Certificate in Drugs Counselling, Theory and Intervention Skills.
Eamonn Keogh
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In this case study we will look at the inner workings of a group that I was involved in. This paper will be broken into four different sections. In the first section I will give a description of the group covering: the context; the setting; frequency and length of the group; finishing with a description of my role within the group. The second sections will identity the group culture. In this I will explain what the group norms and belief systems are. My feeling around being a member of this group will also be discussed in this section. The third section will be a reflection on the efficacy of the group. The main points in this section are what does/does not work well in the group and why; is the group addressing its task; what do I think could improve the group. In the final section I will be pointing out the key learnings I got for this module and how would I put this learning into practice.
Description of the Group:
The group being used in this case study is a step meeting of Narcotics Anonymous (NA). NA is an international community based organisation for recovering drug addicts. Na members learn from each other how to live a drug-free life and recover from the effects of addiction in their lives. NA’s primary approach to recovery is its belief in the therapeutic value of one addict helping another. Members take part in NA meetings by talking about their experiences and recovery from drug addiction. The NA programme is one of complete abstinence from all drugs, including alcohol. The only requirement for membership is the desire to stop using. The core of the NA programme is the twelve steps. These steps are a set of guidelines outlining a practical approach to recovery. Apart from the regular meetings there are also step meeting in the NA programme. I’m going to use the step meetings for this case study. The task of step meetings is to broaden its member’s knowledge of each of the twelve steps. The format of these groups is one step is covered each week starting with 1 finishing with 12. The meeting lasts one hour. The room is set out with all the chairs in a circle so each member is able to see each other. One benefit of this is that there is a sense of belonging and togetherness. A NA moto about why they are in a circle is “that no addict will stand alone.” At the start of the meeting one person will open up the meeting and give their experience, strength and hope around the particular step being covered that night. This opening is called a ‘chair’. The person that gives the chair is someone that has completed this step previously and has in excess of six months clean time. The chair will last up to 15min long. When the chair is finished the other members of the group will share their experiences and knowledge of the step or identify with what the person giving the chair said. This ties in nicely with the ethos of NA that one member helping another. I have a couple of roles to play in this group. Firstly I’m a member going to the group to learn about of each of the steps individual and to broaden my knowledge around my own recovery. The second role I will fill in this group is that of the person giving the chair at the start of the meeting.
Identification of Group Culture:
As pointed out by Chase (2013) the group’s culture underlies all of its behaviours and actions. The culture of groups is constantly developing as it adapts to each new situation or event it confronts and to the needs of the group and its members. The group’s culture is an abstinence based group. In my group each member has a common intellectual purpose for being together and that is to gain greater knowledge of the step involved on the night and the NA programme as a whole. The artefacts used in these meeting would be the ‘Big Book’ and a step working guide. Both of these were developed over time by members for members using collective knowledge they acquired over the years. Some of the group norms are as follow: Each member in the group is given a chance to talk: The last 10 minutes of the meeting is given up to new members or people that have less than 90 days clean time: Speak honestly and with consideration and respect of others and their efforts: Maintain confidentiality: Members will place phones on silent: Members will listen to each other and not interrupt.
With the NA programme being a spiritual programme, the main belief involved with NA is the belief in a higher power. NA is not a religious organisation. Each member can choose their own higher power. Some examples are the god we grew up with, the group itself, past family member. The belief in a higher power is that a power greater than ourselves can restore us to sanity.
As a whole the behaviour in the groups is good. Members respect each other and where they are in their own recovery. There is a great sense of comradery and concern for each other. The ethos of the step meeting leads itself towards this in the way the person that does the chair is trying to help the newer members, that haven’t taking that step yet, gain a greater knowledge of the step or to get someone who has to maybe look at that step in a different light. If there are conflicts or members become unhappy with the way the group is developing they have a medium in group contions. This is held once a month and members get to address any concerns they have around the meeting as a whole. This is a very important tool in making sure the group guidelines are being followed and the group is achieving its goal.
Some of the benefits of being an active member of this group are I feel very comfortable in the group. I get great support from the group and its members. I feel like I belong to the group and my voice is heard. Having completed the 12 steps I felt a sense of achievement and spurred me on to do the chair which was extremely humbling.
Reflection on the efficacy of the group:
When thinking what works well in my group Weegman (2004) make a valid point that
“Group members learn they can help each other identify and modify in self and others their tendency to be unaware, deny, or remain oblivious to their pain, suffering, defences and the costly nature of their addictive solutions.”
