Why a Quick Guide?..........................................2 
 

What ,s a TIP?....................................................3 
 

Introduction .......................................................4 
 

Brief Interventions.............................................5 
 

Brief Therapies............................................... 13

Brief Cognitive–Behavioral Therapy.............. 20 
 

Brief Strategic/Interactional Therapies ........ 24 
 

Brief Humanistic and 

Existential Therapies......................................26

Brief Psychodynamic Therapy .......................28 
 

Brief Family Therapy ......................................30 
 

Time-Limited Group Therapy .........................33 
 

Glossary ..........................................................36 
 

Contents 
 
   

Quick Guide
 For Clinicians
 

Based on TIP 34

Brief Interventions and Brief

Therapies for Substance

Abuse

This Quick Guide is based almost entirely on information contained in TIP 34, published in 1999 and based on information

updated through May 1998. No additional research has been

conducted to update this topic since publication of the original

TIP.
   

   

   

   

   

   

   

2 Brief Interventions and Brief Therapies for Substance Abuse

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany

Brief Interventions and Brief Therapies in

Substance Abuse, Number 34 in the Treatment

Improvement Protocol (TIP) Series published by

the Center for Substance Abuse Treatment (CSAT),

Substance Abuse and Mental Health Services

Administration. This Quick Guide is based entirely

on TIP 34 and is designed to meet the needs of

the busy clinician for concise, easily accessed

"how­to" information.

The Guide is divided into 10 sections to help readers quickly locate relevant material.

Terms related to these treatment methods are listed on page 38 in the Glossary. These terms are

included to enable clinicians to talk knowledgeably with their clients and clients' medical

providers.

For more information on the topics in this Quick

Guide, readers are referred to TIP 34.
     

   

   

What  Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.

This series provides the substance abuse treatment and related fields with consensus­based,

field­reviewed guidelines on substance abuse

treatment topics of vital current interest.

TIP 34, Brief Interventions and Brief Therapies for

Substance Abuse:

• Addresses concerns of a broad range of readers

including clinicians, social workers, medical personnel, mental health workers, program administrators, and policymakers.

• Includes extensive research.

• Lists numerous resources for further information.

• Is a comprehensive reference for clinicians on

applying these methods in substance abuse

treatment.

See the inside back cover for information on how

to order TIPs and other related products.
   

   

   

   

   

   

   

4 Brief Interventions and Brief Therapies for Substance Abuse

INTRODUCTION

The use of brief intervention and brief therapy

techniques has become an increasingly important

part of the continuum of care in the treatment of

substance abuse problems. They provide the

opportunity for clinicians to increase positive outcomes by using these modalities independently as

stand­alone interventions or treatments and as

additions to other forms of substance abuse and

mental health treatment.

Used for a variety of substance abuse problems

from at­risk use to dependence, brief interventions can help clients reduce or stop abuse, act as

a first step in the treatment process to determine

if clients can stop or reduce on their own, and act

as a method to change specific behaviors before

or during treatment. 

For more detailed information, see TIP 34, 

p. 1.
   

   

     

   

   

Brief Interventions 5

BRIEF INTERVENTIONS

Brief interventions are those practices that aim to

investigate a potential problem and motivate an

individual to begin to do something about his substance abuse, either by natural, client­directed

means or by seeking additional treatment.

The basic goal of any intervention is to lower the

likelihood of damage that could result from continued use of substances. The specific goal for each

individual client is determined by his use and by

the setting in which the brief intervention is delivered.

Professionals who can administer brief interventions:

• Primary care physicians

• Substance abuse treatment providers

• Substance abuse clinicians

• Emergency department staff members

• Nurses

• Social workers

• Health educators

• Lawyers

• Mental health workers
   

     

   

   

   

   

   

6 Brief Interventions and Brief Therapies for Substance Abuse

• Teachers

• Employee assistance program counselors

• Crisis hotline workers, student counselors

• Clergy

Objectives to Address with Brief Interventions

• Learning to schedule and prioritize time

• Expanding a sober support system

• Socializing with recovering people or learning to

have fun without substance abuse

• Beginning skills exploration or training if unemployed

• Attending an AA or NA meeting

• Giving up resentments or choosing to forgive

others and self

• Staying in the "here and now"

Treatment Needs During the Stages of

Change

• Precontemplation. The client needs information

linking his problems with his substance abuse.

