Group Therapy Weekly Intervention Plan - Term Paper Example

RUNNING HEAD: Weekly Group Therapy Plan Group Therapy Literature Review & Weekly Plan [Pick the Overview Prisons in United s are showing an increased rate of incarceration where a substantial prison population appears to be comprising of female law offenders. Where these inmates are accused for crimes having different severity levels, most of them are found to have a common trait: substance abuse. This substance abuse can be related to alcohol, cocaine, heroin, coke, other illicit drugs and psychoactive substance resulting in dependence syndrome. The purpose of this research paper is to develop an outline for the psychological support program intended to develop a therapy group of population comprising of female prisoners from low security prisons. This group therapy is intended to alleviate the self-perception of these prisoners which is expected to have a positive impact on their self-esteem. Purpose of the Group Like stated earlier, the purpose of this group is to create a recreational environment for the prisoners who have developed an addiction of varied kind over time and are suffering from low-esteem and trauma caused by the prison. Due to addiction and poly-substance dependence, these prisoners tend to suffer from major personality disorders. Some of the first-time offenders also suffer from adjustment disorder leading to trauma and hopelessness. Due to these factors, the prisoners suffer from sleep deprivation, feeling of detachment, irritability, hypervigilance, and restricted range of affect (SAMHSA, 2005). Population of the Group The population of the group will comprise of prisoners from minimum security treatment facility which means that these participants are mild offenders of law who are not susceptible of any major violence or any other form of offense. Addiction and substance abuse will be the key criteria for selection of the participants and their details will be provided by the clinical administration staff of the prison. Upon entry into prisons/ jails, all the offenders are made to go through quick screening which would help in identifying underlying mental and psychological issues that the incumbents have been facing and the possible outcomes and reactions expected from these mental problems. This primary testing will help us select our desired population. Another common criterion of selection of the participants would be the presence of a child. Due to statistical probability, it is expected that the population selected will be having children i.e. of age 1 to 18 years, who are dependent on their mothers. Furthermore, these participants are expected to be dependent on their families i.e. parents, spouse, siblings, for further care and support. Native American background is also one of the common pre-requisites which would help in creating an environment of security within which the participants would feel comfortable. While selecting the population and forming a group, possible causes for dropouts will also be considered. Participation in such programs usually means leaving prison jobs and opting for a rather non-rewarding option with no explicit benefits. Also, fear of leaving the group conformity, peer pressure, absence of support and continued care on release, lack of coherence between group objectives and personal goals, lack of willingness to help one’s peers, lengthy sentences where there are no possible chances of early release, and social stigma are the possible reasons of drop outs or primary reluctance to join these programs (SAMHSA, 2005). Reasons for selecting this particular population is its susceptibility to lower self-esteem and other mental disorders stemming out of this problem. Where the number of female prisoners is increasing at an exponential rate, it is important to note that the present judicial system behave differently on gender basis. The present criminal justice system tends to improve the behavioral patterns of the offenders by providing them solitary confinement however this notion turns out to be more discomforting for women as they are less likely to be committing a violent crime and more susceptible of using drugs. Due to this disproportion in the nature of offense and resulted punishment, women tend to suffer more from criminal disorders. Secondly, dependence on other substances i.e. drugs and alcohol, further takes away pride and self-confidence from them. Thirdly, most of the prisoners from substance abuse have children solely dependent on them. Factors provoking depression can be uncertain circumstance on release and during confinement concerning well-being of the children. Being unskilled and uneducated, are the other main factors leading to substance abuse resulting in low-self esteem. Where there are interventions present to support male prisoner, female prisoners are rather neglected despite their increasing percentage in the present judicial confinement (Convington, 1998). Logistics The primary settings for the clinical therapeutic group would