Encyclopedia of Social Work with Groups

Alex Gitterman, Robert Salmon, Alex Gitterman, Robert Salmon

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781135251871
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

What do you have to know, today, to be an effective group worker and what are the different group work approaches? With 110 articles and entries, this book provides a comprehensive overview of social work with groups from its initial development to its astounding range of diverse practice today with many populations in different places.

The articles have been written by social workers trained in the group approach from the United States, Canada, England, Australia, Spain and Japan, and all involved are well known group workers, acknowledged as experts in the area. The book covers all aspects of social work with groups: including its history, values, major models, approaches and methods, education, research, journals, phases of development, working with specific populations and ages, plus many more. Each article includes references which can be a major resource for future exploration in the particular subject area.

Both editors have many years of productive work in group work practice and other areas and are board members of The Association for the Advancement of Social Work with Groups. The Encyclopedia of Social Work with Groups will be of interest to students, practitioners, social work faculty, novice and experienced group workers.

Group Work with Specific Populations

Adolescents with Co-Occurring Mental Health and Substance Use Problems

Marvin W. Clifford

Adolescents typically do well in groups in which the members have similar problems and ages (Sugar, 1986). Adolescents with mental health problems and simultaneous drug, alcohol, and excessive behavioral addictions require a comprehensive approach for treatment (Riggs, 2003). The approach should include group work to help the adolescents interact with each other, to offer support, and to meet the developmental needs of adolescents to identify with a peer group. Other services included in a comprehensive approach are individual therapy, family therapy, educational approaches, and medical and psychiatric interventions as are appropriate (Anderson & McNelis, 2006). A team approach is helpful provided services from varied agencies and programs provide a safety net called the wrap-around concept to help the adolescent with complex problems to succeed (Kerbs, Gaylor, Pullman, & Roe, 2004).

Groups designed to help adolescents with combined mental health and addictive disorders present unique issues for the social worker leading these groups. These issues include the skills and knowledge needed by social workers to lead this type of group, team-work skills to collaborate with other agency and community professionals, and knowledge of evidence-based practices that are effective with adolescents having co-occurring disorders (Bryan, 2003).

In addition to group process (Malekoff, 1993), mutual aid (Steinberg, 2004), and peer group identification, the following theories and techniques can also be helpful for working with adolescents in groups: motivational interviewing (Miller & Rollnick, 2002), motivational enhancement therapies (New Orleans Practice Improvement Collaborative, 2004), cognitive-behavioral therapy (Bryan, 2005), harm reduction (Rotgers, Little, & Deanney, 2005), and solution focused therapy (Metcalf, 1998; Tellerman, 2001). Family system approaches are useful for working with the adolescent and his or her family within this context while the adolescent attends group therapy (Walsh, 1997).

A well-designed group for this population is important. Clients need to be carefully selected for appropriate group member composition. An ideal co-occurring disorder adolescent group would include an equal number of boys and girls, be diverse in population, and have group members aged 13 to 17 who have had some type of previous treatment, have strong family or agency support for the need to be in group treatment, and would be willing to make a long-term commitment and to follow the group’s guidelines. For those in recovery from addictions, they must agree to remain clean and sober, and for those on medications, they need to continuously follow their doctor’s recommendations for prescription medicines and dosage. Group members are expected to interact and contribute to the group process, goals, and purpose. It is expected that group members would also be in other social work services, for example, individual casework, family work, and possibly Alcoholics Anonymous or Narcotics Anonymous meetings for teens, when appropriate.

Adolescents with combined mental health and addictive disorders can be helped, and social groups provide a method when comprehensive services and skills, provided by trained social group workers, can address the group members’ complicated problems (Malekoff, 2007). A co-therapy team, composed of two social workers who are trained in co-occurring disorders intervention present an effective professional team to help these adolescents. This also offers the group workers support, influencing group members with their expertise, information, ideas, and interventions (Reid, 1997).

An example of a recent group, where the names have been changed and the scenario does not include the actual clients, is as follows:

Michael (age 14): I wonder what it is like to use marijuana again?

Cascio (17): You do not want to know!

Michael: I want to get high!

Jessica (16): Why?

Michael: I just want to get high!

Worker: Michael, what is going on in your life to make you want to use?

Michael: I want to feel good! My life is bad.

Cascio: Don’t do what I did. Look at me. Don’t be like me.

Worker: What is bad about your life, Michael?

Michael: I don’t know! Just feel bad all the time. School, people, everybody bugs me. I hate it!

Jessica: Michael, it scares me when you talk this way like you need to get your feelings out here and not on weed.

Worker: Michael, what do you hear group members saying to you?

Michael: That I should not use weed! And maybe talk more in group.

