The Benefit of Groups in Outpatient Rehab

One of the most important aspects of an intensive outpatient rehab program, such as an IOP, is the power of groups. Much research has been performed both in psychology and sociology elaborating on the effects groups have on individuals. In fact, it is believed that participating in a group is a fundamental human need.

Here are some important aspects of group psychology that positively contribute to the success of an outpatient rehab program:

Ambiguity’s Role in Social Influence

Group social influence happens when people don’t know what the best thing is to do or say in a certain situation. In such a case, people look to the behavior of others in the group, including the group facilitator, as an important source of information, and use it to make choices.

This seems like an obvious scenario and one that we can all relate to. We often find ourselves in situations where we don’t know something, such as attending a new course in college or starting a new job. In such cases, we quickly learn from others in the group and often assimilate their behaviors and pay particular attention to their suggestions. According to research, this is especially the case when the situation is ambiguous – e.g., a situation involving fear, confusion, or crisis.

This is an important element in group therapy, especially for people who are attending an outpatient rehab program perhaps for the first time. Not knowing what the sessions are about, how to behave, what to say, and how to participate, allows the participant to be influenced by the therapist and longer-term group attendees. Furthermore, when working through addiction, one frequently experiences fear and confusion.

The therapist is typically the perceived expert in therapy and, therefore, commends a lot of influence on the group. The information conveyed by the therapist during times of ambiguity can be very influential.

Norms and social influence

Humans have a strong need to be accepted. We tend to change our behavior to match that of others, not necessarily because they are right but because we want to remain members of a particular group. The effect of being rejected by a group is very strong, and, therefore, we do our best to avoid the pain of rejection.

Social conformance to group norms is said to be stronger depending on the strength, purpose and size of the group. We tend to conform more when we are in a group we care about, the group has a common purpose, and a particular size.

Group size and conformance to social norms

A study by Asch identified that conformity increases as the number of people in the group increases. But that’s the case up to a point. Once the group reaches four or five other people, conformity does not increase much further.

When looking at our IOP groups, we particularly like to keep them between 3 and 7 participants, though we have also worked outside those quantities. Once a group gets to 10 or more people, however, many of the benefits of participation are reduced. People don’t get as much attention or as many chances to participate. As a result, they tend to lose interest or just don’t feel a strong sense of belonging.

The perceived importance of the group

Another study suggested that the strength of the group, as defined by how important the group is to us, makes a difference. Group normative pressures seem to be stronger when they come from people we appreciate or a group we strongly identify with. This is often seen when people participate in competitive sports teams, where there is a strong interest in being a part of that team, participation is perceived to be of high value.

Obviously, this is very important in therapy and also one of the reasons we especially like clients who are self-motivated to get better and are excited to be part of the group. It’s not only themselves they are improving but the quality of the whole group.

This is also the reason why it’s very important to have a therapist who has experience, empathy, and even charisma. These elements come together to further enhance the group’s success. When participants look up to the therapist, or the outpatient center has a certain level of positive history and reputation, those attributes contribute to the participant’s chances at getting value.

Critically thinking about groups

As an exercise, we would like you to take a few minutes and think about some of the groups you belong to. This isn’t just about your therapy group. This could also be your school group, social group, work group, competitive teams, or your family group.

What kinds of benefits do you get by being a member of these groups?

Think about how your attendance in those groups is helping or hurting you.

Do any of the groups you belong to frequently deal with ambiguity?

Think through some scenarios and look to see if you often come across points of ambiguity. For instance, do you socialize with a group that takes on risky actions? Perhaps you belong to a group that likes to take things to the edge a bit as a form of entertainment. Does ambiguity arise in the form of fear and uncertainty in you? If so, pay attention to those particular moments and see if there are moments when you are being particularly influenced by others.

Who are the influencers in the group?

In each of the groups you participate in, are there key individuals that seem to dominate the conversations? Does one person’s opinion seem to have a stronger resonance with the group than the others?

Are you being positively or negatively influenced?