A brief intervention might be to educate him

about the negative consequences of substance

abuse.

• Contemplation. The client should explore feelings of ambivalence and the conflicts between

her substance abuse and personal values. The
   

   

   

   

   

   

Brief Interventions 7

brief intervention might seek to increase the

client's awareness of the consequences of continued abuse and the benefits of decreasing or

stopping use.

• Preparation. The client needs work on strengthening commitment. A brief intervention might

give the client a list of options for treatment,

then help the client plan how to go about seeking the treatment.

• Action. The client requires help executing an

action plan and may have to work on skills to

maintain sobriety. The clinician should acknowledge the client's feelings and experiences as a

normal part of recovery.

• Maintenance. The client needs help with

relapse prevention. A brief intervention could

reassure, evaluate present actions, and redefine long­term sobriety plans.

It is important to extract one measurable change

in the client's behavior, such as:

• Attending an AA or NA meeting.

• Expanding his sober support system.

• Socializing with recovering people.
     

   

     

   

8 Brief Interventions and Brief Therapies for Substance Abuse

FRAMES

A brief intervention consists of five basic steps

that incorporate FRAMES and remain consistent

regardless of the number of sessions or the length

of the intervention:

• Feedback is given to the individual about personal risk or impairment.

• Responsibility for change is placed on the participant.

• Advice to change is given by the provider.

• Menu of alternative self­help or treatment

options is offered to the participant.

• Empathic style is used in counseling.

• Self­efficacy or optimistic empowerment is

engendered in the participant.

A brief intervention consists of five basic steps

that incorporate FRAMES:

• Introducing the issue in the context of client

health

• Screening, evaluating, and assessing

• Providing feedback

• Talking about change and setting goals

• Summarizing and reaching closure
   

   

   

Brief Interventions 9

Screening, Evaluating, and Assessing

This is a process of gaining information on the targeted problem; it varies in length from a single

question to several hours of assessment on the

targeted topic of change. Additional information

about and examples of screening and assessment

instruments can be found in the TIP.

Attitude of Understanding and Acceptance

Clinicians must assure their clients that they will

listen carefully and make every effort to understand the client's point of view during a brief intervention. Active listening saves time by reducing or

preventing resistance, focusing on the client,

focusing the clinician, encouraging self­disclosure,

and helping the client remember what was said

during the intervention. Skilled active listeners

perform these three steps automatically, naturally,

smoothly, and quickly:

• Listen to what the client says.

• Form a reflective statement. To reflect your

understanding, repeat in your own words what

the client said.

• Test the accuracy of your reflective statement.

Watch, listen, and/or ask the client to verify the

accuracy of the content, feeling, and/or meaning of the statement.
   

   

   

   

10 Brief Interventions and Brief Therapies for Substance Abuse

Brief Interventions in Substance Abuse

Treatment Programs

Brief interventions can be used before, during,

and after substance abuse treatment. The following is a list of the potential benefits of using brief

interventions in substance abuse treatment settings:

• Reduce no­show rates for the start of treatment,

no­show rates for continuing care, and dropout

rates after the first session of treatment

• Increase treatment engagement after intake

assessment 

• Increase compliance for doing homework

• Increase group participation and mutual­help

group attendance

• Address noncompliance with treatment rules

• Reduce aggression, violence, and isolation from

other clients

• Obtain a sponsor, if involved with a 12­Step program

• Increase compliance with psychotropic medication therapies and outpatient mental health

referrals

• Serve as interim intervention for clients on treatment program waiting lists
   

   

       

   

   

   

Brief Interventions 11

Brief Interventions Outside Substance Abuse

Treatment Settings

Brief interventions are commonly administered in

nonsubstance abuse treatment settings, often

referred to as opportunistic settings, where clients

are not seeking help for a substance abuse disorder but have come to receive medical treatment,

to meet with an Employee Assistance Program

counselor, or to respond to a court summons. 

