How to Begin a Psychotherapy Group (RLE: Group Therapy)

Six Approaches

Herbert M. Rabin, Max Rosenbaum, Herbert Rabin, Max Rosenbaum

• Publisher: Taylor & Francis
• Year: 2014
• Print ISBN: 9781138801394
• eBook ISBN: 9781317624639
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Originally published in 1976, this book discusses the formation and beginning of psychotherapy groups and examines the treatment of a number of social problems through group therapy. Inevitably a product of the time in which it was written, this book nonetheless makes a valuable contribution to the history of group psychotherapy and will still be of interest to group psychotherapists, psychoanalysts, psychiatrists, social scientists, social workers and group managers today.

Cooperating editor’s note

DR. EDWARD SCOTT has been a creative force in group therapeutic approaches to the alcoholic for many years, through his several books (Struggles In An Alcoholic Family and An Arena for Happiness) and papers, his important position in Oregon, and his activity in the AGPA (American Group Psychotherapy Association).

This article reflects his non-doctrinaire eclectic approach. Not adhering to any one theoretical system, his guidelines for action are always pragmatic, clearly implying “I’ll use whatever works.” Moving from his basic assumptions about the treatment of alcoholics, he takes into the intimate goings-on of the eclectic clinic for alcoholics which he runs.

The alcoholic group: formation and beginnings

EDWARD M. SCOTT

A therapist’s techniques and goals rest upon philosophic assumptions. Usually, the therapist’s assumptions or “philosophical world” is never mentioned. I want to relate my “philosophic—therapeutic—world,” in the following series of statements.

I.	MY BASIC ASSUMPTIONS

There are some alcoholics (approximately 10–15 percent) who will be helped by almost any treatment method. These individuals have committed themselves to sobriety and want another life-style than drinking. Some “belief systems” (form of therapy) conclude incorrectly that their form of therapy “really” did help. Any form of therapy would have been as effective.

Some alcoholics (approximately 10–15 percent) cannot be helped by any method of treatment. These individuals are simply not ready, or prefer a slow death. For instance, I know an alcoholic who had aversion treatment at a private hospital, specializing in this kind of treatment; twice to a veteran’s hospital which had a medical unit for alcholics; four “tries” at our clinic (state operated out-patient clinic); A.A.; twice on antabuse; once to a state hospital and presently is returning to the veteran’s hospital. At this time, no treatment method appears successful.

It is my clinical impression, based on twenty years of working with alcoholics in a variety of settings (state hospital, state prison, medical school, private practice, and out-patient clinics) that the majority (60–70 percent) benefit from a particular form of treatment, or a combination of treatments.

The World Health Organization (1967) states:

The treatment of persons dependent on alcohol, with the best methods available has produced encouraging results. Marked improvement or social recovery has been reported in up to 50–70% of the cases, depending mainly on the underlying personality of the person treated.

For instance, I have in mind an alcoholic who was dry, as a result of attending A.A. for twenty years, but came to our clinic because he felt a need for something more. It was quickly apparent that this individual was schizoid and frightened of his feelings. Our first endeavor was to have him experience some feelings. We had him buy a bag of marbles and bring them to the clinic as a “price” for coming to group therapy. He was able to feel as he brought the marbles to us. We placed him in a group at the clinic which has a special emphasis on sensitivity. The group therapist has reported to me that he is “doing excellently.”

Some alcoholics try one type of modality, find it unsatisfactory and search out another form of treatment. Several of our patients first attempted sobriety in A.A. and found it unsuccessful, but have been successful with group therapy.

Some alcoholics (approximately 5–10 percent) recover by a combination of help. Group therapy and antabuse are often needed.

Some alcoholics (approximately 5–10 percent) recover by a conversion experience. For instance, a male alcoholic tried A.A., but failed. He came to the clinic. Later he related, “I learned I was an alcoholic, from both places, but couldn’t do anything about it.” He left the clinic and later was converted. In recounting his conversion, he remarked, “I gave my problem to Jesus, as my personal Savior. One day I turned it over to Him. Here it is, I said—it’s your problem. I felt need for alcohol go right then.” This was three years ago. Since all patients coming to the clinic are requested to take an MMPI, I gave him another one three years after his conversion and found major, favorable changes.

