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Group therapy and group work are among the most common modalities used in substance abuse treatment (Lenihan, 1995; Matano & Yalom, 1991), and various group modalities have proven to be effective, economical, efficient, and practical in providing support to people who can easily become isolated (Stuart 8c Sundeen, 1995). Also, group work is appropriate for women with diminished status because of their "other-ed" and outsider positions that include dual ethnic and gender statuses that can amplify social rejection and discrimination (Pack-Brown, Whittington-Clark, & Parker, 1998). Group work can facilitate the formation of alternative learning communities in which women come to reflect on their lives, the dynamics of their addictions, and how to overcome the factors that threaten recovery (Lee, 1989). Groups form a context that enables their members to learn from one another, and, as a result, participants can obtain a vicarious understanding of their situations and of their own issues by hearing and listening to others. Participants can take advantage of a number of factors relevant to recovery, including a safe place to share what they view as stigmatizing behavior, test and evaluate new behaviors, and expose personal issues to stimulate feedback from others to resolve these issues. In addition, group work can bring assumptions, thoughts, and feelings that may be outside of immediate awareness into consciousness to act as catalysts for action (Washington & Moxley, in press). Participants can effect behavioral change by learning to think in more empowered ways, reducing excessive emotional reactions, and overcoming self-defeating behaviors (Beck, Wright, Newman, & Liese, 1993).
Group work also can offer a conduit through which chemically dependent women can achieve such important proximate treatment outcomes relevant to the realization of recovery. For people who experience sustained oppression to obtain the resources they need and desire, empowerment suggests that they must proactively resolve and overcome challenging situations, engage in persistent and prolonged struggles to gain control over their situations, and escape stigmatizing statuses. Empowerment is particularly important to individuals who have social characteristics that can undermine their self efficacy and their willingness to act (Cox & Parsons, 1993). Interventions that seek to empower people also can heighten their social awareness and personal understanding of what creates negative outcomes (GlenMaye, 1998). Empowerment requires that people increase and strengthen personal efficacy, which enables them to take advantage of opportunities, overcome challenges and barriers, and establish new roles (Bandura, 1997). Group work can foster effective
Using Gestalt Experiments. Members of the experiential group completed three gestalt activities (two sentence-completion and one top-dog/underdog exercises; Thompson & Rudolph, 1992). During one sentence completion activity, members filled in sentence blanks by reflecting on their feelings and the percentage of responsibility they were willing to assume for their feelings. For the second sentence-completion activity, participants recorded how they both help and hurt themselves. Examples of these respective activities are: "Right now I am feeling lonely and vulnerable and take 70 percent responsibility for how I feel." "I also take 50 percent responsibility for the way I manage my life." "I help myself when I am being productive and focused." "I block or hurt myself when I feel I'm not being trusted and I feel lonely."
Participants in the top-dog/underdog debate were divided into two subgroups. Members of the top dog group listed reasons for engaging in certain tasks or behaviors (that is, remaining clean, being better parents), with underdog group members listing reasons for engaging in other tasks or behaviors (that is, desiring to reunite their families, gaining custody of their children, being happily married). Compiling and discussing lists led to spontaneous discussions among participants endeavoring to reconcile gaps between what they thought they should and wanted to do.
Engaging in Prayerful Homework and Meditation. Participants were asked to compose a prayer and share it at a group meeting. Qualitative analysis of these prayers suggested that they helped participants engage in quiet reflection. Prayers and attendant meditation provided a calming effect and encouraged participants to contemplate, which many participants found physiologically and emotionally comforting. Most prayers revealed participants' concerns: finding new life directions, caring for their children, mourning the loss of health, and obtaining jobs, housing, and income. This intervention appeared to draw from participants' spirituality and deeply held religious beliefs. One participant noted that prayerful homework enabled her to "get closer to her spirit."
