Design a TATTOO for Recovery!

Most of the clients who come through my facility have tattoos and lots of them. It is a rare day for us to get through a group session without them talking animatedly about either a tattoo that they already have or one they are planning on getting.  Therefore, when the topic for group one night was one that would be difficult to stretch to cover all two hours, I thought, why not have everyone design their own recovery tattoo?

Having clients design a tattoo that signifies their recovery allows them to become open and creative in different ways, ways they may not be able to do with their words alone.  Another benefit of this activity is that it allows clients to take it as deep or keep it as superficial as they feel comfortable. Some clients will probably make a joke of their tattoo and make it funny, whereas others may use symbolism to highlight their struggle with addiction. Regardless of what they choose to do, it is important to remember that your opinion as a counselor is not important.  However they choose to participate in this activity is up to the client. There is nothing more counter productive to therapy than a counselor who judges the client based on what they share in group.

Respect their experience and respect their ideas.

JENGA in Group Therapy!

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Alright, so it has been a while since my last post! I guess that’s what happens when you try to maintain a blog and balance everything else! Since my last post, I have continued to run groups at my site and have continued to bring new activities to the sessions.  One activity that has been a big hit each time I have used it has been JENGA therapy!  Now, when JENGA comes out, be prepared for there to be excitement and then a very quick reeling in of that excitement when you explain that it is therapeutic JENGA, but after they start playing, they will be so absorbed in the game that they won’t mind to be doing therapy at the same time.

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Wondering how to make therapeutic JENGA? There are many ideas out there, but I have found the numbering system is the best.  Some people write specific questions on each piece and when the piece is pulled, the client answers that question.  I, however, have found that writing the question on the piece limits what I can use therapeutic JENGA with in group.  Therefore, I have numbered each piece 1-8.  Then, depending on the session, each number will relate to a predetermined question based on the topic at hand.

For example, when the group topic is triggers, questions may look something like this:

1. What are your internal triggers?

2. What are your external triggers?

3. In what ways do you cope with triggers? (Name one)

4. In what ways do you hope to work with triggers? (Name one)

5. What thought stopping techniques do you know of? (Name one)

6. Name two strengths that you have.

7. Name one social support that you have in recovery.

8. Freebie (no question!)

 

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When the inevitable happens and the tower falls down, be sure to have one MEGA JENGA question prepared for such an event.  Sometimes, I have had that one be that the one who dropped the tower needs to compliment each client in the room. Other times, they have had to say 3 positive things they have in their life at this moment.  Either way, be sure that the question is different and one that warrants being the end of game question.

The Ungame

ungame

While I was looking for fun and exciting games to bring to my group therapy sessions, I kept coming across the Ungame. So, after weeks of hemming and hawing, I decided to give it a chance and bought it through Amazon.  Most of clients are in their 20s/30s so I bought the Ungame for 20 Somethings, hoping it would be less “hokey” and “family fun” and more geared to this age group.

Overall, it was a nice addition to the group because it was a break from our usual conversation based session. Clients were at first excited to play a game, but the problem was that this game doesn’t really feel like a game, rather it feels like you’re just going through a list of questions.

A few suggestions for the game:

  • Use deck 1 if you are utilizing the Ungame for a break from “formal” therapy. The questions are lighter and keep the conversation flowing and the clients connecting with one another without feeling like they need to share some deep, dark secrets.
  • Go through the cards! Some of the cards will be of no benefit to your particular group of clients so take them out.  Nothing kills the momentum of the game faster than pulling a card that takes everyone out of the moment.
  • Great game for clients who do not know each other too well – so try to use it on a newer group, or a group that recently added some new members.  It allows them to open up in an environment without any pressure. It is far easier to share your favorite movie than it is to talk about a relationship you ruined because of your drug use.  However, after connecting with others about something as minor as a favorite movie, the clients are laying the ground work for more deep and serious conversation later on.
  • Make it more of a game! Every other turn, I allowed the clients to either answer their question or give the question to someone else – the only rule was once they passed the question to another person, that other person could not be asked another question that round. Clients love this aspect and it brings more of a “game element” to the activity.

So go out and give the Ungame a try! If you have used the Ungame before or have any ideas on how to better incorporate it into therapy, let me know!

Group Activity – The DBT House

At my internship, I have been given the opportunity to lead the relapse prevention group with our substance abuse clients.  This past week, one of our lessons was to talk about Acceptance in recovery.  Like all units, the manual relied purely on discussion and did not bring in any other type of learning styles.  Having been with this group since August and seeing just how much they enjoyed talking for two straight hours about their recovery (can you sense my sarcasm?), I immediately starting looking into alternative ways to get the clients engaged. Now, we still did spend about half of the time talking about Acceptance and what that meant to our clients, BUT we also did an activity called the DBT house.

