depends on the capacity of the patients, thesetting, and the type of group. More functional patients can handle longer sessions than lessfunctional or younger patients. The materials presented in this manual are intended for two-hourgroup sessions.Once the time boundaries have been established, it is very important to begin and end groupsessions on time.SpaceThe space chosen for group meetings will make a statement about the importance given to thisactivity. The space should be psychologically positive and provide a safe environment for theemotional risks that go with treatment. The space should be well lighted, well ventilated, and anappropriate size for the size of the group. A private location that is accessible, free frominterruptions, and physically safe should be chosen.
Types of GroupsDifferent types of groups serve different purposes. The following is a review of some options tohelp you decide what type of group is most practical and useful for the setting.Mandatory or Voluntary Group?You might assume that voluntary groups are best, but research and practice indicate that bothvoluntary and mandatory groups have their advantages and disadvantages.Mandatory groups ensure that members will attend. With regular attendance the group processcan develop with little disruption. Unfortunately, mandatory requirements often increase hostilityand resistance and intensify denial. No one likes to be told they must go to a counseling group,and few counselors like being confronted with such hostility, particularly by a group of eight ormore people.When the counselor is well prepared, the situation can be managed. Patients will attempt toengage you in battle. The best tactic is to avoid these battles. One way to do so is to join with thegroup by saying something like, "You have to be here and I have to be here. I understand andappreciate your anger but it is not my fault. How can we both make the best of things?" Offeringconcrete rewards for cooperation may also help. Setting rules for attendance can eliminate overtresistance but seldom reduces passive resistance.The disadvantages of the mandatory group become the advantages of the voluntary group.Members of voluntary groups identify with one another, denial is less potent, there is lesshostility, and one can move on more quickly to group goals. However, the voluntary group doesnot have some major disadvantages. When participation is voluntary, members often findexcuses to be absent when there is pressure on them to face problems. Without a "captive"audience, leaders find that it is hard to ensure member attendance and that it is difficult for thegroup process to evolve with absent members.Which type of group is best? Research indicates that mandatory treatment works as well asvoluntary treatment with substance abusers. In a criminal justice setting, required attendance canbe useful for all.Open or Closed Group Membership?One issue to be decided in advance is whether or not to add members after the group has started.The terms Aopen membership" and "closed membership" are used to describe the two options.Open membership can reach more clients and is easier to keep going over time because lostmembers can be replaced. However, adding new members can cause a loss of group intimacyand cohesiveness. Development may regress. Although this may not be ideal, depending on thegoals of group, adaptations can be made. Closed membership allows for greater individualprogress but is impractical in some settings.
Page 1: Counselor's Manual for Relapse Prev
Page 4 and 5: Criminal behaviors. Chemical depend
Page 6: Transition StageThe transition stag
Page 9 and 10: Post Acute WithdrawalSome of the sy
Page 11 and 12: Unstabilized relapse-prone patients
Page 14 and 15: which provide specific information
Page 16 and 17: ecovery plan to determine whether h
Page 18 and 19: "When you said that, I began to thi
Page 20 and 21: Have the patient form a sentence st
Page 22 and 23: There are many models for the stage
Page 26 and 27: Time-Limited or Open-Ended Group?It
Page 28 and 29: The abstinence goal. The first focu
Page 30 and 31: Group sessions are 2 hours in durat
Page 32 and 33: They will confuse thoughts and feel
Page 34 and 35: Step 3: Identification of Alternati
Page 36 and 37: Opening Procedure—PurposeEstablis
Page 38 and 39: G—GENERALIZE: "What did you learn
Page 40 and 41: they really understand each exercis
Page 42 and 43: Early Recovery Patients: These pati
Page 44 and 45: Instructions. Again, it is best to
Page 46 and 47: Exercise No. 17: Identifying High-R
Page 48 and 49: eading the cards and also carries t
Page 50 and 51: Dysfunctional: Unable to function i
Page 52 and 53: The purpose of this workbook is to
Page 54 and 55: Read This Workbook. By reading and
Page 56 and 57: ________9. Do not listen: Other peo
Page 58 and 59: Part of the Relapse Prevention Work
Page 60 and 61: personality, it is important for yo
Page 62 and 63: treat someone else badly.____ ____
Page 64 and 65: 2. Unless I really want to give up
Page 66 and 67: 1. I stopped using on _____________
Page 68 and 69: B. Problems with situations:1.2.3.4
Page 70 and 71: E. What happened to you or other fa
Page 72 and 73: C. What did alcohol or drugs help y
Page 74 and 75:
C. What did alcohol or drugs help y
Page 76 and 77:
D. What thoughts, feelings, problem
Page 78 and 79:
Exercise No. 7: Life History Summar
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. .. .. .. .6. Adult Work. .. .. ..
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Purpose. There are many ways you ca
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it, but the feelings do not go away
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___ 39. Deep resentments: I feel an
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Phase II: External Dysfunction: In
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___ 30. Believing "just this time":
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A. TitleB. Write the words you unde
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3. Write down any new thoughts, fee
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H. The next thing I felt wasI. The
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9. Finish the following sentence fi
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5. Warning Sign:Summary Title:6. Wa
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14. Warning Sign:Summary Title:Revi
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Warning Sign Sentence:5. Summary Ti
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14. Summary Title:Warning Sign Sent
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3. When this warning sign happened
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Summary Title of the Warning Sign _
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B. High-Risk Situation:C. High-Risk
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5. Critical High-Risk Situations: A
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E.F.G.H.I.J.Exercise No. 19: Combin
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2. List the injunctions you think m
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2. The worst that can happen?3. Mos
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If I change the way I think, I will
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If I change the way I think, I will
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A.B.C.4. List three ways that you c
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E. What I will do in the future to
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People who will help me with this p
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Purpose: Make as many copies of thi
Page 134 and 135:
2. How did you handle them? How did
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