Group Therapy in Addiction Treatment

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Entering an alcohol and drug treatment program is a major step toward recovery and one that requires considerable courage. The thought of facing your demons and changing your life in significant ways may elicit a combination of emotions, including anxiety, hope, and perhaps even fear.

One of the most anxiety-provoking aspects of addiction treatment for many is the therapy process. It’s not uncommon to feel some degree of resistance to the prospect of baring your soul to a total stranger in individual therapy or counseling. Even more daunting may be the idea of group therapy, which is an integral part of almost all drug and alcohol treatment programs. While both individual and group therapy are designed to help individuals gain insight, learn healthier coping skills, and work through challenging issues, group therapy has many unique benefits that complement individual therapy.

What is Group Therapy?

Group therapy, in a nutshell, is therapy that involves two or more individuals at the same time – in addition to the therapist – rather than one person in recovery working one-on-one with a therapist. Participants in a therapy group take turns talking about their struggles, feelings, experiences, and goals. Therapy groups may be tailored to a specific recovery topic, such as how to recognize and avoid triggers, or they may be general, such as how to handle difficult family, peer, work, or other interpersonal relationships.

Unique Aspects of Group Therapy

The group therapy process allows you to benefit from your interactions with other group members, not just from the input of and interaction with the therapist. In individual therapy you may wonder if the therapist has ever walked in your shoes and can even begin to truly understand what you’re going through. In group therapy for alcohol or substance use disorders, however, you’re guaranteed to have at least one thing in common with the people in your group: your alcohol or substance use disorder.

Another unique element of group therapy is that the group itself represents a microcosm – a miniature replica of your life and each group member’s life – in the real world outside of treatment. In other words, each person’s weaknesses and strengths are inevitably revealed over time in the group setting. For example, if someone in the group struggles with having empathy for others or gets defensive in response to constructive feedback, that struggle will almost certainly surface at some point during the group therapy process. This provides an excellent opportunity for each participant to work on those challenges in a safe setting, with the help and support of other group members.

What to Expect

Group therapy sessions may be open or closed – meaning new members may join at any time (open) or the group membership remains the same from beginning to end (closed). Open groups may be ongoing, with no specific start or end date, while closed groups are often designed for a predetermined number of weeks or months. Therapy groups in the outpatient setting are often closed groups, while inpatient and residential groups are more likely to be open groups.

Therapy groups may be led by a single therapist (or counselor) or co-led by two therapists. Therapists should be licensed and have training in and experience doing group therapy. The role of the therapist is to set and reinforce group rules and guidelines, lead the group process, and ensure the atmosphere is cohesive, healthy, safe, and productive for all participants. The therapist will ask questions, encourage participation, give feedback when appropriate, and observe how participants interact in the group. The primary goal is to help all participants benefit in a way that moves them closer to reaching their individual treatment goals.  

Confidentiality is an important part of group therapy. For everyone to feel safe opening up in group therapy, all participants are expected to honor the confidentiality of everyone in the group. Depending on the treatment setting, one of the group rules may be that participants refrain from interacting with each other outside of the group setting while they’re actively involved in the group.

Group therapy sessions usually last at least a full hour and often last from one and a half to two hours. The longer length can help ensure that everyone has an opportunity to contribute to the group discussions. Group size can vary, but, on average, therapy groups have between 5 and 10 participants at a time. Too few or too many participants can negatively affect the group process.

In outpatient settings, therapy groups usually meet only once a week. In more intensive treatment settings, such as inpatient, residential, and partial hospitalization settings, therapy groups may meet two or three times per week, or even daily.