Treatment providers who work in settings other

than substance abuse treatment must be flexible

when assessing, planning, and carrying out brief

interventions. When delivering a brief intervention

in any treatment setting, the provider should be

mindful of room conditions and interruptions

because client confidentiality is of utmost importance.

Essential Knowledge and Skills

The following are four essential skills for providing

effective brief interventions:

• An overall attitude of understanding and acceptance

• Counseling skills such as active listening and

helping clients explore and resolve ambivalence

• A focus on intermediate goals
   

12 Brief Interventions and Brief Therapies for Substance Abuse

•A working knowledge of the stages­of­change

through which a client moves when thinking

about, beginning, and trying to maintain new

behavior

For more detailed information, see TIP 34, 

pp. xvi–xvii, pp. 15–29.
   

   

   

   

Brief Therapies 13

BRIEF THERAPIES

The following is a list of characteristics pertaining

to all brief therapies:

• They are either problem focused or solution

focused; they target the symptom and not what

is behind it.

• They clearly define goals related to a specific

change or behavior.

• They should be understandable to both client

and clinician.

• They should produce immediate results.

• They can be easily influenced by the personality

and counseling style of the therapist.

• They rely on rapid establishment of a strong

working relationship between client and 

therapist.

• The therapeutic style is highly active, empathic,

and sometimes directive.

• Responsibility for change is placed clearly on

the client.

• The client is helped to have experiences that

enhance self­efficacy and confidence that

change is possible.

• Termination is discussed from the beginning.
     

   

       

   

   

14 Brief Interventions and Brief Therapies for Substance Abuse

• Outcomes are measurable.

Determining when to use a particular type of brief

therapy is an important consideration for counselors and therapists. Client needs and the suitability of brief therapy must be evaluated on a

case­by­case basis. The following are some criteria

for considering the appropriateness of brief

therapy:

• Dual diagnosis issues

• The range and severity of presenting problems

• The duration of substance dependence

• Availability of familial and community supports

• The level and type of influence from peers, family, and community

• Previous treatment or attempts at recovery

• The level of client motivation

• The clarity of the client's short­ and long­term

goals

• The client's belief in the value of brief therapy

• The numbers of clients needing treatment 
   

   

   

Brief Therapies 15

Criteria for Longer–Term Treatment

• Failure of previous shorter treatment

• Multiple concurrent problems

• Severe substance abuse

• Acute psychoses

• Acute intoxication

• Acute withdrawal

• Cognitive inability to focus

• Long­term history of relapse

• Many unsuccessful treatment episodes

• Low level of social support

• Serious consequences related to relapse

Screening and Assessment

Screening identifies the need for more in­depth

assessment and is not a substitute for an assessment. The assessment should determine whether

the client's substance abuse problem is suitable

for a brief therapy approach. Therapists should

gather as much information as possible about a

client before the first counseling session. Refer to

TIP 34, pp. 41–46 for more information on

screening and assessment issues. 
   

   

16 Brief Interventions and Brief Therapies for Substance Abuse

Core Assessment Areas

Before proceeding with brief therapy for substance

abuse disorders, a number of areas should be

assessed:

• Current use patterns

• History of substance abuse

• Consequences of substance abuse

• Information about major medical problems and

health status

• Information about education and employment

• Support mechanisms

• Client strengths and situational advantages

• Previous treatment

• Family history of substance abuse disorders and

psychological disorders

The Opening Session

In the first session, the main goals for the therapist are to gain a broad understanding of the

client's presenting problems, begin to establish

rapport and an effective working relationship, and

implement an initial intervention. During the first

session, the clinician must accomplish certain critical tasks including:

• Producing rapid engagement.