Now that you have identified the influencers in the group, can you tell if their behaviors, actions, and directions impact you in a positive or negative way? Do you have influencers that take energy away from the group or ones that contribute energy to the group? They are both easy to spot once you start paying attention.

What actions, stances, or behaviors are you taking because of social norms in those groups?

As you thought through some examples from the above questions, were you able to identify how your actions and behaviors may change as a result of the influence of the group or the leading voices? Do you “play along” with a direction that doesn’t resonate with you, just by being a member of that group?

Note that it’s also interesting to do these exercises and focus on groups where you are the leading voice. Respond to the same questions above from that perspective. Do you lead differently during times of ambiguity? How are others brought along to your cause as a result of your influence? Are you contributing to the group or perhaps taking energy away from the group?

The above is not meant to be an exercise in beating yourself up. It’s an exercise in becoming aware of the groups we all participate in and critically thinking through what is going on in those groups.

If you have any questions about the above, or would like to understand your options for treatment, please don’t hesitate to reach out to us.


Aronson, E., Wilson, T., Akert, R. Social Psychology. Firth Edition.

Author: Dr. Seda Gragossian

Dr. Seda Gragossian is the Clinical Director at the Talk Therapy Psychology Center. She has worked in the mental health field in clinical leadership roles in private practice,  at multiple outpatient facilities, as well as at large psychiatric hospital settings.

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Are you or someone you know suffering from depression, anxiety, or addiction? Don’t be nervous or shy about asking for help. We believe that everyone needs a little help now and then. We make no judgments and we meet you where you are at.

25 Practical Tips for Staying on the Road to Recovery from Addiction

Here are some practical tips for helping you stay on the road to recovery:

  • Maintain a healthy diet. There is a strong correlation between diet and mental health.
  • Sleep hygiene. Lack of sleep is tied to mental instability across many research studies.
  • Exercise regularly. Exercise is proven to release good chemicals into the system.
  • Set healthy boundaries.
  • Say goodbye to your “using” buddies.
  • Remove and block the phone numbers for your suppliers.
  • Send a clear message to those around you that you are no longer using. This announces your intentions and helps keep you accountable.
  • Remove yourself completely from unhealthy situations and settings.
  • Practice self-compassion and make amends with yourself.
  • Meditate regularly.
  • Don’t make the process harder than it already is; get all the help you need.
  • Work with a professional, either in individual settings or by attending an outpatient addiction treatment facility.
  • Attend self-help groups.
  • If you slip, don’t beat yourself up. Get back on track.
  • Take responsibility for your choices and feel empowered that change is possible.
  • Pick up healthy hobbies that make you feel good.
  • Structure your day in advance. Too much free time can be problematic.
  • Give back to the community.
  • Let go of the past and engage in the present.
  • Practice gratitude.
  • Practice positive affirmations such as “I choose to live a healthy life”, “I love myself”, “I deserve to be happy”, etc.
  • Smile, even if you don’t feel like it.
  • Mend your relationship with friends and family.
  • Change your job if it involves substances (e.g., for a person who abuses alcohol, being a bartender is not the best choice.)
  • Set small goals and reward yourself frequently with healthy forms of recognition.

Recovery takes work and the above will help you stack up the odds of success in your favor.

All the best.

Dr. Seda Gragossian

858 205-2490


Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Do you really worry about outpatient rehab costs?

We encourage our clients to shop around for not only the best therapist but also the best prices. This is especially true when your insurance does not cover an adequate portion of outpatient rehab costs. However, we are often surprised by people who do not pursue treatment altogether because they believe it is “too expensive”. Similarly, we are surprised when patients cut their treatment short because of financial considerations.  Don’t get us wrong, we understand that getting treatment for substance abuse, whether it is through individual sessions or through intensive outpatient programs (IOP), can be expensive. But money should not be the sole consideration when foregoing treatment altogether or when stopping the therapy before enough positive changes have been made. The reason we say this is because we believe that returning to the addiction can be even more expensive, not only in intangible ways, but also in very real tangible costs.

