GROUP PROPOSAL PAPER 1
Group Proposal Paper
SaQuisha Oliver
School of Behavioral Sciences, Liberty University
Abstract
Misuse of opioids continues to be a significant public health issue among adolescents
aged 14-18, with deep repercussions for individual development, family systems, and
general social welfare. The current proposal examines a peer group therapy model
based on the fundamentals of Gestalt therapy, which aims to engage the emotions and
behaviors confronted by adolescents involved with opioid misuse. The paper addresses
problems related to prevalence and risk factors involved in adolescent substance abuse,
which reveals developmental vulnerabilities along with sociocultural factors. The
theoretical background and practical implications of Gestalt therapy are examined, with
particular focus on self-awareness, personal responsibility, and emotional regulation.
Given that adolescents are formed in the processes of identity and recovery, these three
major aspects will easily fit their developmental needs. The proposed group format
GROUP PROPOSAL PAPER 2
included intervention goals, facilitation roles, and measures of success within the
framework of a holistic and experiential healing approach. Evidence from the literature
and clinical insights provide grounds for arguing that the Gestalt-based model is
successful in promoting youth resilience, insight, and behavioral change. As such, this
proposal is presented in favor of a developmentally appropriate and evidence-based
therapeutic model.
Keywords: Adolscents, Opioid misuse, Gestalt Therapy, Motivational Interviewing, Peer
group therapy
Group Proposal Paper
Substance misuse among adolescents aged 14 to 18 is a serious clinical concern,
needing considerate, age-appropriate care. Avcı (2025) remarks that treatment needs to
incorporate emotional and social aspects affecting a young person's choices regarding
alcohol and other drugs. Gestalt therapy is positively inclined towards self-awareness
and personal responsibility. Role-plays and mindfulness activities allow the adolescent
client to understand their feelings and thereby enhance self-control. In this way, peer
connection and accountability-related dynamics, so important for long-term recovery,
are supported in the group approach. This article will present a Gestalt-based peer
support group model for adolescents experiencing opioid misuse, including goals,
structure, and evaluation strategy.
Theory
Gestalt therapy is a phenomenological and experiential process focusing most on
present awareness, emotional honesty, and personal accountability (Gladding, 2020).
According to the tenets of its main principles, all transformative insight emerges from an
GROUP PROPOSAL PAPER 3
engagement of people direct to their current experiences, especially in relational
contexts. Empty chair, goal-directed dialogue, and role-play are examples of techniques
used by clients to externalize those unresolved emotions and re-frame the internal
narratives. Vitello and Salvi (2023) empirically validate the model, demonstrating
through research that insight is as much a neurobehavioral process as it is an alteration
in cognition but one clearly founded on relational and experiential engagement. Such
results validate the continuing significance of Gestalt therapy in emotional integration
and understanding the
self.
Gestalt therapy has traditionally been utilized for the treatment of anxiety and
trauma. More recently, however, it has been applied to working with adolescents who
are dealing with addictions, specifically misuse of prescription opioids. The procedures
stress emotional honesty and personal responsibility, allowing these young people to
confront the deeper pain that often drives their substance use. Wagner and Ingersoll
(2013) underscore the importance of such experiential methods in addiction counseling,
which tap into mental and physical awareness, further fostering enhanced emotional
insight and resilience. Gestalt therapy promotes this process of dual engagement. Ford
(2019) notes the increasing prevalence of prescription opioid misuse among adolescents
and the need for interventions that are attuned to their emotional state. It is possible
that Gestalt therapy offers a developmentally appropriate way to help adolescents
process emotions and cultivate healthier coping strategies.
In a group context, Gestalt therapy favors emotional involvement among
members and experiential work. Members engage in structured therapeutic activities
like role-playing substance-use situations to understand behavioral triggers and
GROUP PROPOSAL PAPER 4
emotional conflicts in a safe, caring environment. This group context fosters
interpersonal development through built-in feedback, which sharpens awareness and
skill in emotional regulation. Malhotra et al. (2024) support the successful efficacy of
group-based interventions, asserting that they lead to insight and emotional stability,
particularly in individuals with concurrent diagnoses of addiction and mental health
disorders.
