Community Mental Health Group

Community mental health group: Alcohol Anonymous Group
Every recovering addict is welcome to the Sunday Open Meeting organized by Narcotics Anonymous which is located at St. Andrews close to the Sea Lutheran church, 936 Baltic Avenue. The theme of the meeting is ‘We do recover’ and is aimed at helping anyone who desires to be free from drug abuse. This meeting is supportive / therapeutic in nature. These Open Narcotics Anonymous meetings can be attended by anybody who desires to be a part of our Fellowship and everyone is welcome (Narcotics Anonymous, n.d.).
Narcotics Anonymous refers to a non-profit society or Fellowship comprising of people of both sexes who are battling drug addiction. The major function of the Fellowship is creating an avenue where recovering addicts can meet with each other from time to time which would help them stay clean. This Fellowship fosters complete liberation from addiction. Total recovery from all forms of addiction can be achieved via the 12 Traditions and 12 Steps of Narcotics Anonymous. The Fellowship is a worldwide, community-based society of recuperating drug addicts and it holds over 67,000 meetings every week across over 139 countries globally (Narcotics Anonymous, n.d.).
Anybody can attend the Fellowship, irrespective of race, religion, age, sexual identity, lack of faith or creed. Any forms of photographic and/or recording devices are banned from meetings thus “we are under no surveillance at any time”. Equally, it is advised that note-taking shouldn’t be done as members often see this as unusual. Lastly, at a given time in all meetings, everyone has to introduce themselves. Only First name is required and then we ask whether you are an Addict, Visitor, Student or just Interested in the institution. The Fellowship doesn’t provide exclusive meetings for any specific persons. People who have confidentiality concerns could attend a close-door meeting instead, where only addicts or those still unsure of their status are allowed (Narcotics Anonymous, n.d.).
Leaders could equally arise within these meetings. Certain persons often take charge of others within the peer groups and these persons would commonly set the mood and carry out organizational duties for the other group members. Extroverts often command more attention than introverts, however, people who don’t speak a lot but often carry out thoughtful analysis and self-examination could equally rise to become capable and respected leaders. Most groups desire and enjoy healthy interactions. The leaders of occupational therapy apply a number of techniques which aid interaction within the group. When the session commences, the group leader starts interaction by enjoining members to state their opinions of one another or to suggest ideas which will be responded to by everyone. As soon as the meeting starts, members expect the leader to direct them though it is important to ensure that everyone and not just the leader are able to communicate freely. When directly asked a question, the leader could direct the question to another member with questions like 'What would you do in Mary's situation?’ or ‘What do you think?’ (Creek & Lougher, 2011).
From observations of those who respond most times, the leader then creates methods where the less vocal members are better involved and everyone is allowed equal chances of participation. Silence could cause a rise in anxiety among certain members however interruptions every silent moment should be encourages. In some cases, silence gives members the opportunity to ruminate over the topic under discussion and create their unique opinions. When a discussion question is asked, it is important that a large percentage of members have the chance to provide an answer before progressing. Do not assume that a few members voice the opinions of the entire group. It is only when all members have had their say that a valid consensus on an issue can be achieved (Creek & Lougher, 2011).
By classifying the members based on task roles, an initiate will surely be present who will propose new ideas to the group. She/he will offer a new idea as regards problems, goals, procedures and solutions. Equally, there will be an information lover who demands a better explanation of proposed suggestions so as to determine their truthfulness as well as facts and authoritative information related to the issues under discussion. Also, there is the opinion seeker and he/she demands majorly for a better explanation of values related to the group’s objectives or values related to previous suggestions (Bate, 2010). 
The information supplier who provides generalizations and facts that are conclusive or that talks about his/her personal experience related to the group issue. The opinion supplier who provides his/her opinion related to a given suggestion. The main aim of this person is that their beliefs should be the major values and concerns of the group rather than related information and facts. There is an elaborator who explains suggestions based on developed meanings or examples, gives a basic logic for previously proposed suggestions and also attempts to check how a suggestion or idea would work out whenever adopted primarily based on related information and facts. There is the coordinator who clarifies and shows the connection between suggestions and ideas, attempts to mix suggestions and ideas together or to organize the actions of different sub-group members. There is the energizer who motivates the group to take a decision or action and tries to stimulate the group to carry out “higher quality” or “greater” activity. Finally, a procedural technician is present and his/her role is to speed up group actions by doing them his/herself e.g. arranging chairs or passing materials (Bate, 2010). 
If maintenance roles are applied in the assigning of functions to members, then there will be the encourager who commends, supports and follows the suggestion of others. She/he expresses solidarity and warmth in his/her attitude towards the other members, gives praise and commendation and severally shows empathy and concurrence with the ideas, suggestions and points of view of others. There is the harmonizer, who manages the disputes between members, helps to end disagreements, reduces the tension during times of conflict by cracking good jokes, has a gentle and calming attitude etc. (Bate, 2010). 
