Increasing Positive Patient Outcomes Part 2


We have learned that the patient’s perception of the therapeutic alliance accounted for the greatest amount of variance in treatment outcome studies. The more positive the patient’s perception of the therapeutic alliance, the better the outcome. The less positive the patient’s perception of the therapeutic alliance, the worse the outcome from treatment.

Therefore efforts at building a strong therapeutic alliance with our clients will help us increase positive treatment outcome. I previously recommended a review and upgrade of patient orientation practices as one way of strengthening the therapeutic alliance with a new patient. This article will focus on orienting patients to group therapy.

Group Therapy: The Preferred Therapeutic Modality in Addictions Treatment

Group therapy is the most frequently utilized therapeutic intervention in the treatment of alcoholism and other addictions. There are several reasons that group therapy enjoys this status.

First, group sessions facilitate identification. Identification is an important step in recovery. Through sharing their personal experiences with alcohol and other drugs with each other, group members can identify addictive behavior and addictive or “stinkin” thinking. Patients also have the opportunity to realize the universality of the problems associated with addiction, and that addiction follows a particular course of progression that is more similar than not despite a person’s drug of choice, gender, ethnicity or cultural background. Secondly, group therapy helps remove the terrible sense of isolation that develops during the course of the disease. Groups shatter this isolation. People have an opportunity to build new and intimate relationships with each other based on their common struggles, wounds, hopes and aspirations. These new friendships create a fellowship of like minded individuals. We are not alone!

The third value of group therapy is that a new patient has an opportunity to learn that their personal experience and wounds can be of value. We all have something to contribute regardless of the level of our recovery. The new group member is as valuable to the process of the group as is the patient who is ready to go home.

And finally, in addition to providing a means of identifying and connecting, the group sessions become a human laboratory that promotes awareness and learning through experience and taking risks. The climate that makes the group therapeutic is a result of the collective efforts of each member of the group. Once again “we can do what I can’t” is the overriding theme operating in group therapy. So we know that groups are important. But how do we indoctrinate patients to group therapy.

Indoctrination to Group Therapy

The Johari Window has been the most commonly utilized model to help patients understand the benefits of group therapy. This model was developed by two University professors Joseph Luft and Harry Ingram. Hence the model was called the Johari Window pronounced the Joe Harry Window. Their model is based on an interactional model of awareness which is ideal to explain the process of group therapy and its benefits. It contrasts what we know or don’t know about ourselves with what others know or don’t know about us. These conditions are cross referenced in a 2 x 2 matrix:

As you can see the interaction of the rows and columns create four conditions: openness, blind spots, guardedness and unrealized potential.

Openness is defined as those things that I know and am willing to share with you, and what you know and perceive about me that I also know or have awareness of. This cell expands as a result of group therapy. Successful outcome is associated with a greater degree of openness.

Guardedness is defined as those things that I know but that I don’t want you to know. These are secrets, things I feel shame about and therefore don’t want you to know. These are the things that I hide from you. This changes significantly during treatment too. Guardedness decreases. We become less hidden and when I share these secrets in group I become that much more open. This is where that notion came from that says, “We are as sick as we are secretive.”

Blind spots are defined as those things that I am unaware of but that you see in me or know about me or my behavior. Our blind spots are caused by defense mechanisms. These defense mechanisms prevent us from seeing things about ourselves that we wouldn’t like. So we project these undesirable traits or behaviors onto others. Blind spots are transformed into awareness through feedback in group sessions. When group members point something out to me that I haven’t seen, I have the opportunity to become aware of something that I haven’t seen before.

Last but not least is our unrealized potential. This is defined as those things that I don’t know about myself and that you don’t know about me either. This is what makes recovery so remarkable because we have the chance to uncover and discover our lost, true self. We discover unimagined potentials and abilities. As we uncover and discover these hidden potentials we convert them into awareness. These disowned parts of myself become things that are now accessible and available to me. Let’s say I disowned by ability to grieve. In group I recovered this ability. Now I can respond appropriately to loss by grieving. I have access to this previously unavailable part of myself that I can now use to cope with life.

You see one way of looking at what happened to us during the disease is that we shrunk our awareness – we didn’t want to be honest with ourselves because we would have had to do something about our drinking or using. We just weren’t ready to take this step so we blunted and dulled our awareness. In this process we became more and more guarded and secretive, our blind spots grew, and we stop exploring our potential. We withdrew and became less and less open with our friends and family. We disappeared into the abyss of addiction.

Recovery is the opposite. Recovery is based on honesty, open mindedness and willingness. This is precisely what a person must do to get the most out
of group therapy. It fits nicely, doesn’t it? In recovery we are more open. have fewer blind spots, we are less guarded, and are willing to explore our potential. In order to help the new patient integrate themselves into the group process and understand the benefits of the group, it is important to teach them about what happens in group and their role in creating this therapeutic climate. The pamphlet I develop for Hazelden is very useful in this effort. It explains the benefits of group therapy and what a patient can do to get the most out of group therapy. More recently I developed a two part patient education program on DVD for Serene Connections that explains the benefits of group therapy, how to get the most out of group therapy, and delineats the group members responsibilities in making the group climate therapeutic. Part I of this program, The Benefits of Group Therapy, is scheduled to be released in the next month. Contact Serene Connections for further information.

Taking time to insure that patients are indoctrinated to group therapy, instructed as to the benefits of group therapy, and guided in how to participate in group sessions is well worth the effort and will help you increase positive treatment outcomes and more participation in your groups.