Here are some tangible and intangible costs of continuing to use:

1. Risk of dying

First there is the possibility of dying. We are not sure this should be categorized as a tangible or an intangible cost but we certain believe it is an important one. It has been reported that excessive alcohol use kills about 88,000 people in the United States.

2. Cost to society

Substance abuse results in behaviors that cost the whole society quite a bit. Research indicates that the primary costs come from losses of productivity in the workplace, healthcare expenses from treating the substance abuse symptoms and outcomes, law enforcement and criminal justice costs, and motor vehicle related costs. In fact, it is estimated that alcohol use costs the US a staggering $200 Billion per year.

3. Cost of missing work

The most significant problems that companies experienced due to addiction are absences from the workplace, reduced productivity, missed deadlines, and increases healthcare costs.

4. Direct cost of spending on purchasing alcohol

We use alcohol as an example because it is easily researched, though you can substitute illegal substances in here as well. For instance, the costs of drinking a bottle of wine, or a case of beer, per night, comes out to approximately $3,00 per year.

5. Cost of car accidents and DUIs

Almost one third (29%) of all traffic-related deaths in the US are due to alcohol-impairment. In 2015, 10,265 people died in alcohol-impaired driving crashes.

There are obviously many more incidents that did not result in deaths. Every year, 708,000 persons are injured in alcohol related crashes; 74, 000 of those people suffer serious injuries.

One study suggests that there were as many as 111 million self-reported episodes of alcohol-impaired driving in the US in 2015. That year, nearly 1.1 million drivers were arrested for driving under the influence of alcohol or narcotics. This number has gone up to as much as 1.5 million arrests, per another study.

In the case where the driver is stopped for a DUI charge, the fines are significant. It is estimated that the total cost of a DUI that goes to trail is between $8k and $10k. That’s once you add legal fees, rehabilitation fees, increases to your car insurance, and other associated costs from the whole ordeal.

Keep in mind that the increase to your car insurance is not a one-time fee. It takes years of good behavior to get your premium back down again. On average, your car insurance will increase by $3,000 to $6,000 per year.

6. Cost of divorce

While divorce is common in the us, with a first-time divorce rate hovering around 40%, it is interesting to note that the rate is 50% when one spouse drinks heavily. That’s a 25% higher rate than the national average. With the average cost of a contested divorce ranging from $15K to $35K, this is a very real and substantial cost. Obviously, drinking is not the only reason people in this one study got a divorce, the increase in the statistic was significant.

7. Associated smoking expense

According to the NIH, between 80% and 95% of alcoholics smoke cigarettes. Based on CDC estimates, someone who smokes a pack a day spends roughly $2,300 per year.

8. Work absence

Absenteeism is estimated to be on average 6 times greater among alcoholics and alcohol abusers, than the general public. This not only impacts the employer, it also impacts the individual who is potentially hurting chances at a raise, or a promotion. Obviously, absenteeism can also get someone fired.

Additionally, in one study, workers with alcohol problems were nearly 3 times more likely to have injury-related absences, than the general public.

9. Other costs

There are obviously many other general costs that could be considered. For incidents that result in some injury, there are hospital and medical bills to cover. There are also unintentional injuries that may result from being under the influence.

Apart from medical bills, there are other unpaid bills that can add up, as people forego tending to their responsibilities as a result of their addiction.

The list goes on and on. So, now, with those costs in mind, let’s look at what treatment may cost you.

In general, there are a few paths that one can take when seeking treatment for substance abuse. There are inpatient programs, outpatient rehab programs, such as Intensive Outpatient Programs (IOP), partial hospitalization, and outpatient individual sessions.

Cost of Inpatient Care

Inpatient rehab will cost you anywhere between a few thousand dollars to upwards of $60,000 for a month of treatment. There is such wide range largely due to location, the amount of services provided, and the center’s reputation. A basic, low-cost 30-day residential rehab will be in the range of $2 to $7k. your standard residential inpatient treatment will go up from there all the way to $20,000 per month. Above that amount, you enter into the world of premium, luxury, and so-called executive residential inpatient rehab centers. Such options will offer a fast range of amenities on premises, several therapy alternatives, and the highest quality of accommodations.