A salient area of prayerful reflection related to participants' family life and raising their children. The prayers reminded a participant of what was important—her children's well-being and "right" to a drug-free mother. Because of their chemical dependency, some participants expressed grief about loss of their children or their need to make up for lost time with them. The intrusion of social control was very real for these women given changes in federal entitlement programs and the state of Michigan during the latter part of the 1990s regarding child welfare policies, chemical dependency, and income support. New laws require recipients of Temporary Aid to Needy Families (TANF) to obtain employment within two years of receiving benefits and limit benefits to five years over the course of an adult's lifetime. The women also understood that continued substance use could jeopardize their parental status, result in possible loss of their family home and permanent loss of their children if their drug dependence resulted in abandonment of young children (Binsfeld Law, 1997).
Sharing Powerful Stories of People Overcoming Obstacles. Relating "powerful stories" during the group interventions was precipitated by the facilitator who read stories (that is, "Who to Believe," "Just Like You," "And Justice Has Been Served") that emphasized people overcoming obstacles (Canfield, Hansen, Hawthorne, & Shimoff, 1996). After each story was read aloud to participants, the facilitator posed exploratory questions to stimulate group interactions and members' stories. The facilitator asked group members to express their feelings about each story, including the meaning or importance. The facilitator then elicited perspectives about recovery, asking "How did you like the story? What meaning or importance did the story have for you? What pictures developed in your mind as I read the story?" Two additional questions followed: (1) "What did you hear that can strengthen your resolve to get and stay clean?" and (2) "What was it like for you as I read the story?" Group members were asked to reflect on these stories and use them to foster introspection into their own lives. The stories may have provided members a safe forum to develop their perspectives, helped increase their awareness of factors that influenced the use of drugs and fostered addiction, and enabled participants to listen and learn from one another. This narrative technique could be used to facilitate participants' appreciation of common experiences and development of a group identity.
Discussing the Lives of Successful African American Women. Twelve photographs of accomplished African American women, including novelists, scientists, educators, classical musicians, physicians, engineers, and artists, were used to stimulate group discussions about their lives and encourage participants to share their conjectures about how these women overcame societal barriers. At the end of the group session preceding their use, the pictures were shown to the group members, and group members were asked to select a woman they wanted to discuss at the next meeting. At that session each member was encouraged to lead a discussion about her selected woman's accomplishments and the barriers she had overcome to attain her goals. To facilitate this process, members were given a brief synopsis of the women's lives. In subsequent group meetings, participants led discussions regarding their feelings about the woman in the picture, her perspectives on life, and the relevance for their own lives. These observations stimulated considerable reflection among group participants, with several women describing the importance of the exercise in fostering change, planning for recovery and careers, furthering their education, developing relationships, and caring for their children.
Participants' responses to the photographs often paralleled ideas and themes they incorporated into their personal prayers. Themes dominating their responses centered on children, family responsibilities, and feelings of guilt resulting from exposing their children to an addicted lifestyle. Participants also reflected on how the successful women in the photographs managed their lives. Through discussions of the women in the photographs, participants were enabled to express their perceptions of important normative themes (that is, obtaining employment, managing a household,
Exploring Visual Art. The experiential group condition incorporated 15 reproductions of classical paintings to foster opportunities for participants to engage in self-reflection. Few participants had exposure to classical art and its interpretation. The artwork served as a stimulus for self-expression and was useful in helping participants "open up." Group members found the use of art to be a novel, interesting medium through which they could express their perspectives about addictive lifestyles, recovery, and future hopes. Nine participants reported benefits from the experiential group intervention by highlighting the importance of art in their recovery process. One participant said: "The art made me feel compelled to open up and share what I would normally have suppressed." Another participant elaborated by saying, "The art made me talk about feelings and reminded me of unpleasant things that I would have not shared normally." Participants who were exposed to art reproductions seemed to identify with the fear and anxiety expressed in Munch's paintings. The Scream and Anxiety. Through discussions about these pictures, the women were able to get in touch with these feelings and were able to describe similar fearful or anxious situations related to the world of drugs in which they had lived, as well as difficulties they had with their addictions. Munch's The Scream moved some participants to say, "We don't want to face reality. If we go back that way, its death and if we move forward, we might fail... What then?" Thematic discussions about Munch's Anxiety expressed the thought that "The people in the background were all dressed up and yet they appeared to be miserable."
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