Bill Wilson (1971) the founder of A.A., prayed for help when hospitalized in a Manhattan hospital. Later Wilson related, “Suddenly the room lit up with a great white light. I was caught up into an ecstasy which there are no words to describe.”

A second philosophical assumption is that everything has a price. A most primitive paradigm states:

A patient has to “add” and “subtract.” Some patients find it relatively easy to subtract (“give-up” something—alcohol, an affair, etc.) but are pressed to “add” something—new thoughts, or feelings, etc. It’s my assumption, that most patients find it difficult to “add”. In a followup study Gerard (1962) reports that in a study of abstinent alcoholics the following: 54 percent were overtly disturbed, 24 percent were inconspicuously inadequate, 12 percent were A.A. successes, and 10 percent were independent successes. What Gerard calls independent successes (able to grow during their period of sobriety) I call “adding.”

The question—is alcoholism a physical problem may be partially answered by the following illustration: A fifty-five year old man who had been successful in business retired at fifty years of age, but his alcoholism was becoming progressively worse. He was certain that it was a physical condition. In fact, he had been to an institution which specialized in aversion treatment and the physician had told him that it was a physical condition.

As we continued, he stated, “I don’t like moods.” I replied, “Is that physical?” He thought it wasn’t. Furthermore, he added that when he went on his “bats” as we call them—(drinking bouts of 5–6 days) “I try to get out of the mood I’m in, and get to a dream world in which I think I’m the smartest man on earth. When I’m drinking I go out of the way to lie and when I’m sober I hate lying. Sometimes, when I’m at a bar drinking, before I get blotto, I love looking at myself in the mirror.”

When it was suggested that this was a psychological dependence, he was suprised—yet he elicited no desire to stop drinking. Here, I think we have a combined problem. There is an initial emotional need to drink which, as the bout continues, the physical problems “take over” and the psychological aspects are “wiped out.” The process continues. He sobers up, eventually the psychological problem leads to another bout, etc. A theory which champions that alcoholism is a physical condition is merely a partial explanation.

The aversion treatment did not work because he had no desire to stop—because the emotional problems were more forceful.

I have a third philosophic assumption which space does not permit me to discuss at length. In the briefest of outlines, all therapy consists of the following necessary factors: time, sight, relationship and hope (1971A).

With my clinical techniques, I attempt to either maneuver time (“don’t dwell in the past so much”) or sight (“do you really think you’d do better if you understood?”) or relationship (“You can’t seem to tolerate closeness”). The “motor” which moves these factors is hope. All therapy to some degree must include hope. The hope that this (whatever it is) will work is essential. Even the behaviorist hopes that his schedules or reinforcements will result in success.

This chapter has the orientations of an out-patient clinic. Reasons for prompting this orientation have been established by Ludwig (1971). He and his associates found that hospital treatment, of whatever nature, is ineffective for the alcoholic, once he leaves the hospital, Second, it’s my opinion that work with alcoholics has an out-patient setting. Third, special settings can’t be discussed due to limitation of space. Those who are interested in group therapy for alcoholics in a prison setting, or on a work release program, can consult my work, (1973). No discussion for specialized groups of alcoholics will be included; for those interested in group therapy for schizophrenic alcoholics, logotherapy for depressed alcoholics, or inadequate alcoholic, etc. can refer to a former work of mine, Struggles in an Alcoholic Family (1970), as well as my other work (1963).

References in the professional literature concerning the problems, techniques and modalities regarding the early phase of group therapy for alcoholics is suprisingly scant.

For instance, in the text, Alcoholism, The Total Treatment Approach, edited by Catanzaro (1965), there are only meager mentions of the early phase of group therapy. One author in that text, Thomas, wrote that the members of the group should feel useful and unique, and the therapist should be himself.

Rosenbaum and Berger (1963) have edited a volume on group psychotherapy. In their work, one chapter is devoted to group therapy for alcoholics. The authors of that chapter (chapter 40) merely reported, “Direct requests by the patient for information and advice were more frequently satisfied than in analytically oriented group psychotherapy. Interpersonal transactions of one patient with another were analyzed only rarely, while those described by a patient as going on between himself and persons outside the group, including his wife, usually were.”

