Group Psychotherapy with Adult Children of Alcoholics Treatment Techniques and Countertransference Considerations

by Vannicelli, Marsha

• ISBN13: 9780898621679
• ISBN10: 0898621674
• Format: Hardcover
• Copyright: 1989-05-31
• Publisher: The Guilford Press

Summary

For all therapists who work with adult children of alcoholics (ACOAs), this comprehensive guide provides expert guidance in setting up and running a pscyhotherapy group. Successfully integrating theory and practice, the book surveys the current ACOA literature, explains the rationale for group therapy, describes how to set up a group, and suggests specific group leader techniques. Also included are insightful discussions on countertransference issues, the preparation and training of ACOA group leaders, and key areas for future research.

Table of Contents

Foreword	ix
Peter Steinglass
Preface	xiii
Introduction	1	(11)
Who Are the ACOAs?	2	(8)
The Self-Definition of the ACOA Upon Presentation to Treatment	10	(2)
Rationale for Group Psychotherapy with ACOAs	12	(7)
The Interactional Group Therapy Model	12	(4)
Reducing the Sense of Isolation	13	(1)
Instilling Hope	13	(1)
Learning from Watching Others	14	(1)
Altering Distorted Self-Concepts	14	(1)
Reparative Family Experience	14	(1)
Understanding the Effects of Parental Alcoholism	15	(1)
Aspects of Special Appeal	16	(1)
Relationship of Group Therapy to Al-Anon and Al-Anon ACOA Groups	16	(3)
Deciding to do a Group and Selecting and Preparing the Members	19	(14)
The Decision to Begin	19	(2)
Group Composition	21	(1)
The Use of Conjoint Individual Therapy	22	(3)
Open-Ended versus Time-Limited Groups	25	(1)
Member Selection and Prescreening	25	(2)
Taking a Detailed Alcohol and Drug History	27	(2)
Special Problem: Information Delay Regarding Patient's Substance Abuse	29	(1)
Pregroup Preparation: Setting the Group Contract	29	(2)
Simultaneous Membership in Other Groups	31	(2)
Al-Anon and Group Therapy	31	(1)
Education Task Group and Group Therapy	32	(1)
Beginning the Group	33	(8)
Preparing the Room	33	(1)
The Initial Meeting: Helping Members Begin	34	(1)
Providing Appropriate ``Boundaries'' around the Group Time	35	(2)
Maintaining the Boundaries of the Group: Intermember Interactions	37	(2)
Shaping Group Norms with Forecasts and Hunches	39	(2)
Special Issues and Themes	41	(29)
Flight from the Group (The Wish to Leave Prematurely)	44	(1)
Finding (and Removing) the Identified Family Problem	44	(1)
The Search for a Rescuer	45	(1)
Rigid Role Assignments	46	(1)
Hanging On	47	(2)
Negative Self-View to Preserve Parental ``Goodness''	49	(1)
The ACOA Label	50	(2)
The Myth of Equality	52	(1)
Resistance to ``Taking a Look'' at What's Going On	53	(1)
Fear of Losing Control or ``Becoming Unglued'' (Riskiness of Opening Up in the Group)	54	(2)
The Problem is Outside of Me	56	(1)
Will the Leader Understand? (Therapist Transparency about Her Own Past)	57	(2)
Concerns about Early Problem Drinking	59	(1)
Group Deffensive Maneuvers	59	(11)
Perseverating around the ACOA Theme	59	(2)
Other Distraction Activities	61	(2)
Group Laughter as a Distraction	63	(1)
Repetitive, Patterned Interactions	63	(1)
The Assumption of ``Sameness''	64	(1)
Refusal to See the Family of Origin (or the Past) as Relevant	65	(1)
``Smoothing Out'' as a Defensive Reaction	66	(1)
Changing ``Time Zones''	66	(4)
Countertransference Considerations	70	(38)
Countertransference Defined	70	(6)
Subjective Countertransference	71	(1)
Objective Countertransference	72	(4)
Importance of a Continuously Self-Reflective Stance	76	(1)
Heightened Countertransference Reactions in ACOA Therapy Groups	77	(1)
Signals of Countertransference	78	(1)
Self-Reflection Exercises	79	(12)
Therapists' Experiences While Completing these Exercises	91	(2)
Importance of Clear Boundaries and Consistency of Ground Rules in the Treatment of ACOAs	93	(1)
Changing the Ground Rules	94	(2)
Seeking Consultation or Supervision When You Want to Bend a Rule	96	(1)
Noticing Patient-Initiated Modifications	96	(3)
When Patients' Slip-Ups Parallel Similar Slip-Ups by the Therapist	99	(1)
Handling Therapist Mistakes	100	(1)
Procedures for Dealing with Countertransference (What Do You Do about it?)	101	(7)
Leader Issues	108	(20)
The Group Leader Who Is an ACOA	108	(4)
Other Personal Issues in the Life of the Therapist	112	(1)
Selecting a Supervisor	113	(2)
Choosing Between Supervision and Psychotherapy	115	(1)
The Therapist's Motives: On Countertransference Goodness and Availability	116	(4)
Therapist Transparency and Self-Disclosure	120	(2)
Co-Leadership	122	(6)
Benefits and Costs	122	(3)
Choosing a Co-Leader	125	(1)
Processing and Understanding Co-Therapy Conflicts	126	(2)
Leader Techniques	128	(34)
Viewing Therapy as a Journey in Which ``Curiosity'' Is the Guide	128	(1)
Empathy and Therapeutic Attunement	129	(1)
Promoting Self-Evaluation	129	(3)
Phrasing Questions to Maximize Group Processing	132	(2)
Making Interpretations More Palatable	134	(3)
Supporting Group Members' Strengths Before Asking Difficult Questions	137	(1)
Cutting into Boredom	138	(4)
Dealing with a Member Who is Invested in Not Getting Better	142	(2)
Turning a ``Bad'' Group Around	144	(1)
Getting the Group to Ally with the Therapist's Integrity	145	(2)
Protecting Patients Who Fear Their Feelings will Be Too Intense (Sane Pain Control Strategy)	147	(1)
Dealing with Resistance When It Comes Packaged as ``Reality''	148	(1)
Co-Therapy Strategies	149	(1)
Clarifying the Mechanisms of Miscommunication	150	(1)
Tips on Termination	151	(2)
Ending the Session	153	(1)
Thoughts on Names and Other ``Distancing'' Issues	154	(3)
What's in a Name: A Clinical Example	157	(2)
Avoiding Non-Therapeutic Encounters	159	(3)
Preparation and Training of the ACOA Group Therapist	162	(11)
Information about Alcoholism	162	(1)
Complexity of the Problem and Heterogeneity among Alcoholics	163	(1)
Treatment for Alcoholism	164	(1)
Information about the Alcoholic Family	165	(1)
ACOA Education	166	(1)
Group Psychotherapy Preparation	167	(1)
Annotated Bibliography of Substance Abuse Readings	168	(5)
Research Perspectives and Future Directions	173	(9)
CONCLUSION	182	(26)
APPENDICES
A. ACOA Alcohol and Drug History Questionnaire	187	(8)
B. Michigan Alcoholism Screening Test and Scoring Key	195	(6)
C. Group Ground Rules	201	(4)
D. Clinical Face Sheet	205	(3)
References	208	(9)
Index	217