Most evidence-based practices are individualized approaches (Norcross, Hogan, Koocher & Maggio, 2017), while substance use disorder (SUD) treatment counselors disproportionately do their work with clients in groups (Velazquez & Crouch, 2016). As the field moves toward evidence-based practices, we will need to demonstrate that group therapy is an evidence-based practice and improve the effectiveness of groups, retention rates, and treatment outcomes and recovery rates. Studies reveal that clients who complete treatment have higher recovery rates than those who drop out (Sanders, 2011).

Conflict is a leading cause of premature terminations among group members (Yalom, 2020). This post describes strategies for reducing conflict in SUD treatment groups. 

The pre-affiliation state is characterized by approach-avoidance behavior. In this state, members move close to the group, then back away. It is as though they are saying "I want to trust this group, but I don't know if I can." The next state is the power and control phase, in which group members lock horns and vie for power. Most group members who drop out of treatment will do so in this state. The third stage is the intimacy/cohesion stage. Research shows that clients make more progress in cohesive groups. Conflict in the power/control stage is one of the greatest threats to group cohesion (Yalom, 2020). Many group leaders uncomfortable with conflict, but managing conflict helps develop group cohesion. 

Strategies for addressing group conflict

• Stop outbursts early. It's been said that catharsis is good for the soul, and it's OK to "Let 'em shout it out." Yet outbursts make group members feel unsafe (Velazaquez, Crouch, 2016; Yalom, 2020). Many clients with SUD come from families of origin that felt unsafe (Sanders, 2011) and are less likely to return to an unsafe therapy environment. If you wait too long to deal with conflict, you may have to call the police to intervene. 
• Lower your voice. When group members yell at each other, you can model calmness by lowering your voice. Group members will often take heed and lower their voices as well.
• Eliminate threatening behavior. If group members yell at each other, the group leader can ask them to lower their voices. If they stand, you can ask them to site down. If they point at each other, you can ask them to stop pointing.  Make statements such as "Yelling and pointing fingers at each other can be perceived as threats. To communicate with each other effectively it's important for group members to not feel threatened." 
• Create a contract on the spot.  Group leader: "Jason, you told us you have a pattern of getting drunk after arguments, and on several occasions, these conflicts hav led to arrests for disorderly conduct. You mentioned that you would like to learn to express your feelings more effectively in group so that disagreements won't lead to relapse and arrest. Do I have your permission to stop you, in group, when you are having a conflict, to help you find a more effective way to express your feelings?" 

If the client says "yes," you have a contract. 

• Partialize. When disputes arise, point out that members are mostly saying the same thing and are mostly in agreement. This can help reduce tension. 
• Talk directly about an underlying cause of group conflict. Group members will argue about many subjects, ranging from group rules, programmatic rules, group starting time and ending time, procedures, and curfew. Sometimes the real cause of the conflict is anger related to having to give up alcohol and other drugs. Mentioning this gives clients the opportunity to discuss the real cause of their anger. 
• Repeat back. When group members argue, they often are not listening to each other. Asking members to repeat what the other has said to that person's satisfaction can decrease conflict, as the original speaker feels heard.
• Point out mirror reactions. Group members often fight with others who remind them of themselves. This is often unconscious. You can bring this to the surface by asking those who are doing the battle: 
  • "Is there anything about the other that reminds you of yourself?"
  • "Is there anything you admire about this person?"
  • "Is there anything you envy about this person?" 

These are just a few of the strategies that you can apply to reduce conflict in SUD treatment groups. 

Part 2 of this post will be published in September 2021. 
 

References

Norcross, J., Hogan, G., Koocher, G., & Maggio, L. Clinicians Guide  to Evidence-based Practices: Behavioral Health and Addictions. (2017). Oxford University Press. New York, NY> 

Sanders , M. Slipping Through The Cracks. (2011). HCI Books, Deerfield Beach, Florida.

Velasquez, M & Crouch, C. Group Therapy For Substance Abuse (2016). Guilford Press. New York, NY.

Yalom, I. The Theory And Practice of Group Psychotherapy. (2020). Hachette Books. New York, NY.