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How to Use This Book: A Facilitator’s Guide

Through our experience in the field, we have learned a variety of strategies that will help you conduct dynamic groups. In this section, we share our methods for engaging participation and maximizing opportunity for therapeutic transformation.

The activities in the book may be done in any order as they might fit into your group.

Group Management: We always begin these activities with a short summary emphasizing patience, being aware of self in the present moment, and the importance of self-care. Starting with a brief review of the body’s needs for a balance of nutrition, sleep, and exercise, we also emphasize a need for good spiritual and mental health. We briefly call attention to each of the six areas this book is divided into and clarify how the chosen activity relates to those areas.

We use analogies about how addiction has commonalities with other conditions. People who have brain damage from stroke, head injury, or alcohol and other drug use often have impairments in short-term memory, long-term memory, verbal or written language expression, motor skills, and emotional regulation. The concept of neuroplasticity is introduced in simple terms. Group activities are then described from the perspective of being an opportunity to enrich oneself through conditions (novelty, enrichment, and exercise) that hold promise for accelerating healing and enhancing the probability of success in recovery.

We invite participants rather than instruct, and we accept the depth and direction of engagement each participant chooses. Over and over we stress: There is no right way to do an activity; it is a process of trial and error, a discovery, a journey. We hope each person will find some aspects of the activity useful in recovery.

As clinicians and facilitators, we find it essential to stay flexible and compassionate and be willing to modify activities to suit the capabilities and moods of each particular group. One of the lessons implicit in the activities is that artistic creations rarely come out the way they are envisioned. The processes of using unfamiliar materials, making mistakes, recognizing limitations, and accepting what is imperfect are all part of what is expected. Repeatedly, we stress that it is not the product but rather the participation. The process of being expressive, creative, and challenged by a new activity is therapeutic in itself, with or without a final product. We suggest participants turn attention inward and notice what is happening in the moment (thoughts, sensations, emotions, or moods). Learning can come from handling the materials, envisioning direction, and finding a personal way to proceed. The more creative and original the direction, the more likely the participant is to make positive associations with recovery.

Participatory Reluctance: It is not unusual for individuals in inpatient treatment to ask to be excused from activities. We encourage participation, even if modified. For those less ready to adapt, individuals are encouraged to remain in groups, sit quietly, and observe what can be learned from watching others. One humorous example of how this reluctance can evolve into full participation occurred in “Exercise Circle.” One participant stated she was unable to stand or exercise, so the facilitator brought her a folding chair and encouraged her to do only what was comfortable. When it was that participant’s turn, she jumped up and led the group in a series of push-ups and dance moves so vigorous that few others were able to follow.

In any group, we anticipate some degree of self-consciousness or fear of participation. Certain activities involve more face-to-face contact than is comfortable for some. “Magic Hands,” “Think About Me,” and “Lean My Way” are among a half dozen or so activities that involve facing a partner. Some clients have stated they are uncomfortable even looking at themselves and having a partner doing the looking can be frightening or overwhelming. For these activities, we stress the voluntary nature of participation and encourage those who are not comfortable to stand back and watch the process as it evolves. Frequently, participants become more willing to explore after watching others.

The good-natured cooperative energy that evolves in groups is a powerful motivator to draw in the hesitant. One of the most delightful elements of group work is how role-modeling by some enthusiastic group members encourages participation by others, perhaps by sparking mirror neurons. For a fascinating and simple explanation of mirror neurons and brain function, we refer you to neuroscientist V.S. Ramachandran and his 2009 talk, “The Neurons that Shaped Civilization,” which can be found online. Time spent observing others brings added depth and awareness. The surprising paradoxical effect of late starters becoming strong advocates is truly a beautiful process to witness.

Remarkably, cooperative sharing of skills and helping one another also tends to promote patience. One participant who had a long legal record resulting from impulsive anger management showed incredible patience in teaching others her own origami skills. She expressed insight into the change that came over her while working with the paper and began to envision how she might apply it to her own behaviors.