• Identifying, focusing, and prioritizing problems.
   

     

   

     

   

   

Brief Therapies 17

• Working with the client to develop possible solutions to substance abuse problems and a treatment plan that requires the client's active participation.

• Negotiating the route toward change with the

client.

• Eliciting client concerns about problems and

solutions.

• Understanding client expectations.

• Explaining the structural framework of brief

therapy, including the process and its limits.

• Making referrals for critical needs that have

been identified but cannot be met within the

treatment setting.

Maintenance Strategies

Maintenance strategies must be built into the

treatment design from the beginning. A practitioner of brief therapy must continue to provide support, feedback, and assistance in setting realistic

goals. Also, the therapist should help the client

identify relapse triggers and situations that could

endanger continued sobriety.

Strategies to help maintain the progress made

during brief therapy include the following:

• Educating the client about the chronic, relapsing nature of substance abuse disorders.
       

   

   

   

     

   

         

18 Brief Interventions and Brief Therapies for Substance Abuse

• Developing a list of circumstances that might

provide reasons for the client to return to treatment and plans to address them.

• Reviewing problems that emerged but were not

addressed in treatment and helping the client

develop a plan for addressing them in the future.

• Developing strategies for identifying and coping

with high­risk situations or the reemergence of

substance abuse behaviors.

• Teaching the client how to capitalize on personal strengths.

• Emphasizing client self­sufficiency.

• Developing a plan for future support, including

mutual help groups, family support, and community support.

Ending Treatment

Termination of therapy should always be planned

in advance. In many types of brief therapy, the

end of therapy will be an explicit focus of discussion in which the therapist should:

• Leave the client on good terms, with an

enhanced sense of hope for continued change

and maintenance of changes already accomplished.

• Leave the door open for possible future sessions dealing with the client's other problems.
   

Brief Therapies 19

• Elicit commitment for the client to try to follow

through on what has been learned or achieved.

• Review what positive outcomes the client can

expect.

• Review possible pitfalls the client may

encounter.

• Review the early indicators of relapse.

For more detailed information, see TIP 34, p. xvii, 

pp. 39–48.
       

   

       

   

       

   

   

   

   

20 Brief Interventions and Brief Therapies for Substance Abuse

BRIEF COGNITIVE–BEHAVIORAL

THERAPY (CBT)

The cognitive–behavioral model assumes that

substance abusers are deficient in coping skills,

choose not to use those they have, or are inhibited from doing so. Cognitive–behavioral theory is

generally effective because it helps clients recognize the situations in which they are likely to use

substances, find ways of avoiding those situations, and cope more effectively with the variety of

situations, feelings, and behaviors related to their

substance abuse. To achieve these therapeutic

goals, CBT incorporates three core elements:

• Functional analysis—This analysis attempts to

identify the antecedents and consequences of

substance abuse behavior, which serve as 

triggering and maintaining factors.

• Coping skills training—A major component in

CBT is the development of appropriate coping

skills.

• Relapse prevention—These approaches rely

heavily on functional analyses, identification of

high risk relapse situations, and coping skills

training, but also incorporate additional 

features.
     

         

   

   

Brief Cognitive­Behavioral Therapy 21

When Not to Use Brief Cognitive–Behavioral

Therapy

CBT is generally not appropriate for certain

clients, namely, those:

• Who have psychotic or bipolar disorders and are

not stabilized on medication.

• Who have no stable living arrangements.

• Who are not medically stable (as assessed by a

pretreatment physical examination).

Initial Session for Behavioral Techniques

The initial session in brief behavioral therapy
 

involves an exploration of the:
 

• Reasons the client is seeking treatment.

• Extent to which this motivation for treatment is

intrinsic, rather than influenced by external

sources.

• Areas of concern that the client and significant

others may have about his substance abuse.

• Situations in which she drinks or uses 

excessively.
 

• Consequences she experiences.