There is the compromiser who works from the midst of a conflict which involves his/her opinion or idea. She/He might decide to agree by letting go of his/her opinion, by admitting error, by making a partial compromise with the other group members or by disciplining him/herself so as to keep the group together. There is the gatekeeper who assists the efforts to ensure smooth communication by enjoining others to participate with statements like; "we haven’t gotten the ideas of Mr. X yet," etc., or by exerting control over the communication flow, "why don’t we limit the length of our contributions so that everyone will have a chance to contribute?" etc. The standard setter sets group standards. These set standards are focused on the group operations’ quality or they help enforce limits regarding the allowed individual conduct from group members (Bate, 2010). 
There is the group observer that takes record of certain parts of the group operation and then later supplies this data with its suggested meanings to be used for procedural evaluation by the group. The summarizer is the one who points out the group’s position in relation to its targets via a summary of previous occurrences, identifies deviation of the group from agreed goals and direction or queries the subject of the group discussion. There is a reality tester that measures the success of the group with certain standard(s) of group operations within the group task context. Therefore, the person might examine and challenge the “facts”, the “practicality”, the “procedure” or the “logic” of a suggestion or an aspect of the group discussion (Bate, 2010). 
Irving Yalom (1995) carried out an advanced study of group psychotherapy focusing on the creation of an effective theoretical logic to be used for group psychotherapy, advanced research and the description of therapeutic features i.e. components which directly influence and measure patient improvement.
Therapeutic factors refer to the features of group-based therapy which are identified during group operations. They refer to the major components that improve the condition of a member. These factors are the culmination of efforts by members, the group leader and/or the person him/herself (Yalom, 1995). 
The first of these factors is the infusion of hope. Several clients join up with a therapy setting with a defeated mentality and are often sorrowful for their inability to manage their substance use. They always feel they have run out of options and have no hope of a better future. When persons having these mentalities join up with people who have faced similar issues, they are presented with the awesome opportunity of observing change in the life of others and concurrently having their personal little triumphs celebrated and commended by the other members. From this, their hope starts to increase. The effect of hope and the attention given to this factor is of high importance among the several therapeutic models (Yalom, 1995)
Several exercises are applicable for an improved infusion of hope in people battling substance abuse. Clients could be instructed to go through a visualization program where they picture themselves living a life devoid of substance abuse, with focus laid on how their lives would be better and different under these conditions. The energy of the group helps drive this experience and this increases the intensity of support available to the clients. Just like every “guided imagery exercise”, the group facilitator has to proceed with caution. Several substance-abusing persons might find it difficult to picture themselves living without it and therefore such a program could turn out to be humiliating if not delicately handled. If the sufferer isn’t able to visualize, he/she is once again made to feel like a failure (Yalom, 1995). 
In order to prevent this possible unwanted and shameful event, the group leader needs to be actively involved in the image’s creation and to monitor it to ensure it is safe for every group member as it progresses. An example is when Narcotic Anonymous met during one of their meetings, the participants were hopeful of recovering. In line with the meeting’s theme; meeting ‘We Do Recover’, an addict could see that there was hope in the fellowship (Yalom, 1995). 
Universality is the next factor. Substance abuse related problems commonly affect relationship adversely and cause clients to go into isolation. During a short group meeting, the clients come in contact with other persons who have battled similar issues. They then realize that their problem is not peculiar to them and they are able to find huge satisfaction in this knowledge. The idea that their suffering is not unique or exclusive to them and that other people facing similar issues are ready and willing to help them is highly soothing. It helps the clients leave their isolation and increases their hope in life which in turn, helps drive their change. During the Narcotics Anonymous therapeutic group meetings, the participants or members are those who have experienced the difficult times of substance addiction and desire to get better. This collective objective brings them together to form a family (Yalom, 1995). 
The next therapeutic factor is Imparting Information and it is an important factor which must be considered. The inescapable transference of information within a group help members functions from day to day. Just like formal psychoeducational groups, therapeutic self-help groups give their members opportunities to meditate on the new knowledge gained and concurrently using these new information in the group. The information exchanged is confidential and is in most cases seen as motivational. The client battling substance abuse is able to listen to accounts from others about how they conquered their difficult concerns. This openly shared success provides a positive vibe to the entire group and aids change. Immediately after each Sunday session, every member is allowed the opportunity to state their opinions of the meeting (Yalom, 1995). 
The next therapeutic factor is Altruism. A basic human trait is the wish to assist others whenever they are going through a rough patch. Clients going through substance abuse are commonly focused on their personal problems and often find it difficult to assist others in need. Group therapy presents the members with chances to give aid and advice to each another. Most especially within the MIGP model, the leader pays huge attention to selfless actions by the members. These actions are often acknowledged and commended. As the individuals understand that they possess something which can help their other group members, their self-esteem increases as self-efficacy and change are backed. Via the Narcotics Anonymous Sunday meetings, members who have completely recovered from various addictions are ready to assist others still within the recovery period (Yalom, 1995). 
