ANÁLISIS DEL CONTEXTO PROCESAL PENAL.
3. LA BÚSQUEDA DE RESULTADOS EN LA GESTIÓN DEL PROCESO PENAL.
mentoftheclient’sabilitytoparticipateinthe groupandtheclient’sneedsanddesiresregard- ingtreatment.Thisassessmentcanbeginas partofageneralassessmentofclientsentering theprogram,buttheevaluationprocessshould continueaftertheinitialinterviewandthrough aslongasthefirst4to6weeksofgroup. Assessmentshouldinquireaboutalldrugsused andlookforcross-addictions.Italsoisimpor- tanttomatchgroupstoclients’currentneeds. Inadditiontotheseandotherassessmentcon- siderations,clientsshouldbeaskedaboutthe compositionoftheirsocialnetworks,typesof groupstheyhavebeenin,theirexperiencein thosegroups,andtherolestheytypicallyhave playedinthosegroups(Yalom1995).
Tohelpassessclients’relationshipsandtheir abilitytoparticipateproductivelyinagroup, thecliniciancanhavetheclientdrawan eco-map(seeanexampleinFigure3-1).An
eco-map(sometimescalledasociogram)isa graphicrepresentationthatdepictsinterper- sonalrelationships(GarvinandSeabury1997; Hartman1978).Theclientoccupiesthecenter ofthepage.Then,circlesareaddedtoshow eachsignificantrelationship.Thecloserthe relationship,thecloseritistothecentercircle. Asolidlinebetweencirclesindicatesastrong, nurturingrelationship,whileadottedline depictsaconflictedconnection.Arrowsdrawn onthelinescanrepresentthedirectionofthe relationship.Anarrowfromthecenterout means“Icareaboutthisperson.”Anincoming arrowmeans“Thispersoncaresaboutme.” Clientswhoareinarticulateorwithdrawnmay welcometheopportunitytopresentinforma- tionvisually,andclinicianscangatheruseful informationfromthesediagrams.Ifthedia- gramindicatesfew,distant,andconflictedrela- tionships,theclientmayrequireagroupthatis verystructured.
Theeco-mapisindicative,butnotcomprehen- sive.Itonlyprovidestheclient’sviewpoint. Thoughitisausefultool,leadersshouldbe
Figure 3-1 Eco-Map Mother Boss Sister Drinking BuddyJoe Brother #2 Client Father Brother Wife Ex-wife
Source:AdaptedfromGarvinandSeabury1997;Hartman1978. Usedwithpermission.
Criteria for the Placement of Clients in Groups 38
waryofbasingplacementdecisionsonthisor anyothersinglesourceofinformation.Clinical observationandjudgments,informationfrom collateralresources,andotherassessment instrumentsallshouldcontributetoadecision onaclient’sreadinessandappropriatenessfor grouptreatment.Eitherthegroupleaderor anothertrainedstaffpersonshouldmeetwitha clientbeforeassignmenttoagroup.Inthis interview,itisimportanttoevaluatehowthe clientreactstothegroupleaderandtoassess currentandpastinterpersonalrelationships. Thegroupleaderalsomayholdanorientation group(perhapseducationalinnature)to observehowtheclientrelatestoothers.The clientalsomaybeobservedinawaitingroom withotherclientsorinasimilarsocialsituation togaininsightintohoweachpersonrelates toothers.
Theclinicianpayssuchcarefulattentiontothe relationshipsclientscanmanageattheircur- rentstageofrecoverybecausethiscapacityhas everythingtodowithhowabletheclientisto participateinagroup.Whatevertheirdiagno- sis,clientsingroups—especiallyinterpersonal processgroups—needtobeabletoengagewith otherpeople.Theyneedmotivationtochange, creativity,anddoggedperseverance(Brown 1991).Furthermore,thegroupleadershould continuetoassessclientsastreatmentprogress- es.Theclients’needsandabilitiesareaptto change––changeispartofsuccessfultreat- ment––andtheappropriatetypeofgroupor thesuitabilityforgroupingeneralmayshift dramatically.
Notallclientsareequallysuitedforallkindsof groups,norisanygroupapproachnecessary orsuitableforallclientswithahistoryofsub- stanceabuse.Forinstance,apersonwho relapsesfrequentlyprobablywouldbeinap- propriateinasupportgroupofindividuals whohaveattainedsignificantabstinenceand whohavemovedontoresolvingpracticallife problems.Itwouldbeequallydisadvantageous toplaceapersoninthethroesofacutewith- drawalfromcrackcocaineinagroupofpeople withalcoholismwhohavebeenabstinentfor3
months.Agroupusuallycanbeheterogeneous indemographiccomposition,includingmen andwomen,youngerandolderclients,and peopleofdifferentracesandethnicities,but clientsshouldbeplacedingroupswithpeople withsimilarneeds.
Peoplewithsignificantcharacterpathology(for example,apersonalitydisorder)placedina groupofpeoplewhodonothaveasimilardis- orderalmostcertainlywouldviolatethebound- ariesofthegroupandofindividualsinthe group.Asaresult,boththeclientswhohave andwholackthecharacterdisorderwould haveanegativegroupexperienceandlimited opportunityforgrowth.Clientswithaperson- alitydisordergenerallyneedagroupthatcan placesignificantlimitsontheirbehaviorboth inandbeyondthegroupsetting.Ingroups treatingclientswithactivepsychoses,special adaptationswouldneedtobemadeforpossible psychoticsymptoms,delusions,andparanoia. Oncesuchadaptationsintechniquearemade tofitthespecialcircumstancesofthepopula- tionbeingtreated,grouptherapy—inthe handsofaskilledgroupleader—canbean effective,appropriateformoftreatment. Othertypesofclientswhomaybeinappropri- ateforgrouptherapyinclude
•Clientswhorefusetoparticipate.Noone shouldbeforcedtoparticipateingroup therapy.
•Peoplewhocan’thonorgroupagreements. Sometimes,asnoted,theseclientsmayhavea disqualifyingpathology.Inotherinstances, theycannotattendforlogisticalreasons, suchasaworkschedulethatconflictswith thatofregulargroupmeetings.
•Clientswho,forsomereason,areunsuitable forgrouptherapy.Suchpeoplemightbe pronetodroppingout,gettingandremaining stuck,oractinginwayscontrarytotheinter- estsofthegroup.
•Peopleinthethroesofalifecrisis.Such clientsrequiremoreconcentratedattention thangroupscanprovide.
•Peoplewhocan’tcontrolimpulses.Such clients,however,maybesuitablefor homogeneousgroups.
•Peoplewhosedefenseswouldclashwiththe dynamicsofagroup.Peoplewhocan’ttoler- atestrongemotionsorgetalongwithothers areexamples.
•Peoplewhoexperiencesevereinternal discomfortingroups.