Mullan and Rosenbaum (1962) write:

The overall aim of the therapist during the first session is to bring to play all the forces at his disposal that will induce with the group a feeling of closeness, unity and togetherness.

Stein and Friedman (1971) present material of the early phases of group therapy for alcoholics. Several shortcomings emerge from their illustration. Their group was composed almost entirely of veteran patients. One patient had been in treatment for eight years; another patient had five years of both individual and group therapy. Hence the flow of the group dialogue, as well as the interaction, was reflective of their prior therapy. Other criticisms are: little, if any unique techniques or methology emerged; no theoretical positions were taken by the authors. What emerged were typical reflections and comments about any group therapy session.

It is my hope that this chapter presents an accurate view of both therapy and practice, so that the reader gets a “correct feel” for what is presented.

Klien et al., (1964) report on the contrast between what they observed in actual practice of behavior therapy, from the articles written about behavior therapy.

II.	CLINIC PREPARATION OF THE PATIENT

Before a patient is placed in group therapy he undergoes the following plan. The patient is initially seen at the clinic by one of our social workers who makes a decision whether the patient should be referred elsewhere (state hospital, crisis unit, de-tox center, etc.) or become a patient at our clinic. Once the social worker decides the patient can benefit from the clinic’s program—and the patient tentatively agrees, brief informational data is collected. The interview is terminated by referring the patient to a series of five lectures (orientation) on the following topics: definition and phases of alcoholism; medical aspects of alcoholism; characteristics of successful patients in and outpatient clinic; and, group therapy—how it works; your task, other patients’ tasks, therapists’ tasks, and goals.

A patient can enter at any phase in these lectures, which are held every Wednesday evening. The number attending these lectures, vary from 20–45. Various staff members participate in the lecture series. We have found the most difficult lecture to be the one on group therapy. We use former patients, who are volunteers at the clinic, to help in this matter. It’s our impression that this is an effective technique.

During the process the prospective patient is required to take the personality tests, the MMPI, and the Edwards Personal Preference Schedule.

At the first intake interview the patient is urged to have his spouse join him. The rate of success in this matter is high—perhaps 95–98 percent of the time the spouse comes to the clinic.

Toward the end of the lecture series, a Staffing time is arranged. Staffing time varies—twice in the evening, once in the afternoon and once in the morning—to make it as convenient as possible for the patients.

At the Staffings members of the clinic are present. Every clinic person, whether volunteer or trainee, or employee is required to attend one staffing a week. Prior to staffing we have a Journal club, in which various staff members present current, pertinent literature. These two “events” help to motivate, up-date, and solidify the Staff.

Prior to the patient’s entrance to staffing, a summary is given, in order to brief the staff (which varies from 5–15) concerning the patient. Once the patient and his spouse are present, fairly routine procedures occur. We ask: what are your problems? do you, as a couple, help or hinder the problems? and how can the clinic help?

The results of the personality tests are given, which help in zeroing in on trouble spots. At times the problems appear to be intrapersonal; other times, interpersonal. By these methods, we are able to sharpen the differences between personality problems and marital problems—and how alcohol “fits in.”

After some discussion, a bargaining process begins. For instance, we might insist, due to the patients’ poor prior attempts at sobriety (A.A., aversion, etc.) that Antabuse be a condition of acceptance at the clinic.

If the prospective patient denies drinking as a problem—or that he has any problem—we give him a week to think it over. If he still feels the same, we will not accept him at the clinic. It’s our feeling, that this realistic factor is necessary; otherwise, an unrealistic contract is entered.

Some pat...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Copyright Page
• Table of Contents
• From the Editor
• HOW TO BEGIN A PSYCHOTHERAPY GROUP: SIX APPROACHES
• Co-operating Editor’s Note
• Co-operating Editor’s Note
• Co-operating Editor’s Note
• Co-operating Editor’s Note
• Co-operating Editor’s Note
• Co-operating Editor’s Note
• About the Authors