Motivational interviewing comprises a structured supportive approach toward
addressing mixed feelings that people have about change. Wagner and Ingersoll (2013)
assert that MI is a way of pulling clients toward their motivation by using open-ended
questions, affirmations, reflective listening, and summarizing. These tools help clients
reason through both the reasons they use substances and the reasons they want to
stop. According to the explanations of Emery and Wimmer (2023), MI works better in
addiction because it cherishes the voice of the client which drives a self-directed change
in the client's behavior. MI together with Gestalt therapy would help the clients
understand emotionally while upholding clear thinking in moving them forward in a
balanced yet meaningful way.
Goals
Gestalt therapy promotes self-awareness, emotional insight, and personal
responsibility when applied in adolescent peer support settings- Gladding (2020). It
encourages the youth to look at thinking, feeling, and acting as being interdependent
and thus leads them to use reflection by the group in making choices and reaching
conclusions. The shared experience of peers acts as a mirror in which learning and
growth are maximized. Motivational Interviewing (MI), in this regard, works with
GROUP PROPOSAL PAPER 5
adolescents circling around ambivalence, which allows them to articulate the goals they
want, which would be based on their values (Wagner & Ingersoll, 2013). Together,
Gestalt and MI hold emotional safety, independence, and continued follow-through of
change commitment. As underlined by Miller et al. 2025, engaging adolescents into
treatment for opioid use disorders requires developmentally appropriate relational and
grounded findings in setting up such a combined framework over the care cascade.
Processes and Exercises
Gestalt therapy peer support groups commonly involve role-playing, empty
chairs, and guided imagery to help the adolescent articulate feelings, accept
responsibility, and relate to others in a meaningful way. As said by Stripling (2021), these
techniques enhance emotional awareness and relationships in youth. A few other tools
from Motivational Interviewing are suggested, such as value sorting, weighing the pros
and cons, and encouraging change talk, to assist adolescents in making healthy choices
(Wagner & Ingersoll, 2013). Together, these approaches create an environment where
recovery can take root and flourish in safety and support.
Techniques
Gestalt experiential approaches are effective for adolescents from 14 to 18 years of age
abusing opioids since it touches on aspects of emotional awareness and give expression
to dimensions which are relevant within the context of addiction neuobiological- and
relational effects.
•Empty Chair Technique: This classic Gestalt method invites participants to
communicate with an imagined person, object, or emotion sitting in an empty
GROUP PROPOSAL PAPER 6
chair. For persons in recovery, it may concern the drug itself or unresolved
emotional injuries. The exercise captures emotional existence and insight.
•Role-Playing: The facilitator leads participants through enactments of triggering
scenarios to help them develop perspective and rehearse healthier coping.
•Body Awareness: Gestalt therapy fosters awareness of the mind-body
connection. It helps clients reconnect to bodily sensations and emotions, which
may assist with integration of trauma and cravings and somatic triggers.
Group Leadership Style
Leading a group in therapy for young people battling opioid misuse requires far
more than clinical competence. It calls for relational depth, cultural awareness, and
emotional attunement. According to Gladding (2020), another expectation of the group
leader is to establish safety, trust, and momentum for therapy. Empathy and active
listening are key elements in engaging the youth, ages 14-18. Gestalt-informed and
culturally responsive practices address the needs of diverse members. The confidence
and preparation of the leader also greatly influence the tone and outcome of the group.
Thombs et al. (2022) indicate that support group leaders with co-designed training
programs found themselves to be more self-efficacious and to have better facilitation
skills. These findings strengthen the assertion that intentional leader development is
central to creating inclusive, supportive, and healing spaces for adolescents.
Session Outlines Session
1
OBJECTIVES:
1. Give time for group introductions to build rapport among members.
2. Discuss and set group guidelines for safety and respect.
GROUP PROPOSAL PAPER 7
3. Set overall group goals but allow individual members to voice their personal
goals.
ICE BREAKER ACTIVITY: In the Now-and-Here Check-In Circle, every member provides
their name, one word corresponding to their feeling, and a goal for the group. It's a way
to safely open the session and connect. In hearing each other's longings and feelings, we
build trust to work further as a group. This relates to motivational interviewing's
emphasis on goals and shared understanding (Wagner & Ingersoll, 2013). GROUP
CLOSING ACTIVITY: At the end of the session, each member will share one takeaway
whether it be a personal goal or a positive insight about the group. This activity is
believed to contribute to Gestalt therapy's tenets which emphasize work with present
moment awareness and reflection in regards to the past. This activity also inspires
members to hold on to the moment and prepare to use it fully in the subsequent
sessions
(Gladding, 2022).