Benefits of Group Therapy in Addiction Treatment

Following are some of the unique benefits of group therapy:

  • A Sense of Belonging (Universality). Individuals with alcohol or substance use disorders often become isolated from family, friends, and the world in general. Their substance use interferes with their relationships and may even cause irreparable damage. Group therapy allows these individuals to experience a sense of connection and belonging that may be missing in their lives. The realization that they’re not alone and that others can relate to their pain and struggles helps alleviate their sense of isolation, which in turn allows for healing and positive change to occur.
  • Giving and Receiving Support. One of the most powerful benefits of group therapy is the opportunity for participants to support each other and provide helpful knowledge and feedback based on their own experiences and struggles. The person offering support and the person receiving it both benefit from this exchange. Those providing support feel empowered by realizing they have something valuable to offer others, not to mention the good feeling of helping someone else. This also improves their self-esteem, which plays an important role in maintaining sobriety. Receiving support allows group members to realize that it’s okay to accept help from others, and often inspires them to support others moving forward.
  • Learning New Ways of Interacting. Participants in a therapy group can learn appropriate ways of interacting from other members as well as the group leader. Since therapy groups serve as a microcosm of everyone’s life outside of group, dysfunctional patterns of relating to others will eventually surface. The group is a safe place for individuals to practice new ways of interacting and start building healthy new relationships with other participants.
  • Better Communication Skills. Group therapy can provide a safe setting to practice communicating in an assertive, open, honest, and respectful manner. For many participants, this may be entirely new territory for them. Participants can practice giving and receiving constructive feedback without attacking or getting defensive.
  • Variety of Perspectives. Group therapy gives everyone an opportunity to hear many different perspectives, rather than just the point of view of the therapist. This provides an opportunity to consider multiple ways of looking at their situation, themselves, or an issue with which they’re struggling. Realizing there are almost always many ways to look at something can help enhance their problem-solving skills and allow them to understand and move past old perspectives that may have created obstacles in their lives.
  • Feedback from Peers. One of the most powerful and beneficial aspects of group therapy is the opportunity to get feedback from peers. Often, individuals will be more receptive to the feedback they get from other participants than to the feedback they get from the therapist. This is largely due to the perception that other participants can relate to their struggles or issues far more readily than the therapist.
  • Building Relationships and a Support System. It’s very common for participants to develop friendships with other group members. These new friendships can provide a source of ongoing support and encouragement long after they’ve completed treatment, which in turn can increase the likelihood of long-term sobriety.
  • Hope for a Better Future. Living with an alcohol or substance use disorder can leave people feeling lost and helpless, with little to no hope that they can ever live life in the way they want to. Group therapy allows them to witness others making positive changes while working on their own progress. Group members can celebrate and affirm victories, and also support each other during setbacks or challenges. This can provide a powerful sense of hope that fuels the recovery process.

Potential Drawbacks of Group Therapy

While group therapy offers many benefits, it’s important to understand it has its disadvantages. Two of the main disadvantages include:

  • Confidentiality Concerns. Therapists are expected and required to honor confidentiality as part of their professional ethics. In group settings, however, there is no guarantee that all participants will honor the confidentiality of their fellow group members. One of the best ways (although not guaranteed) to offset this risk is for the group therapist to consistently strive to enhance group cohesiveness.
  • Less Personal Attention. In individual therapy, the client is the sole focus of the therapist’s attention. In group therapy, the therapist’s attention is spread throughout the group. Quieter individuals may feel invisible, especially if there are one or more very talkative participants who tend to dominate group sessions. A skilled therapist will strive to ensure everyone has an opportunity to contribute and will also be adept at drawing out those who tend to disappear into the background.

While these concerns are real, the advantages of group therapy far outweigh the disadvantages. For this reason, group therapy is a mainstay of almost all treatment programs.

The Importance of Group Therapy

Group therapy has long played a vital role in the treatment of alcohol and substance use disorders. While it may seem scary, uncomfortable, and even daunting to participate in a therapy group at first, most people find that once they attend two or three groups their initial fears subside. As mentioned above, one of the most beneficial aspects of group therapy is being surrounded by a small group of peers who have walked in your shoes, can share your struggles, support you along the way, and celebrate with you on your recovery journey.