Initial Session for Cognitive Techniques

Cognitive therapy works under the assumption

that a client can be educated to approach his
     

   

   

   

   

         

     

       

   

   

22 Brief Interventions and Brief Therapies for Substance Abuse

problems rationally. There are three major steps in

this process:

• The therapist establishes a rapport by listening

carefully to the client, using questions and

reflective listening to try to understand how the

client thinks about his life circumstances and

how those thoughts relate to problematic feelings and behavior. Thus, the client educates the

therapist about himself and his problems.

• The therapist educates the client about the cognitive model of therapy and determines if he is

satisfied with the model.

• The therapist asks the client to describe a

recent event that has triggered some recent

negative feelings, as a way of illustrating the

cognitive therapy process.

Sample Script to Introduce Cognitive Therapy 

"I want to spend a few minutes telling you about

my approach. It seems that how we feel and how

we act in certain situations depend on how we

think. In working with you, my goal is to understand how you see things—the important things in

your life that relate to substance abuse. I want to

help you look at those things objectively and honestly.

"Maybe, you are viewing everything correctly. But

often, people get into automatic ways of thinking
   

   

Brief Cognitive­Behavioral Therapy 23

about themselves and their circumstances. They

don't examine the facts carefully.

"So, let's explore some possibilities and find out

how you think about things. How does that sound

to you?"

For more detailed information, see TIP 34, p. xxii, 

pp. 59–67.
   

       

       

     

   

24 Brief Interventions and Brief Therapies for Substance Abuse

BRIEF STRATEGIC/INTERACTIONAL

THERAPIES

In brief strategic/interactional therapies, the focus

is on the individual's strengths rather than on

pathology, the relationship to the therapist is

essential, and interventions are based on client

self­determination with the community serving as

a resource rather than an obstacle.

No matter which type of strategic/interactional

therapy is used, this approach can help to:

• Define the situations that contribute to substance abuse in terms meaningful to the client.

• Identify steps needed to control or end substance use.

• Heal the family system so it can better support

change.

• Maintain behaviors that will help control substance use.

• Respond to situations in which the client has

returned to substance use after a period of

abstinence.

Strategic/interactional therapies normally require

6 to 10 sessions, with 6 considered typical.

Sessions are usually weekly, with no more than

two per week.
       

   

   

     

       

   

           

       

Brief Strategic/Interactional Therapies 25

Initial Session of Brief Strategic/Interactional

Therapies

The first question that a therapist using a strategic/

interactional approach should ask is, 

"Why are you here?" 

The first session should be spent trying to understand the client's problem.
 

Once the therapist has encouraged a person with

a substance abuse disorder to take further steps

toward change, the subsequent sessions will

focus on identifying and supporting additional

steps in the same direction. As the end of the

therapeutic process nears, the therapist can follow these suggestions to help the client prepare

for the future:

• Prepare the client to maintain positive change

through difficult times.

• Identify what the potential next stressors and

challenges will be.

• Devote some time to preparing the client for

changes to the environment.

• Ask the client to look into the future at the end

of the treatment period and tell the therapist

where he intends to be at a certain time.

For more detailed information, see TIP 34, 

pp. 87–101.
   

       

   

   

     

26 Brief Interventions and Brief Therapies for Substance Abuse

BRIEF HUMANISTIC AND EXISTENTIAL

THERAPIES

Humanistic and existential therapies are united by

an emphasis on understanding human experience

and a focus on the client rather than the symptom. Psychological problems are viewed as the

result of inhibited ability to make authentic, meaningful, and self­directed choices about how to live.

Initial Session for Brief Humanistic and 

Existential Therapies

The opening session is extremely important in

brief therapy for building an alliance, developing

therapeutic rapport, and creating a climate of

mutual respect:

• Start to develop the alliance.

• Emphasize the client's freedom of choice and

potential for meaningful change.

• Articulate expectations and goals of therapy

(how goals are to be reached).