TIME ALLOTED:
•Welcome and Overview -15 minutes
•Icebreaker- 15 minutes
•Group Guidelines- 15 minutes
•Icebreaker: 15 minutes
•Group and individual goal setting: 15 minutes Closing activity: 15 minutes
SUPPLIES:
•Notepads (each member will keep) and Pens
•Whiteboard or flipchart with markers for recording group guidelines and
shared insights
•Comfortable chairs in a circle
•light refreshments (water, snacks)
GROUP PROPOSAL PAPER 8
GROUP SET-UP: The seats are arranged in a circle to facilitate eye contact and equal
participation. As a reason for reducing the hierarchical nature of the group, an
interpersonal connection is created to promote the initial group cohesion (Gladding,
2020).
Session 2
OBJECTIVES:
1. Assist members in identifying and contemplating personal values that serve to
regulate their behavior.
2. Discuss influences from peers, family, and the media on their decision-making,
especially around substance use.
3. Enhance group cohesion through shared discussions and creative expression.
ICE BREAKER ACTIVITY: The group will participate in the "Personal Coat of Arms" activity,
which involves drawing symbols of things they value, their strengths, and their
intentions of recovery. This exercise will add to developmental growth in that it has
combined identity formation and reflective therapy. It also allows those shy to voice
their experiences to express themselves nonverbal. Creative symbolism is underlined by
Gladding (2022) as a tool of group trust and emotional resonance.
GROUP CLOSING ACTIVITY: The participants are invited to work in pairs and share one
insight they gained regarding either a personal trigger or a coping strategy. Each
participant will then thank their partner for their contribution to the session. This
exercise emphasizes accountability to each other and mutual affirmation, resonating
with Wagner and Ingersoll's (2013) focus on collaborative learning and interpersonal
feedback within group motivational interviewing.
TIME ALLOTED:
•Opening and Review of group guidelines- 10 minutes
•Icebreaker activity- 25 minutes
GROUP PROPOSAL PAPER 9
•Open discussion about values and influences- 30 minutes
•Closing activity-25 minutes
SUPPLIES:
•Pre-printed templates of Coat of Arms (four quadrants shield format)
•Colored pencils, crayons, and pens
•Whiteboard or flipchart with markers for documenting the values and influences
selected by the group
•Notepad from the previous sessions to carry themes and continuity over
•Comfortable chairs in a circle
•light refreshments (water, snacks)
GROUP SET-UP: As suggested by Gladding (2020), the room will have a circular seating
arrangement that prevents uneven participation and aids mutual visibility. For the
closing activity, the facilitator will invite participants to step out of the circle and pair off
in areas of the room designated for private conversation. This structured transition will
allow for intimate interpersonal reflection in a manner that respects the integrity of the
group space. After their paired exchange, participants will return to the circle, where the
facilitator may invite sharing or some brief reflections about what the participants
gained from the activity, reinforcing the group bond.
Session 3
OBJECTIVES:
1. Attend to emotional states around substance use and associated personal
change.
2. Reflect on internal ambivalence and relational tension using “empty chair”
3. Strengthen self-compassion and resilience as a way to increase motivation for
sustained recovery.
ICE BREAKER ACTIVITY: The Gratitude Circle is a symbolic opening ritual through which
participants may express their feelings of gratitude for something meaningful in their
recovery: be it a healing relationship, a personal breakthrough, or a mantra that keeps
GROUP PROPOSAL PAPER 10
them on solid ground. This act of expression adds emotional value to the group and
begins the process of building iconic group cohesion. Gladding (2022) proposed that the
rituals impart structure and meaning to the process of group work; Wagner and
Ingersoll (2013) noted the motivational value that lies in affirming values in a shared
space. GROUP CLOSING ACTIVITY: All participants will compose a letter to their future
selves expressing their developments up to now and outlining aspirations for further
healing. This letter can include affirmations, lessons learned through experiences, and
goals for the coming months. Symbolic rituals like letter writing provide a bridge
between past, present, and future selves with identity development and continuity in
therapy, as pointed out by Gladding (2022). The letters will be sealed and returned in
the last session, bringing a sense of closure and self-awareness.