Costs of Outpatient Care

Intensive outpatient program (IOP) participation will range between a few thousand and $10,000. Such programs can be very effective while also allowing you to continuing carrying on with your life’s responsibilities, including work, and family care.

It should be noted that both inpatient and outpatient rehab centers can take insurance. You should consult your insurance or talk to the treatment center you are considering to understand what your insurance covers.

Cost of Detox Centers

Sometimes, detox is first required before therapists can start working with you. Often, this is in response to a significantly compromised individual who requires some return to normalcy before pursuing treatment or returning to their daily lives. Detox treatment centers will typically charge by the day and the range can be anywhere between a few hundred dollars to $1,500 per day. Again, the location, reputation, and amenities of the facility play a big role in the big range in costs.

As always, we encourage people to consider their options. Sometimes, a few individual sessions is all you need to get back to balance. Other times, a more intensive treatment option may be warranty. However, we would like to encourage all those who are dealing with substance use issues to seek help. Even if you pursue a free, community-based solution, it is better than doing nothing. It will also get you moving into the right direction.

If you have any questions about the above, or would like to understand your options for treatment, please don’t hesitate to reach out to us.

All the best.

Dr. Seda Gragossian

858 205-2490

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!





11 Tips for Finding a Good Psychologist

There are many things to consider when looking for an individual therapist or a mental health treatment center. Yet, many people don’t take any time to do the necessary research. The result of choosing haphazardly is that you may find someone who is not a good fit, or doesn’t have the necessary experience to truly help you. You wind up wasting your time, money, and energy and postponing your opportunity to get better.

Spending even a few minutes to think through your selection criteria will help greatly in finding the right therapist. Here are some considerations:

1. Therapist experience and specialty. Look for programs that are facilitated by qualified individuals with past experience in the particular area of treatment. If you are battling with addiction, you don’t want to go to a generalist. You want to speak with someone who has worked through the particular challenges of that condition. If you are an adolescent, you don’t want to go to someone who has no experience working with people in your age group. 

2. Testimonials from past clients. It is important to see client feedback, even if published anonymously. Given HIPAA restrictions, it is very difficult to publish full names of clients. So, you will have to trust the anonymous testimonials that are published by the therapist or center. Do they have testimonials from clients who are working through a similar situation as you? Do they have both older and more recent testimonials published on the site?

3. If joining a group therapy setting, like an Intensive Outpatient Program (IOP), group meeting attendance levels are important. Look for a program that has enough participants to remain intimate and beneficial, with good group conversations. Some group-oriented programs will just pile people into the room for financial reasons, or because they don’t have enough of a specialization. While there is no ideal group size, we tend to find that smaller groups are more beneficial for our clients.

4. Availability of free consultation and initial group meeting participation. while a free consultation is not always necessary, it’s good to know that you have the option to “kick the tires” so to speak. Note that attending a free group session may not be appropriate. Typically, a center will want to meet you in private first to assess your situation and fit. But after this is done, it’s possible to ask to sit in on a group session before officially joining.

5. It is a two-way street. It is good when a center asks pointed questions to assess client fit. This shows that the program administrators care about the impact that a new patient will have on their existing patient base. Sometimes, the sign of a quality center is one that actually turns potential clients away. Of course, if the center is not able to take you, for whatever reason, they should at least give you a solid referral to another center or individual therapist.

6. Availability of therapists outside of formal sessions. Some situations call for quick access to a therapist to discuss an urgent matter. Depending on the condition, people will often have relapses or will have situational emergencies. Sometimes, you wan’t wait until your weekly appointment. It’s good to have access to a treatment center or therapist who can take the occasional emergency call. This sort of availability also goes a long way towards strengthening the bond between patient and therapist and ensuring the therapist is truly vested in your well-being.

