ABSTRACT
Early stage treatment issues deal primarily with precontemplation, contemplation, and preparation stages of change that have been outlined by Prochaska and DiClemente (1992). Most of the therapist's energy will be directed toward getting alcoholics and addicts to recognize, admit, and move past their high levels of ambivalence and denial. Beginning group leaders soon discover that few alcoholics and addicts enter treatment of their own free will. Consequently, when these patients are initially introduced to treatment and group, usually they are either under extreme external pressure from their family, their employer, or a judge, or they are compelled by serious physical health problems related to their chemical use. Group leaders find that many of their group members are in a severe emotional state characterized by guilt, shame, and depression or are extremely obstinate and angry because others have forced them to comply with demands that seem to them to be unjust, unfair, and punitive. Even if chemically dependent individuals agree that they need treatment, they usually harbor wishes to be able to drink and use drugs in a safe and normal way. Their compliance to treatment is motivated more by their remorse and wish to avoid further condemnation than it is by their desire to actively learn ways to ensure that their treatment will be successful. Thus, the group leader is faced with the difficult task of dealing with resistant patients on two different levels. If the group members are not actively rebellious and resistant to treatment, they usually are working very hard to give the staff and group leader the impression that they are actively engaged in their recovery and treatment. This presents the group leader with a delicate problem because those group members who are actively resistant are usually easier to treat than those who are passively compliant.