Cascio: Do not relapse like me. It really set me back – school, family, probation. It was like starting all over.

Franchesca (17): Michael, tell us you won’t get loaded! Take my number. Call me if you feel shaky. I’ll talk to you. I need support too, you know.

Jessica: Michael, we care! Tell us about yourself, man.

Worker: Michael, everyone wants you to open up and agree not to use again.

Michael: Well, I’ll think about this.

Worker: What does Michael want for Michael?

Working with adolescents with complex mutual health and addictive disorders can be demanding work. The group worker must demonstrate enthusiasm with this population and in group sessions. Emphasizing members’ strengths helps in engaging adolescents and their families (Yip, 2003).

References

Anderson, T. B., & McNelis, D. N. (2006). Co-occurring substance use and mental health disorders in adolescents: Trainer’s manual (revised. ed.). Pittsburgh, PA: Northeast Addiction Technology Transfer Center.

Bryan, M. A. (Ed.). (2003). Co-occurring disorders: Implementing evidence-based practices. Addiction Messenger, Fall, Special Issue.

Bryan, M. A. (June 2005). CBT and adolescent marijuana dependence. Addiction Messenger, 8(6), 1–3.

Kerbs, J., Gaylor, R., Pullman, M., & Roe, P. (2004). Wraparound and juvenile justice: Making a connection that works. Focal Point, Summer, 19–22.

Malekoff, A. (1993). A guideline for group work with adolescents. Social Work with Groups, 17(2), 5–19.

Malekoff, A. (2007) Group work with adolescents (2nd. ed.). New York: Guilford Press.

Metcalf, L. (1998). Solution focused group therapy. New York: The Free Press.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing (2nd ed.). New York: Guilford Press.

New Orleans Practice Improvement Collaborative. (2004). Motivational enhancement therapy with substance involved individuals: A clinical research guide. New Orleans, LA: Author.

Reid, K. E. (1997). Social work practice with groups: A clinical perspective (2nd ed., p. 99). Pacific Grove, CA: Brooks/Cole.

Riggs, P. A. (2003). Treating adolescents for substance abuse and comorbid psychiatric disorders. In D. Anderson (Ed.), Science and practice perspectives (Vol. 1, No. 2, pp. 18–29). Rockville, MD: National Institutes of Health.

Rotgers, F., Little, J., & Deanney, P. (2005). Harm reduction and traditional treatment: Shared goals and values. Addiction Professional, 3(4), 20–26.

Steinberg, D. (2004). The mutual-aid approach to working with groups (2nd ed.). Binghamton, NY: Haworth Press.

Sugar, M. (Ed.). (1986). The adolescent in group and family therapy (2nd ed.). Northvale, NJ: Jason Aronson.

Tellerman, J. S. (2001). Solution oriented groups for teens, pre-teens, and their families. In: L. Vandercreek (Ed.), Innovations for clinical practice: A source book (Vol. 20). Sarasota, FL: Professional Resources Press.

Walsh, F. (1997). Family therapy: Systems approaches to clinical practice. In J. F. Bondell (Ed.), Theory and practice in clinical social work (pp. 132–163). New York: The Free Press.

Yip, K.-S. (2003). A strengths perspective in working with adolescents with dual diagnosis. Clinical Social Work Journal, 31(2), 187–203.

Adults with Co-Occurring Mental Health and Substance Use Problems

Brian E. Perron and Kimberly Bender

The epidemiological and services research consistently shows that co-occurring psychiatric and substance use disorders (also referred to as “dual diagnosis” and “comorbidities”) are the rule rather than the exception. That is, persons with a psychiatric disorder are likely to have a substance use disorder, and vice versa. Treating co-occurring psychiatric and substance use disorders involves considerable challenges, as they are associated with multiple treatment needs, loss of support systems, increased symptom severity, poor treatment retention, and frequent relapses and hospitalizations.

Historically, treatment for persons with co-occurring disorders has been limited. Mental health programs often do not provide counseling to clients who are active substance abusers, and many addiction treatment programs are not designed to address psychiatric disorders. Thus, persons with co-occurring disorders have often been excluded from one or both systems of care. Recent efforts in the field of social work have been devoted to improving the quality of care for this population. Existing research shows that treatment for co-occurring disorders can be effective through integrated or highly coordinated services. This approach considers both disorders as primary disorders and treats them concurrently. Social work groups are an important part of the overall set of strategies for helping this population (Hendrickson, Schmal, & Ekleberry, 2004). Outlined below are different types of groups that are commonly used.