Humanistic and existential approaches can be

used at all stages of recovery in creating a foundation of respect for clients and mutual acceptance of the significance of their experiences.

Some therapeutic moments lend themselves

more readily to one or more specific approaches:
   

   

     

Brief Humanistic and Existential Therapies 27

• Client­centered therapy can be used immediately to establish rapport and to clarify issues

throughout the session.

• Existential therapy may be used most effectively

when a client has access to emotional experiences or when obstacles must be overcome to

facilitate a client's entry into or continuation of

recovery.

• Narrative therapy can be used to help the client

conceptualize treatment as an opportunity to

assume authorship and begin a "new chapter"

in life.

• Gestalt approaches can be used throughout

therapy to facilitate a genuine encounter with

the therapist and the client's own experience.

• Transpersonal therapy can enhance spiritual

development by focusing on the intangible

aspects of human experience and awareness of

unrealized spiritual capacity.

For more detailed information, see TIP 34, 

pp. 105–108.
     

     

   

         

   

       

   

   

28 Brief Interventions and Brief Therapies for Substance Abuse

BRIEF PSYCHODYNAMIC THERAPY

A psychodynamic approach enables the client to

examine unresolved conflicts and symptoms that

arise from past dysfunctional relationships and

manifest themselves in the need and/or desire to

abuse substances. Psychodynamic therapy is generally thought more suitable for the following types

of clients:

• Those who have coexisting psychopathology

with their substance abuse disorder

• Those who do not need or who have completed

inpatient hospitalization or detoxification

• Those whose recovery is stable

• Those who do not have organic brain damage or

other limitations due to their mental capacity

In the treatment of substance abuse disorders,

defenses are seen as a means of resisting

change—changes that inevitably involve eliminating or at least reducing drug use. The following

strategies are recommended for avoiding ineffective adversarial interactions around the client's

use of defenses:

• Working with the client's perceptions of reality

rather than arguing

• Asking questions
   

   

   

   

Brief Psychodynamic Therapy 29

• Sidestepping rather than confronting defenses

• Demonstrating the denial defense while interacting with the client to show her how it works

The Therapeutic Alliance

Of all the brief psychotherapies, psychodynamic

approaches place the most emphasis on the therapeutic relationship and provide the most explicit

and comprehensive explanations of how to use

this relationship effectively.

For more detailed information, see TIP 34, p. xxiv, 

pp. 128–131.
   

   

   

         

30 Brief Interventions and Brief Therapies for Substance Abuse

BRIEF FAMILY THERAPY

For many individuals with substance abuse disorders, interactions with their family of origin, as

well as their current family, set the patterns and

dynamics for their problems with substances.

Furthermore, family member interactions with the

substance abuser can either perpetuate and

aggravate the problem or substantially assist in

resolving it.

Family therapy offers an opportunity to:

• Focus on the expectation of change within the

family.

• Test new patterns of behavior.

• Teach how a family system works and how the

family supports symptoms and maintains needed roles.

• Elicit the strengths of every family member.

• Explore the meaning of substance abuse within

the family.
   

       

       

   

   

       

       

   

Brief Family Therapy 31

Opening Session for Brief Family Therapy

• The therapist seeks to clarify the nature of the

problem and to identify the family's goals with

open­ended questions such as "What is your

goal in coming here?"

• The therapist educates the family in what is

needed to participate effectively in the therapeutic process and to understand key biosocial

issues related to substance abuse.

• The therapist provides feedback to the family on

what was said, demonstrating whose goals are

similar or different.

• The therapist can then move on to prioritizing

directions for change or, if the direction is sufficiently clear, start work. 