be within prison. Administrative support will be acquired from the staff of the prison and a separate room with necessary facilities such as audio and visual media and other necessary sitting infrastructure will be a pre-requisite for this support program. The therapy group itself, will comprise of twelve members in the preliminary phase whereas the expected dropout rate is 20 percent based on previous experience. Therefore, the final population is expected to be nine to ten participants by the final stage of the session. In the cases, where dropout rate is exceptional in the preliminary phase, more intakes will be considered so that maximum population is benefited from this therapy group. The sessions will comprise of 120 minutes with each sitting being conducted once in a week. Possible time and days will be decided with the help of administrative staff of the prison. Ethical and Legal Considerations Group therapy is not as crystallized as an individual therapy. Due to participation of multiple participants, there are possibilities of emergence of ethical issues which may hamper the overall well-being of the participants. Due to these ethical considerations, the rights of the participants and role of the leader must be known to the group. Group therapy practice stems out of psychotherapy and is intended to induce a desired cognitive behavior in the participants. Various rights of the group members include the assurance that other group members’ objectives are coherent with the goals of individual members and vice versa. Assurance related to informed screening is included in it (Corey et al., 1995). Secondly, where participants are participating against their own will, it is important that ethical issues emerging due to this involuntarily participation must be addressed through informed consent (ASGW, 2000). Thirdly, maintaining confidentiality in the group settings is highly challenging. Necessary steps must be taken by the counselor to ensure that participants’ individual privacy remain intact. Testifying in legal proceedings can be considered as major infringement (Corey et al., 1995). Along with these ethical considerations, it is also important the group leader/ counselor is well-trained and has core competencies of working in group settings. Compliance to ASGW trainings standards while operating in group settings will help in developing an ability to work in closed and open groups, develop desired behavior in the group members, engagement of the leader in reasonable self-disclosures, and helping members in deriving meaning out of this practice. Furthermore, awareness of the cultural and communal background of the group and individual participants also plays a vital role in overcoming overall ethical obligations (ASGW, 1998). Avoiding dual relationships, intervention selection and handling difficult participants are also some of the core responsibilities of the group leaders (Corey et al., 1995; Glass, 1998; Kraus et al., 2001). Literature Review When many female prisoners enter into confinement, they have a history of trauma and abuse attached to them causing poor self-image. Therefore, a strong self-identification is of substantial value for recovery. Addiction is a form of self-disorder which is resulted by blurred self-evaluation. Also, poor peer relationships or bonds with family and spouse are the main reasons behind use of drugs and alcohol. Making these female patients in incarceration aware of the consequences of unhealthy and unequal relationships is the primary step in therapeutic interventions. Development of sense of community through therapy groups is intended to fill this void and improve poor self-image resulted by failed or unhealthy relationships in previous lives. Healthy sexuality and spirituality are also some of the major areas requiring extra attention while designing therapeutic intervention since these two areas are directly related to healthy self-image (Covington, 1993; Schnarch, 1991; Covington, 1998). Where substance abuse treatment programs are stemmed out of psychotherapy, the treatment of patients in prison confinement requires a different approach altogether. Selective approaches deduced out of social learning theories, cognitive-behavioral improvement approaches, and other relevant directive models should be used (Peters & Stienberg, 2000). According to Izzo & Ross (1990), appropriate group counseling programs should use strategies encompassing “problem solving, negotiation, skills training, interpersonal skills training, rational-emotive therapy (REBT), role-playing and modeling, or cognitively mediated behavior modification (p.139)”. Cognitive and behavioral groups should focus on questioning the rationale behind use of substance abuse and the possible outcomes of this abuse according to participants. It is the responsibility of the group counselor to make the participants aware of the benefits which can be incurred by prosocial-behavior and develop accountability by introducing incentives into the therapeutic interventions. Through