Persons with co-occurring disorders commonly have functional impairments that present as barriers to independent living, employment, and socialization. A variety of skills groups have been developed to help overcome these impairments (Psychiatric Rehabilitation Consultants, 2000). Skills groups typically involve a structured curriculum that is administered by a professional or paraprofessional service provider. There are both proprietary (i.e., commercial) and non-proprietary curriculum materials. Some materials include specific scripts that can be read by the group leader and/or supplemental videos that provide additional learning context or specific examples of the skills taught. The group leader then uses a series of behavioral principles (e.g., coaching, modeling, role-playing, and feedback) to promote acquisition of the target skills.

The group approach provides a safe environment for practicing specific skills that can be generalized to everyday experiences. These groups are often used to target short-term objectives while working toward long-term outcomes. For example, some clients may need to develop core social skills in order to benefit from other skills-based groups such as vocational groups or peer support groups (described below). Thus, skills groups can easily be arranged sequentially to achieve various outcomes.

Peer support groups, sometimes referred to as “self-help” groups, provide a way for persons with co-occurring disorders to interact with and support other persons with similar disorders and problems (Davidson et al., 2001; Gitterman, 2006). Treatment programs may organize peer support groups, but persons with experience successfully coping with the disorders typically lead these groups. Co-occurring support groups vary slightly from traditional 12-step groups of Alcoholics Anonymous by focusing both on maintaining sobriety and on coping with symptoms of mental illness. Peer support groups are an effective way of normalizing experiences, reducing social isolation, and promoting the development of new and healthy relationships. The group format also provides an opportunity for mutual problem solving. That is, members experienced in their own recovery can offer specific strategies derived from their personal experiences. Thus, participants can provide mutual aid to one another, benefiting from the support of others while offering tools, support, and challenge to fellow group members (Gitterman & Shulman, 2005; Steinberg, 2004).

Groups exist for dealing with both substance use and psychiatric problems. Unlike peer support groups, therapy groups are facilitated by a professional and are goal oriented. They commonly use a cognitive-behavioral and problem-solving orientation for addressing specific symptoms and challenges associated with co-occurring disorders (Kopelowicz, Liberman, & Zarate, 2002). Therapy groups provide a safe setting for patients to explore behaviors, emotions, and thoughts related to reaching individual goals for improved functioning (Hendrickson et al., 2004).

By coordinating services with other providers, leaders of therapy groups can help address specific goals that may be part of the client’s overall treatment plan. Therapy groups can be especially important to clients who have been recently hospitalized or are presently unstable in their recovery. Specifically, group leaders can monitor emerging problems and help coordinate a plan to avoid relapse or hospitalization.

Co-occurring disorders can place significant social and economic burdens on families. Families commonly report that they do not understand the complexities of co-occurring disorders, which can lead to significant discord among family members. An effective way of helping families understand the complexities of co-occurring disorders is through family psychoeducation (Dixon et al., 2001). This is the process of working with families to support the recovery of their family member with co-occurring disorders. Family psychoeducation is typically administered in a group format, involving multiple families. Groups may be facilitated by a human service professional or a family member experienced in this area.

Family members are taught about the various illnesses, which helps dispel myths associated with stigma. Family members also learn specific strategies for coping with the various stressors, delivering effective support, and planning ways of dealing with crisis situations (Hendrickson et al., 2004). A notable advantage of the group format is that it helps normalize experiences for families and addresses the stigmas commonly associated with psychiatric and substance use disorders (Kelsey, 2004).

Similar to adult treatment, therapy groups, skills groups, and peer support groups are important for the treatment of adolescents with co-occurring disorders. However, in order for social work groups to be effective, adult-oriented treatment should be tailored to the developmental needs of the adolescents (Lysaught & Wodarski, 1996; Malekoff, 2005). This includes making the treatment environment inviting and comfortable; involving important individuals to the adolescent such as family members, friends, and school personnel; and using language and experiential techniques that are developmentally appropriate.

The group format is particularly advantageous for treating adolescents with co-occurring disorders, as they tend to place a high value on peer interaction. The group format also provides an opportunity to incorporate a wide array of didactic treatments (e.g., decision-making skills, communication skills, impulse control) in the context of social activities. This can help improve treatment engagement and retention, thereby ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface
• Introduction
• Group Work History: Past, Present, and Future
• The Association for the Advancement of Social Work with Groups, Inc., An International Professional Organization (AASWG)
• Group Work Values
• Group Work Major Models
• Group Work Approaches and Methods
• Group Stages of Development
• Group Work Phases of Helping
• Group Work Education
• Group Work Research
• Group Work Journals
• Group Work in Fields of Practice
• Group Work with Specific Populations
• Group Work Over the Life Course
• Group Work and Community Context
• Group Work and Organizational Context
• Group Work Leadership
• Group Work and Technology