Family therapy is particularly appropriate when

the client exhibits signs that his substance abuse

is strongly influenced by family members' behaviors or communications with them. Short­term

therapy is an option that could be used in the following circumstances:

• When resolving a specific problem in the family

and working toward a solution

• When the therapeutic goals do not require indepth, multigenerational family history, but

rather a focus on present interactions
   

     

   

   

   

32 Brief Interventions and Brief Therapies for Substance Abuse

• When the family as a whole can benefit from

teaching and communication to better understand some aspect of the substance abuse

disorder

Family therapy can involve a network beyond the

immediate family, may involve only one family

member in treatment or a few members of the

family system, or may even include several families at once. Multiple family therapy offers an

opportunity to deal with concerns for families in

which substance abuse has been a problem:

• Inadequate internal family development

• Family systems and role imbalance

• Selected socialization variances within the

family

• Dysfunctional, ineffective family behaviors that

maintain the problem

For more detailed information, see TIP 34, p. xxiv, 

pp. 143–155.
   

   

   

   

   

       

     

   

   

Time­Limited Group Therapy 33

TIME­LIMITED GROUP THERAPY

Group psychotherapy is one of the most common

modalities for treatment of substance abuse disorders. Groups can be extremely beneficial to individuals with substance abuse problems and can:

• Help reduce denial, process ambivalence, and

facilitate acceptance of alcohol abuse.

• Increase motivation for sobriety and other

changes.

• Treat the emotional conditions that often

accompany drinking.

• Increase the capacity to recognize, anticipate,

and cope with situations that may precipitate

drinking behavior.

• Meet the intense needs of alcohol­dependent

clients for social acceptance and support.

Assessment and Preparation

Client preparation is particularly important in any

time­limited group experience. In terms of exclusionary issues, persons with severe disorders or

those who cannot accept support may need to be

given more individual time before a group experience. It is particularly effective for group members

as they are being assessed and prepared for

group to either watch or participate in a practice

group as a trial experience.
   

   

   

     

       

       

   

   

   

   

   

   

34 Brief Interventions and Brief Therapies for Substance Abuse

Initial Session for Time­Limited 

Group Therapy

• New group members introduce themselves at

the opening session, responding to a simple

request such as "Tell us what led you here." In

the context of substance abuse treatment, the

therapist should therefore initially discuss with

group members how substance abuse issues

will be addressed so as to ensure that focus is

maintained.

• The "locus of control" for the group is clarified.

Clients explore whether they believe they have

the ability to choose effective actions or if they

think of themselves as helpless victims of circumstance.

• Goals for the group are clarified.

• The therapist seeks to establish a safe, warm,

supportive environment. There may be a need

to establish rules to increase safety.

• The therapist helps group members establish

connections with each other, pointing out common concerns and problems.

Duration of Therapy and Frequency 

of Sessions

The preferred timeline for time­limited group therapy is not more than two sessions per week

(except in the residential settings), with as few as

six sessions in all, or as many as 12, depending
         

     

   

Time­Limited Group Therapy 35

on the purpose and goals of the group. The group

needs time to define its identity, develop cohesion, and become a safe environment in which

there is enough trust for participants to reveal

themselves.

For more detailed information, see TIP 34, 

pp. 158–171.
   

   

     

   

     

36 Brief Interventions and Brief Therapies for Substance Abuse

GLOSSARY

Attribution(s): An individual's explanation of why

an event occurred.

Authenticity: In existential therapy, this concept

refers to the conscious feelings, perceptions, and

thoughts that one expresses and communicates

honestly.

Classical conditioning: According to this theory,

an originally neutral stimulus becomes a conditioned stimulus when paired with an unconditioned stimulus or with a conditioned stimulus.

Cognitive restructuring: The general term applied

to the process of changing the client's thought

patterns.

Contact: A term used in Gestalt therapy that

refers to meeting oneself and what is other than

oneself.

Contingency management: This approach

attempts to change those environmental contingencies that may influence substance abuse

behavior. The goal is to increase behaviors that

are incompatible with use. 

Core conflictual relationship theme (CCRT):

Used in Supportive­Expressive (SE) Therapy, this 
   

   

   

     

Glossary 37

concept refers to the way in which the client interacts with others and with herself.

Core response from others (RO): A term used in

SE therapy to explain one way in which the core

conflictual relationship theme is unconsciously

developed.

