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Decrease conflict in groups

November 1, 2009
by Mark Sanders, LCSW, CADC and Shannon Mayeda, PhD, LCSW, CRADC
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These 15 strategies can improve client retention in group treatment

While most evidence-based practices are individualized approaches, addiction counselors disproportionately do their work with clients in groups.1 As the addiction treatment field moves toward evidence-based practices, we will need either to prove that group therapy is an evidence-based practice or improve the effectiveness of groups in order to retain clients in treatment longer, thus improving recovery rates. Studies reveal that clients who complete treatment have higher recovery rates than those who drop out.2

Conflict is a leading cause of premature terminations among group members.3,4,5 This article will describe 15 strategies for reducing conflict in chemical dependence groups.

Managing threats to success

Therapy groups go through predictable stages, beginning with the preaffiliation stage as characterized by approach/avoidance behavior. This is the stage in which members are moving close to the group, then backing away. It is as though group members are saying, “I want to trust this group, but I don't know if I can.”

The next phase is a power and control phase, in which members vie for power, lock horns, and have power struggles. Most group members who drop out of treatment will do so in this stage.

The third stage is the intimacy/cohesion stage. Research reveals that group members make more progress in groups that are cohesive than in those that are not.

Conflict in the power/control stage is one of the greatest threats to group cohesion.6 Many group leaders are uncomfortable with conflict3, yet its management helps groups develop cohesion.

Strategies for addressing group conflict include:

  1. Stop outbursts early. While it has been said, “Catharsis is good for the soul” and “Let ‘em shout it out,” outbursts serve to make group members feel unsafe.5,6 Many chemically dependent clients are from families of origin that felt unsafe.7 Many are less likely to return to an unsafe therapy environment. If you wait too long to deal with conflict, you might need to call a public safety department to defuse it.

  2. Lower your voice. When group members yell at one another, you can model calmness by lowering your voice. Group members often will take heed and lower their voices as well.

  3. Eliminate threatening behavior. If group members are yelling at one another, the group leader can ask them to lower their voices. If they stand, you can ask them to sit down. If they point at one another, you can ask them to stop pointing. You can make a statement such as, “When group members yell at each other and point fingers at each other, these can be perceived as threats, and in order to communicate with each other effectively, it's important for group members not to feel threatened.”

  4. Create a contract on the spot. The group leader might say, “Jason, you told us that you have a pattern of getting drunk following arguments, and on several occasions these conflicts have led to arrests for disorderly conduct. You mentioned that you'd like to learn to express your feelings more effectively in group, so that disagreements won't lead to relapse and arrests. Do I have your permission to stop you, in group, when you are having a conflict to help you find a more effective way to express your feelings?” If the client says yes, you have a contract.

  5. Partialize. When disputes arise, point out the fact that members are mostly saying the same thing and/or are mostly in agreement. This can reduce tension.

  6. Talk directly about an underlying cause of group conflict. Group members will argue about a number of subjects, including group rules, programmatic rules, group start and end times, procedures, and program curfew. Sometimes the real cause of the conflict is anger that is related to having to give up alcohol and other drugs. Mentioning this gives clients the opportunity to discuss the real cause of their anger.

  7. Repeat back. When two group members are arguing with each other, they're often not listening to each other. Asking group members to repeat what the other has said to that person's satisfaction can decrease conflict, as the original speaker feels heard.

  8. Point out mirror reactions. Group members often fight with others who remind them of themselves. This is often an unconscious process. You can bring it to the surface by asking those who are doing battle, “Is there anything about the other that reminds you of yourself?” “Is there anything you admire about this person?” “Is there anything you envy about this person?” This awareness might help simmer the conflict.

  9. Dismantle subgroups. Subgroups threaten to undermine group cohesion and increase dropout rates, and thus should be handled with care.8,9 Strategies for dismantling subgroups include:

    • Give the subgroup credit. Addicts are often ostracized, stigmatized, and treated as “less than” in society. Being part of the “in group” can feel good.