Both the Stages of Change Model (transtheoretical model [TTM]) and solution focused brief therapy (SFBT) are widely used when counseling substance abusing clients, and there is broad support in the literature to document their effectiveness. Likewise, SFBT has also been applied in the martial and family counseling setting with good results. The authors found no documentation in the literature integrating the TTM and SFBT as a therapeutic technique. As both models are widely used, accepted, and have been empirically validated, after reviewing the pertinent literature, the authors propose a methodology incorporating both the TTM and the SFBT when working with non-substance abusing clients and their families.
Court-mandated substance-abusing clients often have years of use that has slowly eroded their character development. Substance abuse clients are particularly challenging because the use of substances often affects several life domains simultaneously. Group counseling has long been the mainstay of treatment for this population, and various interventions are available for therapists who practice group counseling. The study of character development is an emerging trend in three theoretical orientations-dynamic psychiatry, transpersonal psychiatry, and positive psychology (Peterson & Seligman, 2004). The authors present a self-assessment instrument, the Character Identity Inventory (Hall, 2006), which helps both therapist and client to identify strengths and weaknesses of character. The Character Identity Development Model (Hall) is an adaptation from the character development and positive psychology literature and can be used as a therapeutic framework to integrate the components of character development into group counseling. Use of this model with a court-mandated, treatment-resistant client is presented. Specific examples include how one of the authors (BK) was able to lower the client's resistance and increase motivation within the group setting.
The last two decades have seen a variety of medication-assisted therapies (MATs) become available for the treatment of both opioid and alcohol dependency. The choice to accept or decline MAT is an individual patient choice tempered by a variety of variables. Nevertheless, group therapy has been the mainstay of treatment for the substance abuse population, and often when relapse occurs, clients are either reintroduced to MAT or offered MAT as an adjunct to the recovery process. In this setting, patients are subsequently placed into a therapy group that consists of both members on MAT and those who are not on MAT. This becomes a natural line of demarcation within the group pitting patients who are on MAT against those who are not. This attitude can cause conflict between members in a therapy group and presents a unique form of individual resistance in the group therapy setting. After a brief review of MAT and the concept of resistance in group therapy, the authors offer interventions for overcoming this unique form of resistance.
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