TIME ALLOTED:
•Opening and Review of group guidelines- 10 minutes
•Icebreaker- 15 minutes
•Open discussion for reflection on internal ambivalence and relational tension “
empty chair” – 30 minutes
•Closing Activity- 25 minutes
SUPPLIES:
•Notepad from the previous sessions to carry themes and continuity over
•Envelops for letters
•Whiteboard or flipchart with markers for recording group guidelines and shared
insights
•Comfortable chairs in a circle
•light refreshments (water, snacks)
GROUP SET-UP: Members will be assembled in a circle, which is conducive to openness,
eye contact, and a sense of present togetherness as defined by Gladding (2022). This
seating arrangement removes all physical barriers and psychological barriers and also
GROUP PROPOSAL PAPER 11
contributes to building emotional safety and trust. An empty chair should be placed
within the circle and serve as a prop for role-play, emotional expression, or as symbolic
dialogue which will give structure to participants' unsaid feelings or assertive
communication practice.
Session 4
OBJECTIVE:
1. Review individual and group goals and progress toward them.
2. Reflect on life's applications of material presented to the group.
3. Work with feelings around closure and termination of the group.
ICE BREAKER: The group will participate in a "Web of Support" activity using yarn. Each
individual will mention just one way the group has contributed to their recovery before
passing the end of the yarn to another member. As the yarn travels around the circle, it
will form a web that indicates how each person is connected. This is a visual
representation for presenting to others supportive relationships that strengthen
recovery
(Wagner & Ingersoll 2013).
GROUP CLOSING ACTIVITY: The group is going to have a closing Affirmation Circle where
each member will be honored by others for his/her uniqueness contributing to the
group process. These affirmations may deal with moments of support, courage, or
connection. The activity promotes safety and honors each participant as important.
Affirmations are described by Wagner and Ingersoll (2013) as vital to motivation, while
Gladding (2022) mentions that affirmations promote closure and foster a sense of
belonging to the group.
TIME ALLOTED:
•Opening and Review of group guidelines- 10 minutes
GROUP PROPOSAL PAPER 12
•Icebreakers- 20 minutes
•Open discussion to review group and individual goals – 30 minutes
•Closing activity – 30 minutes
SUPPLIES:
•A ball of yarn to be used in the "Web of Support" activity
•Notebooks and pen
•Whiteboard or flipchart with markers for recording group guidelines and shared
insights
•Refreshments
GROUP SET-UP: Use of circular seating will still be encouraged to promote equality,
visibility, and cohesion among participants, an arrangement strongly endorsed by
Gladding (2020) as being crucial for fostering group interaction and trust. The last
session makes tremendous sense in this configuration, allowing for acknowledgment of
each other, eye contact during affirmations, and the concrete symbolism of unity that
allows emotional closure and common reflection.
Screening
This peer support is designed for adolescents between the age 14 through 18
years old who abuse opioids. They might be misusing prescription drugs such as
oxycodone or using illicit drugs such as heroin or fentanyl. Participants vary in their level
of use, but they must be emotionally and behaviorally stable enough to benefit from
peer-based rather than clinical treatment. Referrals can come from schools, juvenile
justice programs, mental health providers, or from their family members. A key
requirement is that those participating must be able to relate in a respectful and open
manner with other people. The group provides a safe and supportive environment for
teens to share their experiences, develop resiliency, and learn healthy coping skills with
GROUP PROPOSAL PAPER 13
peers. Peer-led programs have been found to positively impact youth behavior and
promote recovery among youth (Veenstra, 2025).
In effective group facilitation, screening for emotional and behavioral
preparedness for peer interaction is necessary. For instance, adolescents experiencing
acute withdrawal, active psychosis, or certain severe cognitive impairments may not
benefit from this setting and would probably need a referral to a higher level of care.
Jørgensen et al. (2025) emphasize that supervision enhances facilitators’ ability to make
ethically sound inclusion decisions within person-centered models. Youth who may have
a history of aggression or persistent non-engagement may also compromise group
cohesion. Gladding (2020) reiterates that emotionally able and relationally willing
members are a prerequisite to the promotion of therapeutic groups' success.
