Affirmation Stones

Working with substance use groups, you usually are talking about heavy topics and it is difficult to have clients focus on the positive aspects of themselves as opposed to dwelling on the negative ones.  In order to combat that, I have found affirmation stones to be a good group activity.  In terms of supplies, everything you need is simple!

1) MAGAZINES – try to get a variety – especially if you have a heterogeneous group. I like to have some Men’s Fitness, Self, People, etc. Try to steer clear from Cosmo unless you want some unnecessary moments of them getting stuck on the sex section and before you know it, an hour has gone by and everyone’s still wanting to talk about the “just right” orgasm.

2) Scissors – get at least one for every two people

3) Tape or Super glue – I tend to stay away from the super glue after some unfortunate mistakes, but it does look nicer than tape.

4) Stones – if you are at a location like mine, you can just walk outside and have them pick their own! Make sure it’s dry and clear from dirt before starting or it will be a gross mess.

After you have all of the supplies, encourage people to look for words or pictures that make them feel good about themselves and that highlight the good they have within themselves. Make sure that if you suspect there are any literacy issues with group members, to offer the picture idea as well.

The rocks serve a purpose other than as a fun activity for a group. When clients start to feel overwhelmed and find themselves in a downward spiral looking only at the negative things they have done and internalizing that as being bad people, they can look at their rocks to remember the positive.

Have you tried affirmation stones with clients before? How was the experience?

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Finding Nemo and Substance Abuse?

Preparing for group this week, the topic was humor in recovery and I was at a loss as to what to do. Humor is absolutely essential for recovery; we take ourselves so seriously in recovery and are always focused on the bad that sometimes you need an outlet to just let loose and have fun.  With that in mind, I was stuck because how do I teach having fun? After consultation with colleagues, the decision was made to show a comedic movie, with certain guidelines. No violence, language, sex or alcohol/drugs. Having quite the extensive comedy collection in my house I was excited to the best one, excited until I began to look at my movies. After going through two rows of movies I realized the one thing all of my comedies had in common – DRUGS.  What is it about comedies that it necessitates the inclusion of drugs into the plot in order to increase the comedic value? I’m trying to help teach my clients that they don’t need drugs or alcohol to have fun, and here was every comedy I could find enforcing the exact opposite.

Second guessing my idea that this was going to be easy, I looked over to the section I was previously ignoring, my embarrassingly extensive Disney collection.  Now, for me, I can think of no better Friday night than coming home from work, having a nice dinner and then cozying up on the couch with my husband and dog and watching a Disney movie – they’re hilarious and make me feel good afterwards, but how was I going to convince a room full of clients the same thing? Throwing caution to the wind, I decided to give it a shot putting my full faith in the universality of Disney (while bringing some snacks to group hoping it would encourage a more positive experience).  I ended up settling on Finding Nemo because it’s a personal favorite and of course, there’s an AA scene in the film (Fish are Friends, Not Food!) so how could it not relate to the group!

My only fear in presenting a pixar movie was that the clients would feel like I was treating them like children.  Hoping to assuage this thought,  I introduced the movie by talking about how we take ourselves too seriously in recovery.  I spoke about when children have a difficult problem, they engage in play which allows them to creatively look at the alternatives and open up a world they may not have thought of. In recovery, we can do the same and sometimes engaging in play in a safe environment may assist them overcome scenarios they otherwise would not be able to do.  Happily, I can say that within a minute of presenting the movie idea to the group, they had already set up their chairs to the television and happily sat back allowing the movie to do it’s job. The room was filled with laughter and for 100 minutes, the stress and troubles in their lives were put on hold for fun.

Now, while I encourage everyone to show a movie like this to their clients in recovery, do keep in mind that at least some psycho-education should come after the movie. Questions to ask could include, how did you feel watching the movie? Did you expect to feel that way?

Also, if there is time, spend a little bit of time discussing the benefits of laughter on the body.  If you do not know the ways in which laughter can help the body, go to this site here for some information: http://www.discovery.com/tv-shows/curiosity/topics/10-reasons-why-laughing-good-for-you.htm

Alright, that’s all I have on showing a film like this in recovery. Go out and give it a try!

Post-Acute Withdrawal Syndrome (PAWS)

I remember when I was tasked with discussing PAWS with my clients and told that the topic would be covered over the span of two nights.  How am I possibly going to stretch this topic out to 6 hours??  Wrecked with self-doubt, I put my most creative energies to work and walked into the group still struggling with an idea on how to make this topic interesting.  As everyone was checking in I realized that I wasn’t really teaching them about PAWS, they were already experiencing it themselves, I was just opening their eyes to what was happening in their bodies!  With that in mind, I started group asking for everyone to talk about the differences they have felt in themselves while in recovery (excluding initial withdrawal symptoms) and within 15 minutes, they had compiled a list that included every symptom of PAWS.

Engaging the group in this way allows the clients to take ownership of their own learning. They didn’t need to be “taught” about the topic, they knew it and were just vocalizing it to the rest of the group. In addition, having the clients discuss their own symptoms in this way normalized the feelings that were happening in the room. No longer was it just one person who was having trouble with their memory, it was many.

Something I have found interesting was their fascination with the science behind PAWS. Often times when we are discussing a topic, the conversation will go back to the physiological reason behind the topic.  When discussing PAWS, it is important for you as the facilitator to be knowledgeable about the physiology behind it and for that I would suggest reading an oldie but a goodie, Stay Sober by Terence Gorski (excerpt can be found here).

Once you are finished discussing the many symptoms of PAWS, it is essential to have a discussion about managing symptoms. Gorski’s reading provides many talking points that should be included in the group discussion and one of the most important topics that should be covered is managing STRESS!!  

Speak to the group about the various ways we place more stress on our bodies and how we should work on being as LEAST stressed as possible during recovery.  Stress exacerbates the symptoms of PAWS. What are some ways to destress?

  • Cut out or limit the amount of caffeine intake! Human beings were not always caffeine dependent and today it seems we have taken caffeine consumption to a whole new level.  I remember when drinking caffeine to stay awake was when my mom would have her morning coffee.  Now that has turned into the morning coffee, and then 3 or 4 more other morning coffees thanks to the Keurig machines in every office. Don’t even get me started on Monster and Redbull!
  • Exercise!! It’s the word nobody wants to hear, but it is essential in managing stress.  Tired of the treadmill at the gym? Go outside!! Hiking can be done almost anywhere and it’s free so there’s really no excuse for avoiding it.
  • Watch a movie/tv.  Now, I’m not saying spend all of your free time in front of the television, but sometimes it’s essential to just unwind and watch something for pure entertainment, come on guys, “New Girl” is back and I know you are all wondering what’s going on with Nick and Jess…
  • Read a book.  I had to include this after I encouraged everyone to become zombies in front of the tv, but it works! Get lost in another world and become someone else for a change. If you’re stuck on what to read, Harry Potter is always getting into some great adventures and provides an excellent outlet for you to release the kid side of you for a few hundred pages.
  • Laugh with friends.  I’m not sure about you, but when I hang out with my friends I tend to be laughing at least 90% of the time.  Laughter is a natural destresser both physiologically and mentally so give it a try! Worst comes to worst, you will enjoy yourself anyway and have a much needed catch up session.

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!

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.