In order to do the DBT house with your clients, have your clients draw a house that includes a floor, roof, chimney, door, billboard and have it divided into 4 levels. For an example of what the general outline of the house will look like, please see below:

DBT house

On each part of the house, have them write:

  • Floor – values of their life
  • Roof – things or people who protect you
  • Walls – things or people who support you
  • Door – things you keep hidden from people
  • Chimney – ways you blow off steam
  • Billboard – things you are proud of and want others to see

On each level of the house, have them write:

  • Level One – behaviors you want to change or gain control over
  • Level Two – emotions you want to experience more or in a more healthy way
  • Level Three – things you’re happy about or want to feel happy about
  • Level Four – what is a life worth living?

Very quickly it became clear that this was a project the clients really enjoyed.  Normally, it is difficult to engage the clients in an activity, but with the DBT house, they were all quiet and taking the activity seriously.  I did not ask that the clients share the specifics of what they wrote on their houses, but instead kept the conversation talking about general themes.

We discussed various aspects such as:

  • What was the purpose of this activity?
  • What did the clients learn about themselves?
  • Was there any difference between who they wrote on the roof and who they wrote on the walls?
  • What is the difference between the people who support us and the people who protect us? How do we draw that distinction?
  • What was the hardest part of the activity?
  • What was it like to think of what you would place on your billboard?

Have you ever used the DBT house with clients? How did it work?

Clients with criminal records: Get your resume OUT of the rejection pile

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Resumes are never easy to write. There are always hundreds of rules on what you HAVE to do in order to get your resume seen and just as many (if not more) rules for what you should NEVER do with a resume.

Clients who have a criminal background are most likely having issues in their employment. Often times these clients quickly accept the first job they are offered and this job is often one that is less than desirable.  Many jobs that are open to those with a criminal background have long hours, the absolute minimum salary possible, and no respect. Unfortunately, many of these jobs exploit the fact that our clients are prejudiced against in the job market and know they can treat them differently from those without records.

This leaves us with the question of, how can we (as counselors) help?

Most clients do not know about the necessity of a fine tuned resume.  A fine tuned resume is difficult for anyone, but for those with criminal backgrounds, the process can seem daunting.

When helping clients with criminal backgrounds, here are some tips to remember:

  1. Choose the appropriate resume format.  Whereas a chronological resume has become the more “normal” way to create a resume, clients with a criminal record may want to look at another option.  For individuals with gaps in their employment history (say from serving a few years in prison), a chronological resume will just place a large spotlight on that gap in employment.  A functional resume may be more appropriate in these circumstances because they focus primarily on the skills of the client, as opposed to the specific jobs they held.
    NOTE: For some hiring companies, a functional resume may make it look like the applicant is trying to hide something.  However,  if the skills on the resume are strong, it may just get them their foot in the door!
  2. Do NOT list that you served time in jail/prison on your resume.  The resume is your chance to get that coveted interview; it’s hard enough to be seen without listing your familiarity of the inner workings of Sing, Sing.  Save the honest conversation about prison for your interview, and what you have learned.
  3. Did you have a job in prison, but are hesitant about placing it in your job history on the resume? Don’t be. You don’t need to write, “English Tutor, while I was an inmate”. Instead, list the job you had and the name of the prison. Again, leave the explanation for the job interview where you can explain yourself more fully.  Be clear on the skills that you learned while incarcerated and your change process.
  4. Make sure the skills you list are relevant to the job in which you are applying.  If you are applying for a construction worker position, it may not be relevant to list your extensive computing skills unless it is somehow relevant to the job description.  Employers want to see that you took the time to truly see how you are a good fit for their company and a tailored resume is the way to do that.  Listing irrelevant skills may make them think you did not take the time to learn about the job you are applying for and could earn you a spot in the rejection pile.
  5. Were you mandated to complete volunteer work? List it on your resume! It does not matter that the work was mandated, the time you spent helping others is something that hiring managers would love to see so be sure to include it.  Many times, the volunteer work helps fill some of the gaps in the employment history so it helps in more than one way!
  6. Be honest about employment dates. If you have gaps in your employment history, do not lie and change the dates of your other jobs just to make it look like there is no gap.  Employers are usually diligent in their background checks and catching you in a lie like this will most likely not get you the job and may hurt further job opportunities.
  7. Actually, just be honest in general. While writing the skills portion of your resume, you may feel inclined to exaggerate your skills in order to impress the hiring manager.  All of a sudden, your knowledge of how to ask “¿Donde está la cerveza?” (and nothing else) gets written as “Advanced Conversational Spanish”.  Well, what happens when the manager, who just so happens to be Peruvian, begins to conduct the interview in Spanish? Needless to say, it wouldn’t end well.

Tiltfactor – Why am I just learning about you now?!

Apparently I have been living under a rock, because just today I heard about this incredible website called Tiltfactor. If you haven’t perused this site, go there, NOW!