The following screening questions would be useful for individual intake sessions
to assess appropriateness for the program. These questions are designed to evaluate the
teen's substance use patterns, emotional and behavioral stability, openness toward
group participation, and any risk factors that might suggest need for alternative
interventions.
Screening Questions:
•What types of opiods have you used, and how often do you use them?
•What influenced you to use opiods (e.g., peer pressure, emotional reasons,
physical pain, curiosity?
•What was your experience trying to cut back or stop using? How did that go?
•Have you noticed any symptoms of withdrawl?
GROUP PROPOSAL PAPER 14
•Have you participated in a support or cousniling group before? If so how was
your experience?
•Do you have a history of mental health conditions?
•Would you be comfortable expressing yourself in a group setting with peers your
age?
•What do you hope to gain from being in this group?
•Were you required to attend this group? If so, what are your thoughts about
joining?
•Have you every been physically aggressive or disruptive in a group setting?
•Are you willing to actively listen to others, follow the group’s rules, and maintain
confidentiality?
Problem Solving
The Chronic Talker/Monopolizer
The chronic talker, or monopolizer, is that member of the group who consistently
dominates discussions by either long-winded talk or unintentionally denying others their
chances to contribute. Such behavior can reduce group cohesion, silence the voices of
quieter participants, and interfere with the group's therapeutic goals (Gladding, 2020).
Intervention needs to be done by the facilitator-with clarity and respect-when
addressing this problem and establishing guidelines for equitable participation, such as
structured turn-taking or time-limited sharing. In some situations, it may be necessary to
have a private discussion with the member to allow them to reflect on their behavior
and its impact on the group (Gladding, 2020).
GROUP PROPOSAL PAPER 15
The Silent Member
Silent members in group therapy seldom participate in discussions because they
might be shy or fear evaluation, lack self-confidence, or simply do not know how a group
works. Gladding (2020) proposes that we should not take silence as indifference; rather,
it could be interpreted as an emotional signal that opens up vulnerability or indicates
uncertainty. The facilitator may encourage the absent member to participate but should
not pressure them excessively. Methods such as asking open-ended questions, soliciting
responses and contributions during low-anxiety moments, or checking in with the
member privately outside of group offerings may begin to establish the trust needed for
gentle engagement (Gladding, 2020).
Attacking Member
Attacking behavior typically involves verbal aggression, sarcastic comments, or
even repeated criticism. Such attacking behavior can shut down group members
emotionally and obstruct the group's possibility of trusting and healing. Although it may
seem purposeful disruption, attacking behavior can very often be the result of
unresolved internal trauma, fear of intimacy, or an attempt made maladaptive in order
to manage anxiety by exerting control. Gladding (2020) stresses that awareness of these
dynamics is vitally important, rather than merely labeling the behavior as oppositional.
The facilitator should remain grounded and nonreactive, using interventions that
validate the attacking member's feelings but do not endorse the damaging behavior.
These interventions can include pausing the group to reaffirm safety agreements,
providing a model of appropriate emotional expression, or directing the group into a
reflective process. Should such behaviors persist, a one-on-one conversation should be
GROUP PROPOSAL PAPER 16
held with the individual at which the principles of motivational interviewing can assist to
elicit from them what their unmet emotional needs may be and reframe their behavior
as a block to connection. It is not about punishment but about healing—healing the
group by making it safe while empowering the member to not harm himself or others
(Gladding, 2020).
Member Who Stops Coming
If absences are not properly explained, they can threaten group cohesion,
sparking curiosity over whether emotional or relational issues remain unaddressed.
Gladding (2022) recommends that facilitators must exercise caution and care, knowing
that withdrawal from group work might signify discomfort, unmet expectations, or
passiveaggressive resistance to the group process. Rather than viewing an absence as an
expression of disengagement, the leaders may want to use a spirit of compassion to
initiate a private check-in with the member, whereby they express their concern and
create space for that member's own perspective to be articulated. This step mirrors
emotional attunement and accountability while also reaffirming the group's
commitment to creating a safe and inclusive space. Gladding (2022), however, also
noted the discussion of attendance patterns among the participants with an emphasis
on confidentiality as a means to enhance group awareness and reinforce commitment to
shared values of engagement and respect.
GROUP PROPOSAL PAPER 17
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