Holiday Blues: Holidays often bring associations with past addictive behaviors inconsistent with recovery. Engaging in appropriate, relaxing activities offers participants opportunities to begin to develop their own reservoir of happy memories associated with dates and seasons that previously created burdens. One example is St. Patrick’s Day. Our activity of having each participant identify a “Hope or Dream” to display on a four-leaf clover provides a visual and emotional shift away from the commonly accepted behavior of binge drinking alcohol on that holiday. Each holiday provides opportunities to develop new associations that are pleasurable, enjoyable, and congruent with recovery.

Disparity of Skills: A broad range of abilities makes large groups challenging to work with. Some of our participants had never the learned basic skills of drawing or using scissors. Others expressed sadness over loss of skills they once had. Many comment on the limitations of their work as an indicator of how their addictions have affected them in ways in which they had not been fully aware.

In speaking with individual clients who feel their talents are limited, we counseled that those who work the hardest actually get more out of the activity than those for whom it is easy. Not everyone is artistic, and not everyone knows how to draw, cut with scissors, act, or read aloud. Not everyone is comfortable with participating in group planning. One learns from making mistakes and discovering that things often don’t turn out as planned. The emphasis on self-acceptance seems to nurture a sense of hope and self-discovery despite limitations.

Materials: Many of the activities in this book require a small budget for basic arts and crafts supplies or other materials. Most of the supplies can be accumulated from households and donations. Magazines for collage, while a popular alternative to drawing images, seem to distract from intended introspection, and we strongly recommend self-generated drawing or creative designs. Some loss or theft of material supplies does occur, but this is minimal.

Samples or Mock Ups: For activities that involve some degree of performance or physical movement, we begin by asking volunteers to show the group what the activity looks like. Demonstrations are far more effective than written directions. In creating a piece of artwork, the value of having samples available is unclear. Some participants benefit from viewing samples, while others attempt to use the samples for an exact template, effectively stifling spontaneous creativity.

Time Management: Time management for some participants presents a challenge. We notice if a group member has difficulty getting started, or progresses at a pace that exceeds the time allowance, we gently call awareness to this. Keep a watchful eye on the clock to assure time is allowed both for clean-up and sharing. When using crafts materials, we eventually developed a routine of giving a ten-minute clean-up warning and allowing a limited check out of materials to conclude projects.

Clean Up: For activities that are messy or create a lot of small scraps, we used paper plates for confinement of debris. The paper plates can be reused for future projects, and interestingly, whenever they were used, some became unexpectedly incorporated into the artistic endeavors.

Adverse Reactions: In any healthcare setting, it is important to be prepared to deal with individual needs or adverse responses. Within our groups, a counselor or intern counselor is always available to deal with any needs or anxiety reactions. Nexus Recovery Center has many clients with severe trauma and PTSD, and we were always aware of the possibility of uncomfortable emotions being triggered. In fact, this happened rarely. Occasionally materials selected inadvertently caused an abreaction. One example of this was the use of India ink that reminded a client of black tar heroin. She became agitated and benefited from the presence of counseling staff. Being prepared can decrease the likelihood of such difficult situations. Subject matter that involves families could put those with significant losses or those raised in dysfunctional or foster families at risk for discomfort. Therefore, we might offer participants an alternative to describing a dream family, church family, or a family of friends. Alternative selections made are unconditionally accepted, and we see them as healthy choices in self-care.

Discussion: It is essential to allow time at the conclusion of the group for clients to present their creations and process feelings about the activity. We offered clients the opportunity to show their work to the larger group, if desired, or to keep it personal, if preferred. You will find that clients are generally enthusiastic talking about their experiences, expressing the meaning they found in the activity, and showing their artistic creations to others. Some participants want to describe ambivalence, difficulties in becoming engaged, or mistakes made. This is not discouraged, and the group forum is an effective opportunity to reframe negative thoughts in a positive way. The diversity of responses adds enormous depth. Creative ideas generated by the clients are some of the more delightful aspects of this work. All the photographs in this manual illustrate actual client work and show clinicians what results can be expected.

Thank you for selecting this book, and we hope that you find it to be useful!