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Tiltfactor is a lab founded and led by Dr. Mary Flanagan that works on creating games in order to address both social and public health issues.  In short, games that would be perfect for group therapy! This group uses a method called “Critical Play” that takes learning and behavior/attitude change and makes it fun!

Here are two of the games that I saw that I will definitely be buying and bringing to my group! I will let you all know how it goes later!

Awkward Moment

Awkward Moment

In this card game, the participants say how they would respond to a variety of awkward social moments. What a great way to add humor to the group and allow everyone to open up in a fun and non-confronting way!

Buffalo

Buffalo

This card game has participants racing to identifying people who fit specific descriptions faster than any of the others in the group. This is a great way to get clients 100% focused on a task and their hearts racing! A great activity to use when the group seems to be falling into a lull and not participating.

There are so many more games on this site to incorporate into your group, these are just the ones that I have bought so far.  Please check out their site and see some new things you can bring to your clients!

BONUS – a lot of these games will be fun for your own social events so after you’re done using them with clients, bring them home for some weekend fun!

The Mandated Client

Prior to my internship, one of my greatest fears was working with the mandated client.  I had enough doubts in my skills as a counselor, the idea of trying to counsel individuals who were mandated by the courts and had no desire to be there was daunting to say the least.  However, I am happy to say that after working with mostly mandated clients, I absolutely love working with this population. They are a challenge, they are exciting and they are teaching me more than I could have ever learned from books or class lecture.

Here are a few things to keep in mind about the mandated client:

  • You can learn a lot from them. A lot of the time, mandated clients have lived in a very different world than you have and if you assume that you know everything, you can lose them very early on in the relationship. Ask them questions!  You don’t always need to be the expert – in fact, asking them for their knowledge will more likely help your relationship grow as opposed to weaken it.   Many of these clients are always told what they need to know, but when you put the ball in their court and ask them to teach you, it helps booster their esteem and foster their autonomy.
  • Just like everyone else, they lie – however, for them the stakes may be a little higher. Many of these clients are here through the court system and one false move can potentially get them “lugged”. (For those that don’t know, “lugged” can be used to mean thrown into prison – you learn something new every day).  With the fear of prison looming over them, they sometimes lie in order to be seen in a more positive light.  Try to remember where your honesty goes when you’re in trouble with the law (I’m talking to you, driver whose father is honestly in the hospital every time they get pulled over for speeding).
  • Working with them will make you a better counselor.  As we all know, it is very easy to get comfortable with any work that we are doing and with that comfort often comes a certain level of laziness.  Working with mandated clients forces you to constantly be upping your game and thinking creatively in order to help them get as much as they can from your program.
  • Not all mandated clients come from the judicial system.  Chances are, no matter which site you are at, you are going to come into contact with a mandated client. Some clients are mandated to therapy by their partner in order to save their relationship and you can run into the same types of obstacles with these clients as you do with those from the courts.  No matter where the mandated client comes from, always work on highlighting their autonomy and the choices they have throughout the therapeutic process.
  • They may not be motivated to change.  Often, voluntary clients come to you because they have a behavior/thought that they want to change and are in the contemplation stage of change or later.  These clients are usually “easier” because they are already in the mindset of wanting to change.  Mandated clients are often not in that same mindset.  Many mandated clients are in the precontemplation stage of change so therapy will need to begin in a very different way.  Motivational Interviewing techniques that help look for and evoke change talk will be highly beneficial!
  • Clients are often mandated to counseling with a diagnosed disorder.  When clients come to you from the judicial system, often, they will come already diagnosed with a disorder like Alcohol Use Disorder (thanks for the new terminology DSM 5).  Many times, after speaking with the client, you will come to realize that perhaps their diagnosis does not match up with what you are witnessing.  Always be careful to look for misdiagnosis or co-occurring disorders so that you are not wasting the client’s time and well-being helping to treat for the incorrect disorder.
  • Watch out for burnout! Working with this population, many counselors reach a point of burnout.  Between the no-show clients, clients returning to jail/prison, positive UA results, and a general lack of motivation for change, many counselors begin to get jaded by the process and some reach a point of burnout. Be sure to be mindful of your own thoughts and behaviors and to watch out for the signs of burnout!  While it is true that you will not get through to every client, you will get through to some and together you can help turn them around.  This is such a rewarding process and will remind you why you are in the profession.
  • Lastly, the most important knowledge I was given when I started my internship – some clients will end up going back to prison.  It does not matter if you are the best counselor in the world and you do everything correctly, some of your clients will end up going back into the judicial system.  Remember that autonomy we talked about earlier and how important it was for the client to realize they still had it? Well, it’s just as important for the counselor to remember the client’s autonomy when they are brought back to prison. Our clients make their own decisions and it is their responsibility to deal with the consequences of that decision.  We are here to help them to the best of our abilities, but their choices are their own.