7. Treatment planning sessions and the creation of a personalized treatment plan. There are various things that can go into a plan and this will be discussed in another article. What is important is that the treatment center or psychologist takes the time, up front, to understand your situation, your background, and your objectives. Together, then, you should work towards creating meaningful milestones, setting expectations for what progress looks like, and discussing the course of care.

8. Cost considerations. Find a therapist or program that takes advantage of your health benefits and fits in your budget. But also realize that therapy is not free. How much you want to invest into your therapist is a direct indication of how serious you are about getting better. You are about to invest a lot of your time and energy into overcoming whatever issue you are working through. Give the therapists the respect they deserve and invest in them so that they may invest in you.

9. Availability of external resources. If the condition requires external support, it is good to find a therapist who is networked and has access to outside groups, adjunctive therapies, etc. Often times, therapy is not a one-trick pony. A good psychologist or treatment center will look for the right combination of internal and external resources to help you. Additionally, when it comes time for discharge, it’s good to know a therapist that can align you with external and long-term resources to help you on your on-going journey to mental wellness.

10. Track record. While it is hard to find accurate information about how effective a therapist is, reviewing testimonials can help. If you are joining a group like an IOP, talk to the other participants and see how they are improving. It’s important to note, as well, that the entire health field is quickly moving to a demonstrated efficacy of care model. More and more, doctors and therapists of all areas will be judged and compensated  by insurances on the results they deliver for their clients.

11. Rapport. During the initial consultation, it is important to establish some rapport with the therapist. Note that this doesn’t necessarily mean you have to find a therapist who validates your every statement. At times, therapy requires tough conversations and helping you look at your deepest thoughts and feelings. Going through this journey with someone you feel safe with is key.

Selecting a psychologist or a psychology treatment center should not be done without some research. Some people just choose the first therapist that shows up on their insurance company’s in-network list. Spending time to assess some of the above criteria also takes away some of the emotional resistance that some people have towards seeking help. By focusing on the research itself, the exercise becomes less emotional and more analytical. People often hesitate to even pick up the phone. This way, the first call becomes less about “I need help and I don’t know what to do” and more about “help me understand why you will be a good therapist to help me through this period of time in my life.”

All the best.

Dr. Seda Gragossian

858 205-2490

Tips for Managing Addiction During the Holidays

We see an increase in addiction challenges during the holidays. Let’s talk about what you can do to increase your chances of staying sober, or to ensure your moderation plan stays on track.

  • WHO: Stay vigilant about who you hang out with. Are there people that tempt you into bad behaviors? Are there key relationships that are particular triggers for you?
  • WHEN: There are certain days of the week when people like to let loose. Friday evening is the obvious one. People are done with work and just want to relax and let go. If there is a particularly vulnerable day of the week for you, plan healthy alternatives during those days. How about making Friday night your netflix night? Perhaps the holidays are particularly difficult, or a key anniversary. Plan ahead of time before that day comes.
  • WHERE: Just like the day of the week, there is also a place that you go where all bets are off. During the holidays, people make trips back home, or to that certain friend’s house. Plan ahead of time. If at all possible, avoid trigger places or places that give you access to those things you are trying to avoid. Sometimes, however, it is inevitable. That annual trip home with the family can often be a tough environment to manage. Create a supportive friend circle and stay in touch with them while on that trip. Have them check in on you. Ask for help from then to hold you accountable ahead of time.
  • WHAT: Think of what you can do ahead of time to avoid temptations. Take a favorite book. Find a new hobby that can keep you engaged. If you are attached to your cellphone, download a new app that can create a healthy distraction. Plan your days ahead of time so that you can have healthy activities timed properly. Maybe going home for the holidays is a trigger for you. But how about visiting some childhood spot like a favorite movie theater, or a local attraction? Spend time around places that you associate with loving and caring moments in your life.

We hope everyone enjoys the holidays and remind you to plan ahead, be safe, and keep your commitments to recovery. As always, if you need some expert advice, you may reach out to us for consultation. We find group therapy, such as our Intensive Outpatient Program (IOP) to be particularly effective during this period as many other participants are dealing with similar challenges and you have get great support and ideas from each other.

All the best.

858 205-2490