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?

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.

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?