Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

23. Group Therapy, Self-Help Groups, and Network Therapy 505processes are linked) is not merely one of academic importance. For example,Harticollis (1980) found that psychoanalytical groups are widely regarded asinadequate and are not recommended for active substance abusers because ofthe counterproductive degree of anxiety that they generate. An early study byEnds and Page (1957) demonstrated that the style of a group of alcoholics predictedtreatment outcome. In this study, alcoholics were assigned to one of severalgroups of different design. Group styles varied from one group described asrelatively unfocused and “client centered,” whose leader avoided a dominantrole and instead promoted interpersonal processes among the group members,to another group based on learning theory, whose leader assumed a dominantrole, offered only conditional support, and focused strongly on punishment andreward. At follow-up, those alcoholics treated in the client-centered groupfared far better than those included in the confrontational group.Descriptions of Some Representative Group ModelsExploratory and Supportive GroupsAn interesting model, the modified dynamic group psychotherapy, developedby Khantzian allows for the identification of individuals’ vulnerabilities andproblems within a context of “safety.” Abstinence is strongly endorsed, and thegroup, which requires an active style of leadership, promotes mutual supportand outreach, and constantly strives to identify and manage contingencies forrelapse (Khantzian, Halliday, & McAuliffe, 1990). According to Cooper(1987), psychotherapeutic groups based on exploration and interpretation aimat forging an increased ability in their members to tolerate higher levels of distressingfeelings, without resorting to mood-altering substances. In contrast,purely supportive treatment groups aim at helping addicted group members totolerate abstinence and assist them in remaining chemical-free, without necessarilyunderstanding the determinants of their addiction.Interactional Group ModelYalom, Bloch, and Bond (1978) described an important group style in whichtherapy is conducted in weekly, 90-minute meetings of 8–10 members who,under the leadership of two trained group therapists, are encouraged to exploretheir interpersonal relationships with the group leaders and the other members.An effort is made to create an environment of safety, cohesion, and trust, wheremembers engage in in-depth self-disclosure and affective expression. The goalof the group is not abstinence but the understanding and working through ofinterpersonal conflicts. (However, “improvement” without abstinence is oftenillusory.) In fact, groups of alcoholics are oriented away from an explicit discussionof drinking. The leaders emphasize that they do not see the group as the