these cognitive groups, the participants are made to question the rationale for their abnormal behavior, reasons for developing substance abuse and addiction and also justify these behaviors. Through various practices, the participants are made aware of their over-generalization of specific events to overall life experience leading to addiction and also the specific kind of thinking patterns that they develop during substance abuse which further result in criminal behavior. Participants are taught to identify their thinking patterns leading to addiction and replace these thoughts with alternative healthy behavior leading to avoidance of drug and alcohol use. In addition to that, participants are encouraged to discuss their psychological issues causing alcoholism and drug addiction which helps them in avoiding substance abuse by discussing their issues with peers having similar behavioral issues. Possible expectations of the group leader/ counselor are made known to the participants in the form of printed material which would help the participants being aware of the synchronized objective of the group ensuring that all the participants are on the same page. The intensity of rehabilitation and overall training decreases over time as the objectives of the training are met (SAMHSA, 2005). Weekly Intervention Plan Week One Goal: To make the participants aware of the drug abuse and it’s physical and mental side effects Topic: What causes drug addiction and how it affects you? Plan of Actions: Participants and therapist will exchange introductions and the purpose of this therapy group will be discussed with them at length so that all the participants are aware of the objectives and goals intended from this program. After introduction, participants will be encouraged to talk about their kind of addictions and how these addictions have affected their role in their family and the possible mental and physical side effects caused by it. Where participants are expected to be reluctant to share their personal details, they will be encouraged to do so by the therapist. Secondly, alumni will also be made part of this group so that participants may feel comfortable to see a live role model. Therapeutic Factors: Cognitive awareness and group forming is the basic purpose for this intervention. Week Two Goal: Evaluation of Patient’s attachment to other individuals and effects of addiction on that attachment Topic: Talking about the loved ones Plan of Actions: Participants will be encouraged to share their views about their attachments to other individuals or subjects and how alcoholism and drug addiction has affected their relationships with others. Also, possible outcomes of this strain in relationships on the overall self-perception will be evaluated through discussion. Necessary mediation will be performed to create an understanding within the group. Therapeutic Factors: This intervention is designed to address the attachment issues in the light of psychodynamic perspectives. Contending forces and development issues and their responses leading to addiction will be discussed (SAMHSA, 2005b). Week Three Goal: Evaluating the outset of alcoholism and drug addiction Topic: How did it started? Plan of Actions: Participants will be encouraged to talk about the events prior to addiction and the causative agents leading to this self-destructive behavior. Participants will be made aware of this topic previous week and will be encouraged to prepare a small play of ten minutes to show what really happened and what provoked them to adopt drugs and alcohol. Their responses will be analyzed by the counselor in the non-judgmental manner and the alternative responses to such situation will be discussed. Therapeutic Factors: The interventions are expected to create cognitive awareness in the participants and also make them realize their pattern of thinking which lead to alcoholism. The idea is to make the participants realize how negative thought pattern leads them into self-destruction mode and how it can be replaced by the positive thinking process. Week Four Goal: Making the participants aware of their self-worth and making them analyze their hidden potential Topic: What I like doing the most? Plan of Actions: Participants will be encouraged to write about their strengths, what they like doing, habits etc. If they like, writing, singing or have any other habit, they will be encouraged to share it with the group. They will also be encouraged to write something that comes into minds at the spur of moment regarding their habits and share it with the class. The counselor will then, elaborate them how these hobbies induce positive and healthy behavior and how they can be used as means of diverging their negative thinking pattern leading to addiction. Therapeutic Factors: The purpose of this practice is to make the participants aware of the alternative activities that may help them combat their stress and depression and opt for activities that interest them and help them overcome distress. Week