This is one of key strengths of the group. The nature of the group is that one member does the chair and explains their experience, strength and hope surrounding the step being covered that night. One member passing knowledge gained to another. This can get members to thinking about their issues in a different light or take action similar to that taken by the person that done the chair. A bond of togetherness comes from this and this is one of the main reasons that N.A. meeting stay together. Yalom (1985) points out the therapeutic factors in group work. I can see my group putting some of these factors into practice and benefiting from them. Instillation of hope is the first one and plays a big role in my group. This is evident even in the literature we read as it was written by member years ago who to this day are still clean and sober. This is helpful with new members as they can see that recovery is possible. Universality is major a factor in helping the members feel part of the group. After hearing other members share concerns similar to their own, members report feeling more in touch with the group and they don’t feel alone. Development of socialising techniques is another therapeutic factor pointed out by Yalom that the group often represents members the first opportunity for accurate interpersonal feedback. It can also point out a variety of social habits which, unbeknown to the member, have been undermining their social relationships. More senior members develop their social skills and have learned how to be helpfully responsive to other and acquire methods of conflict resolution.
The reasonability of the group addressing its task lies with the group itself because any decisions or issues about the group are discussed and teased out in group concions. The secretory of the meeting is also decided here. I feel the group is addressing its task as the secretory chooses someone who has completed the step already to give the chair. The chair sets the tone of the meeting surrounding the step being covered in that meeting.
Having pointed out some of the factors that help the group I will now point out some of the factors that hinder the function of the group. As the only requirement for membership is the desire to stop using from time to time members can come in under the influence of drugs. Due to the chaotic nature of drugs someone under the influence can cause a big hindrance to the group on a number of levels. Firstly the disturbance caused but also it can trigger something off in someone that makes them believe drugs are attractive again. Another hindrance to the group as pointed out by Hough (1998), the conflict stage, members jostle with positions and roles and sub-groups may form. When this happens members tend to be judgmental, critical and advice is freely offered without any real understanding of the problems which people have. The step meeting are a crucial part of the N.A. programme and if these two areas could be addressed and resolved I think the group could improve to reach higher goals than it is already achieving.
Identification of key learning from the module:
I’ve grained a lot from this module. One of the key areas of learning came in the first couple of sessions regarding the necessary decisions when planning a group. Up to now any involvement I’ve had with a group was in a group that was already set up when I joined. I’ve learned that the setting up of an effective group can cause as much stress as the running of a group. I can put this learning into practice as the youth projects I work in are setting up a stabilisation programme. Group therapy is an important factor of the programme with 3 sessions a week. As a result of my learning I feel comfortable I my ability to assist the project in taking the necessary steps when setting up the group. Moving on from the process of setting up the group the next area of key learning was the development of the group. Having watched the group develop and go through the five stages pointed out by Hough (1998) as we learnt them was very interesting. Again going forward the knowledge of these five stages ranging from anxiety to closure will put me at ease when I observe the group going through them. I fell without both facilitator prior knowledge of the development stages of a group it would be very hard for the group to address its task even from the start. The final key learning for me was how the group dealt with absenteeism and the working out of this issue. The group was angry at first with the members that had missed a group but by working through it and voicing the anger the group was able to move on. It was decided that an empty chair be left in for the member that was missing. It was profound the effect the empty chair had on the group. The group member was nearly noticed more in the empty chair than if they were sitting in the group. I feel this is valuable and effective tool to have when working in a group setting. This learning is something that I will use in the stabilisation programme being set up in my work place. With this knowledge I will be able to implement the empty chair from the beginning of the group so the clients won’t have to experience the anger which was felt in the experiential group .
I’ve also had a huge insight as to what way I am in a silence. What way do I internalise this silence and what have I learnt from it. In the first couple of groups there were a few silences and unknown to me my taught would drift away. It was only when asked about the silence and what I was thinking that I realised that my taught were always on other people and things never about myself. For me this was very interesting and showed me that I had some personal stuff still to work through. Having worked through it and realised that it was an old trait of mine to protect myself when I was in active addiction. Another benefit from this insight going forward in my practise is that counter transference won’t be as big an issue for me having done this module and acted on the learning.
Bibliography
Chase, R.S (2013) Elements of Effective Communication, 4th Edition, Plain and Precious Publishing, Washington.
Hough, M. (1998) Counselling Skills and Theory. Hodder and Staunton London. Chapter Nine: The Group Context. Part two pages 213-226
Yalom, I (1985) the Theory and Practise of Group Psychotherapy 3rd Edition Basic Books: USA. Chapter One: Therapeutic Factors in Group Therapy.
Yalom, I (1985) The Theory and Practise of Group Psychotherapy 3rd Edition Basic Books: USA. Chapter Eleven: In the Beginning
