ABSTRACT
The task of group psychotherapy for recovering individuals moves from the early stage of examining the upsides and downsides of continued using to the later stage of examining the multiple difficulties in engaging in secure attachment. Maintenance of sobriety and attachment requires awareness, acceptance and action. The attachment system may open during the crises that occur during treatment and create a favorable therapeutic opportunity, called hitting bottom in AA. Groups may resist their task using antitherapeutic norms including taking turns, creating a one-topic format or a “can-you-top-this?” format, becoming tightly knit and excluding new members, and becoming leader-centered or one-dimensional.
The primary task of the group requires group cohesion addressing punctuality, absences and thoughts and feelings that occur between sessions. Attention to the preferred defense structure of group members includes addressing denial. This attention changes through the stages of group psychological development: forming, norming, storming and performing. Self-disclosure develops as group members take increasing risks in becoming vulnerable. The therapist respects the meaning of group members’ silences and talking. “Checking in” and prohibitions against crosstalk may interfere with the group’s task. The therapist maintains awareness of entitlement, shame and projective identification in the group members’ interactions. This awareness opens the possibility to move from relapse prevention to relapse planning, where group members may “bookend” relapse impulses between sessions. Relapse planning may be integrated with moderation management.