Five Goal: Mindfulness Based Stress Reduction Topic: Meditation, Prayers and Healing Plan of Activities: Help of other counselors will be taken in this session. Participants will be made aware of mindfulness-based stress reduction and its possible relation to stress reduction. The expert hired for this session will be responsible for teaching the participants various techniques of meditation, Hatha and Yoga postures. They will be encouraged to practice these techniques in order to handle stress (Himelstein & Saul, 2011). Therapeutic Factors: The rationale of including this exercise is to enhance personal wellness and spiritual care. Week Six Goal: To make the participants aware of the responses and feelings of other people from their families and how their addiction and stay in prison is affecting them. Topic: Family and Personal Spirit Plan of Actions: The participants will be made to mediate for 30 minutes using the techniques taught to them in the previous session. After that, they will be asked to think and write about a family member or anyone who has suffered the most from their possible addiction and share the outcomes with the class. Also, they will ask to share how they will amend their behavior to compensate for the damage caused to them. Therapeutic Factors: This intervention is influenced by experiential therapy and motivational enhancement therapy which are also the rationale behind 12-step recovery principles (Borman & Dixon, 1998). The rationale of this activity is to analyze the impacts of addiction on the loved one which will provide the participants a motivation for avoiding possible relapse of addiction. Week Seven Goal: To make the participants aware of the healthy life style Topic: Me, My Health and My life Plan of Actions: This session will be of rather educational nature. They will be given details of healthy life style and its possible relation to addiction. Participants will be encouraged to share the details of their current life style and also compare it with the ideal life style. They will be asked as to how they will be incorporating the desired life style and related habits into their existing pattern of living. Necessary guidance will be given to them in this regard. Therapeutic Factors: The participants will be encouraged to think about their daily living habits and effects of nutrition and health education on their present state and expected future state. This is also a part of 12-step recovery program. Week Eight Goal: To recall what has been taught and how the participants will be using the techniques taught in future. Topic: Am I going to be an Addict Again? Plan of Actions: A quick recap and personal reviews will be taken about the activities that have taken place so far. Necessary literature will be provided to the participants for future guidance. Through these interventions, the group is expected to pass through the phases of pre-affiliation, counter-dependency, norming or developing intimacy, differentiation or working together and adjourning (AGPA, 2012). The rationale behind these interventions is to make the participants aware of what caused addiction, how certain pattern of behavior can be avoided or replaced by the healthy habits, impacts of these self-destructive patterns on the loved ones and also habits leading to healthy life style. References American Group Psychotherapy Association. (2007), “Group therapy”, Retrieved 19 November 2012 from http://www.agpa.org/guidelines/groupdevelopment.html Association for Specialists in Group Work.(2000). “Professional Standards for theTraining of Group Workers”. Alexandria, VA: Author. Association for Specialists in Group Work. (1998), “Principles for Diversity- Competent Group Workers”. Alexandria,VA: Author. Borman, P. D., & Dixon, D. N. (1998). "Spirituality and the 12 steps of substance abuse recovery". Journal of Psychology & Theology, 26 (3): 287–291 Corey, G., Williams, G., & Moline, M. (1995). Ethical and legal issues in group counseling. Ethics & Behavior, 5(2), 161-183. Convingtion, S.S. (1998), Women in prison: Approaches in the treatment of our most invisible population, Women and Therapy Journal, 21(1), pp.141-155. Covington, S. (1993). Alcohol, addiction and sexual dysfunction. In E. Freeman (Ed.), Substance abuse treatment (pp. 189-216). Thousand Oaks, CA: Sage Publications. Glass, T. (1998). Ethical issues in group therapy. In R.M. Anderson, T.L. Needels, & H.V. Halls (Eds.), Avoiding Ethical Misconduct In Psychology Specialty Areas (pp. 95-126). Springfield, IL: Charles C. Thomas. Himelstein, S., & Saul, S. (2011). Mindfulness-based substance abuse treatment for high-risk and incarcerated adolescents: A drug and alcohol self-awareness program. Manuscript in preparation. Izzo, R.L. & Ross, R.R. (1990), Meta-analysis of programs for juvenile delinquents: A Brief Report. Criminal Justice and Behavior, 17(1):134–142. Kraus, K., DeEsch, J., & Geroski, A. (2001). Stop avoiding challenging situations in group counseling. 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