The next therapeutic factor is the Corrective Recapitulation of the Primary Family Group. This factor refers to the crucial nature of relationships present in the client’s original family, as this is certainly expressed within the group. “Recapitulation of the family group” takes place whenever a client – both deliberately and non-deliberately – connects with a fellow group member like that member is a part of his/her original family and they both struggled together previously. This event is obviously a projection; however it is identifiable by the facilitator and the group members concerned can both benefit from this as they examine novel methods of relating which takes apart the previous dysfunctional structures of their original families. Somehow, the group starts to serve as a new and substitute family. The group members are seen as siblings and the leader as the parent. Even if the group is time-restricted, matters of transference and countertransference might need attention. Nonetheless, MIGP commonly reduces this transference by “spreading it throughout the group” instead of keeping it concentrated and exclusive to the dyadic counseling connection. Whenever the group members start to reveal their long held secrets and over time are able to share whatsoever with a member, then the group becomes like a family (Yalom, 1995). 
Next is Development of Socializing Techniques. Several substance addicts are “field-dependent” or “field-sensitive” persons who are very mindful of certain relationships as against generalizations or principles which are applicable irrespective of context. Group therapy could exploit this trait and direct the energy possessed within these relationships to bring about change. As the participants take part in their relationships, they develop novel social skills which assist them in ending their isolation and relating with people in more productive ways. They equally master the act of disconnection, an equally important skill especially when considering the concerns connected with the loss of a relationship. The group leader might occasionally intentionally lay emphasis on these new social skills via modeling or role-playing exercises located within the group context. The clients gradually get healed as they take their new knowledge and experience from within the group and apply it generally to their lives away from the group (Yalom, 1995). 
Imitative Behaviours is another significant factor. These behaviours are a crucial learning source during group therapy. The modeling process is quite important as the clients learn novel ways of tackling difficult feelings without using drugs or getting violent. Therapists have to be very sensitive of the crucial role they play as regards this as the clients commonly expect them to showcase new behaviours as they come across them within the group. Members could equally learn by copying other group members that are successfully battling their problematic relational issues. It is beneficial for a fresh memeber to experience an established group in which people are challenging their problems properly, leaving behind old and ineffective methods and creating new relationships where change is supported. The group then becomes a real-life demonstration of these novel behaviours, which supports and eases insight and the process of change (Yalom, 1995). 
Another therapeutic factor listed by Yalom is Interpersonal Learning. Groups give opportunities to members to develop their knowledge of intimacy and relationships. Even the group serves as a laboratory wherein the members are able to - possibly for their first time ever - freely communicate with persons who will help them and give them unbiased feedback. Interpersonal Learning is backed by the MIGP framework, as exclusive attention is provided for relational problems within the group context (Yalom, 1995). 
Another important factor is Group Cohesiveness. Majorly misunderstood, this factor refers to a mentality which defines the person not just as regards to his/her personality but rather with regards to the group. It refers to a powerful mindset that a person is needed and valued in a relationship. Developing group cohesion is quite crucial in these groups, in order for the members to feel relaxed and guarded enough to disclose their secrets and change their habits. This sense of being values is empowering and nurturing. Via this togetherness, the members have the mindset that they are going through similar problems and they are equally involved in solving these problems (Yalom, 1995). 
From the Irving Yalom (1995) study, catharsis was identified as another therapeutic factor. In some cases, group members will suddenly gain insight via interaction and this could bring about a considerable shift within them as regards to the way they react to life issues. These insights might be followed by emotional bursts via which anger or pain associated with previous psychological wounds is released. This process takes place more smoothly within a group in which the level of cohesion is high and in which the therapist engenders a secure environment where emotions are shared without restrictions. It is crucial to identify, nonetheless, that even though catharsis is very genuine, it isn’t seen as curative all on its own. Significant levels of emotional interchange which are not tackled within the group might lead to possible relapse triggers and these could reduce the success rate of the clients. The therapist recognizes the strong emotions after the group member has openly shared them however he/she still asks the entire group and the member as well to give a meaning to these emotions within the group context. Therefore, the emotional experience and the knowledge of the way this emotion either supports or inhibits relationships are both therapeutic (Yalom, 1995). 
Finally, therapeutic groups are influenced by Existential Factors. Existential factors such as loss or death are common sources of huge pain and discomfort within the substance-abusing group. The shortness of a time-restricted group experience brings these problems to the fore and gives members the opportunity to tackle them openly within the safe group environment. Time itself stands for loss and equally acts as a motivator, because the members are constantly faced with the end of every group session and generally the group therapy experience. The more they become knowledgeable of the problems of reality and also their limits, clients are able to receive group support in going through “life on life’s terms” rather than following their previous escape patterns (Yalom, 1995). 











References
Bate, S. P. (2010). Strategies for cultural change. Routledge.
Creek, J., & Lougher, L. (2011). Occupational therapy and mental health. Elsevier Health Sciences.
Narcotics Anonymous. (n.d.). Frequently Asked Questions. Retrieved September 24, 2017, from http://www.nanj.org/questions.shtml
Yalom, I. D. (1995). The theory and practice of group psychotherapy. Basic Books (AZ).