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 523Unlike family members involved in traditional family therapy, networkmembers are not led to expect symptom relief for themselves or self-realization.This lack of expectation prevents the development of competing goals for thenetwork’s meetings. It also provides the members protection from having theirown motives scrutinized, and thereby supports their continuing involvement,without the threat of an assault on their psychological defenses.Adapting Individual Therapy to the Network TreatmentOf primary importance is the need to address exposure to substances of abuseor to cues that might precipitate alcohol or drug use (Galanter, 1993). First,both patient and therapist should be sensitive to this matter and explorethese situations as they arise. Second, a stable social context in an appropriatesocial environment—one conducive to abstinence with minimal disruptionof life circumstances—should be supported. Considerations of minor disruptionsin place of residence, friends, or job need not be a primary issue forthe patient with character disorder or neurosis, but they cannot go untendedhere. For a considerable period, the substance abuser is highly vulnerable toexacerbations of the addictive illness and in some respects must be viewedwith the considerable caution with which one treats the recently compensatedpsychotic.Study on Training Naive TherapistsA course of training for psychiatric residents naive to addiction and ambulatorytreatments was undertaken over a period of 2 academic years. Before beginningtreatment, the residents were given a structured treatment manual for networktherapy and participated in a 13-session seminar on application of the networktherapy technique. Cocaine-abusing patients were eligible for treatment in thisstudy, if they could come for evaluation with a friend or family member whocould participate in their treatment. In all, 22 patients were enrolled. The treatingpsychiatric residents were able to establish requisite networks for 20 of thesepatients (i.e., a network with at least one member). The networks had an averageof 2.3 members, and the most typical configuration included family membersand friends. Supervisors’ evaluation of videotapes of the network sessionsemploying standardized instruments indicated good adherence to themanualized treatment, with effective use of network therapy techniques. Theoutcome of treatment (Galanter, Dermatis, Keller, & Trujillo, 2002; Galanter,Keller, & Dermatis, 1997; Keller, Galanter, & Weinberg, 1997) reflected retentionand abstinence rates as good as, or better than, comparable ambulatorycare carried out by therapists experienced in addiction treatment. The studydemonstrated the feasibility of teaching the network technique to therapistsnaive to addiction treatment.