Core response of the self (RS): A term used in SE

therapy that helps to develop an individual's core

conflictual relationship theme.

Counterconditioning: A method that uses classical conditioning principles to make behaviors previously associated with positive outcomes less

appealing by more closely associating them with

negative consequences.

Countertransference: The phenomenon in which

the therapist transfers his emotional needs and

feelings onto his client.

Covert sensitization: A technique used in counterconditioning therapy that pairs negative consequences with substance­related cues through

visual imagery.

Cue exposure: This principle of classic conditioning holds that if a behavior occurs repeatedly

across time but is not reinforced, the strength of

both the cue for the behavior and the behavior
     

   

   

       

   

   

     

38 Brief Interventions and Brief Therapies for Substance Abuse

itself will diminish, and the behavior will eventually

vanish.

Defense mechanisms: The measures taken by an

individual's ego to relieve excessive anxiety.

Deliberate exception: A situation in which a client

has intentionally maintained a period of sobriety

or reduced use for any reason.

Directive approach: This form of group therapy

offers structured goals and therapist­directed

interventions to enable individuals to change in

desired ways.

Effect expectancies: A set of cognitive expectancies that the client develops concerning anticipated effects on her feelings and behavior as drinking and drug use are reinforced by the positive

effects of the substance being taken.

Family sculpting: A technique used in family therapy. The therapist "sculpts" family members in typical roles and presents significant situations related to substance abuse patterns.

Functional analysis: A process used in behavioral

and cognitive–behavioral therapy that probes the

situations surrounding the client's substance

abuse.
     

   

   

Glossary 39

Insight: A particular kind of self­realization or selfknowledge, usually regarding the connections of

experiences and conflicts in the past with present

perceptions and behavior, and the recognition of

feelings or motivations that have been repressed. 

Miracle question: A solution­focused interviewing

strategy in which the therapist asks the client the

question, "If a miracle happened and your condition were suddenly not a problem for you, how

would your life be different?"

Operant learning: Refers to the process by which

behaviors that are reinforced increase in 

frequency. 

Process­sensitive approach: The process­sensitive group approach examines the unconscious

processes of the group as a whole, using these

energies to help individuals see themselves more

clearly and therefore open up the opportunity for

change.

Psychodrama: A method of psychotherapy in

which clients act out their personal problems by

spontaneously enacting specific roles in dramatic

performances performed before fellow clients.

Random exception: An occasion upon which a

client reduces substance use or abstains because
   

40 Brief Interventions and Brief Therapies for Substance Abuse

of circumstances that are apparently beyond his

control.

Selfobject: A term used in self psychology that

refers to something or someone else that is experienced and used as if it were part of one's own

self.

Therapeutic alliance: The development of a positive relationship between the therapist and client.

Transference: The process, basic to all psychodynamic therapies, of the client's transference of

salient characteristics of unresolved conflicted

relationships with significant others onto the

therapist.

Transpersonal awakening: The process of awakening from a lesser to a greater identity in

transpersonal psychotherapy.

For more detailed information, see TIP 34,

Appendix C.

For information on resources for brief interventions and brief therapies, refer to TIP 34, 

pp. 209–214.

Other HHS products that are relevant 

to this Quick Guide: 

TIP 25: Substance Abuse Treatment and Domestic 

Violence SMA 12-4076
 

TIP 26: Substance Abuse Among Older Adults 

SMA 12-3918
 

TIP 29: Substance Use Disorder Treatment for People 

With Physical and Cognitive Disabilities 

SMA 12-4078
 

TIP 32: Treatment of Adolescents With Substance 

Use Disorders SMA 12-4080
 

TIP 35: Enhancing Motivation for Change in 

Substance Abuse Treatment SMA 13-4212
 

See the inside back cover for ordering 

information for all TIPs and related products. 

HHS Publication No. (SMA ) 15-4136

 Printed 2001
 

Revised 2006, 2011, and 2015