Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual (review)

Abstract

issn 0362-4021 © 2017 Eastern Group Psychotherapy Society group, Vol. 41, No. 2, Summer 2017 169 1 Correspondence should be addressed to Leon Gellert, PsyD, 24 Decatur Road, Havertown, PA 19083. E-mail: leongellert@gmail.com. Book Review Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual, 2nd ed. By Mary Marden Velasquez, Cathy Crouch, Nanette Stokes Stephens, and Carlo C. DiClemente. New York: Guilford Press, 2016, 308 pp. Reviewed by Leon Gellert1 The first edition of Group Treatment for Substance Abuse was published in 2001. Since that initial publication, there has been significant evolution in the underlying philosophy and techniques used in treating substance use disorders. The authors, all of whom have more than 20 years of experience treating substance use or in a related area, successfully adapt many of these popular treatment techniques to integrate with the transtheoretical method (TTM). The book provides a strong and accessible foundation and rationale for using the 35 sessions that make up the treatment itself. Prochaska and DiClemente introduced the TTM of behavior change more than 30 years ago. DiClemente (2006) authored Addiction and Change: How Addictions Develop and Addicted People Recover and has also written two self-help books, with Prochaska, using TTM to change bad habits. Velasquez and DiClemente previously coauthored, along with two other authors, the second edition of Substance Abuse Treatment and the Stages of Change (Connors, DiClemente, Velasquez, & Donovan, 2015) and, along with Couch, coauthored the first edition of this manual. Stephens, who has more than 20 years of experience working specifically with TTM and motivational interviewing (MI), replaced Maurer, an outreach counselor, as coauthor from the first edition to the second edition. The second edition boasts a multitude of changes from the first edition. The authors do a sufficient job of explaining why these new techniques and theories are being added to the manual and how each one complements the TTM. The integration of MI theory (e.g., ambivalence) and techniques (e.g., open-ended questions, 170 gellert affirmations, reflective listening, summary reflections [OARS]) is the most impactful change to the second edition. Other significant additions include using psycho­ linguistic research to identify “change talk” and “sustain talk.” The new edition includes several new sessions that focus on bolstering self-control, mindfulness techniques, and assertiveness. Last, the authors have been influenced by positive psychology to focus on the strengths and values of clients. The treatment manual presents 35 sessions in total, which the authors separate into two parts. The first sequence consists of 17 sessions that are aimed at moving through the first three stages of change. The second sequence consists of 18 sessions that are aimed at moving through the final two stages of change. The authors are clear that, although it is preferred that all sessions be used, it is not necessary to do so. Clinicians should feel free to determine which sessions are most applicable to their group or individual patients. As the authors state, “sequence and related techniques are not ‘cast in stone’” (p. 20). The first three chapters of the book offer a succinct and straightforward overview of the TTM, skills and strategies implemented by the manual, and how to develop such a group. TTM identifies five stages of change: precontemplation, contemplation , preparation, action, and maintenance. It also identifies 10 processes that “are the engines of change that help people accomplish essential tasks that promote successful change” (p. 10). The 10 processes fall into two categories: experiential and behavioral. The experiential processes are elicited more in the first three stages of change, whereas the behavioral processes are the focus of the last two stages. For a reader unfamiliar with the TTM, this chapter offers a strong foundation for understanding the rationale and objectives of each of the 35 sessions. However, at times, the authors stray too far into the foundations of their theory. For example, they spend time explaining Pavlov’s research on conditioning and Skinner’s work on reinforcement, which is unnecessary given the education of the target audience. The authors state in the first line of the introduction, “This manual is for clinicians who work with clients who have substance use disorders” (p. 1). The authors intended...