Groups in Residential Treatment and IOP – What is their purpose?

By Gail M. Ross, Ph.D.

people in recovery attending meeting

Anyone who has been in an alcohol and drug rehab and/or has attended IOP (Intensive Outpatient Program) sessions know that there are regularly scheduled and mandatory ‘groups.’  These can be run by therapists within the programs that clients are attending, or by outside, independent contractors known as ‘group facilitators.’

When run by internal therapists, the purpose is obvious – to continue the therapeutic process as directed by the institution’s mission, and to enhance the therapeutic process within the group itself.  These groups will be focused on, and shaped by, the intimate and specific knowledge the therapists have of each client in the group.  These groups tend to follow an overall treatment plan trajectory put in place for each client, and serve as therapeutically based and directed interactions among clients, and between therapist and clients.

First of all, people in early recovery frequently feel overwhelmed with the new perspectives that therapy reveals to them.  In well-run facilities, clients see their individual therapists at least once a week, and begin to figure out why and how to live life without alcohol and drugs.  In these therapeutic sessions, clients begin the life long process of learning about themselves, and how to use tools other than alcohol and drugs to manage difficulties, anger, and resentments. It is likely that clients have used alcohol and drugs to self-medicate feelings they felt they couldn’t handle, or didn’t know how to handle.  Therapists get to the very specific core of each client’s addiction pattern.

Frequently, alcohol and drug rehabs employ group facilitators to run groups in addition to their therapist-run sessions.  So … why bring in ‘outsiders?  As an outside, independent group facilitator for almost twenty years in Palm Beach County, the differences and purpose are clear, and provide added value to the clients during their early recovery journey.

A group facilitator can represent an example (assuming they are in recovery from alcoholism and addiction themselves) of living each day alcohol and drug free.  Additionally, group facilitators do not use, nor should they use, psychological terminology during their groups, thereby, removing the ‘authority figure’ from conversations between the facilitator and clients.  Trained and licensed therapists can and do diagnose clients, and give very specific, individual directions to clients.  The group facilitator does none of that.

To begin with, the focus of a group run by an outside facilitator is rarely on just one client or one client’s specific issues.  A group facilitator presents relapse prevention tools and living skills discussions in a broad sense to help all clients begin the process of moving from a structured recovery environment, to the real world which they will have to learn to navigate without alcohol and drugs.

Subject areas such as anger, fear, sadness, shame, blame, remorse, lack of self-esteem, job hunting, spirituality, codependence, improving work skills, educational skills, and interpersonal skills (in personal and family relationships) are frequent centers of conversation during group.  Additionally, group facilitators illuminate the process of being in recovery with an introduction to the basics of 12-step programs, and other options available to support recovering clients.

Because long-lasting sobriety encompasses far more than just staying away from a drink or a drug, discussions abound regarding continuing spiritual and emotional growth in recovery.  The subject of the difference between religion and spirituality always brings active participation in groups.  The common fears of boredom, or no longer having ‘fun’, is another area of discussion that clients eventually have to address, and a group facilitator can bring focused and identifiable positive responses to these discussions.  The outside group facilitator can also spend time with clients to help them understand the brain science behind the disease of addiction.  No matter the subject brought up in a group, the facilitator can bring a common sense, sober view of life on life’s terms, without alcohol and drugs.

It is important that group facilitators know and agree with the mission statement of the recovery facility.  The facilitator must follow the tenets of the organization, and be prepared to defend and support it.  It is not unusual for the facilitator to be at the receiving end of client complaints. Redirecting clients to the appropriate person or department to express such complaints is important.  Facilitators must understand the boundaries between them and clients, as well as between them and the therapeutic staff.

No one ‘gets’ anyone else clean and sober, but a good group facilitator knows how to attract clients to the thought process necessary to improve themselves, and be open to the possibility of living life without alcohol and drugs.  Facilitators have an opportunity to share what they’ve learned in recovery – through experience, by being involved in recovery programs themselves, through continuing the process of researching the causes and effects of addiction – and to lend their learned expertise to people in early recovery, reassuring them that living alcohol and drug free is not only possible – but extremely worthwhile.  Removing the hopelessness most addicts in early recovery are feeling can be accomplished with open, honest and consistent communications.  The combination of therapy, groups run by experienced facilitators, and the introduction of peer group meetings outside of the recovery facility can provide a new perspective for those coming out of addiction.  Is this a magic formula?  No.  Does it work for every client? No.  However, there is evidence-based data to support its efficacy in the field of addiction, and I believe when intentions are aligned, good can result.

When therapists and group facilitators share the mission of rehabilitation and strive to reach the goal of providing as much help as possible to clients wanting to live a clean and sober life, the outcome can be positive and rewarding.

Gail M Ross, Ph.D. has 20 years of experience in group facilitation at many Palm Beach County drug and alcohol rehabs that are enhanced by her years of being a college professor and 31+ years of personal recovery.