Rehabilitation centre Group Therapy
Group sessions are carefully selected for the rehabilitation centre to cover a wide area of concerns that typically surrounds the nature of addiction. These groups are therapeutic related, educational and/or support driven. Some of these topics may form part of the individual treatment plan.
Main areas focussed on in group topics:
The awareness of our feelings, motivations, behaviours, thoughts and sensations are explored. Self-awareness also includes an awareness of the triggers, which lead to drug use, such as certain emotions, situations and people. The awareness of self allows individuals to take control of these behaviours, emotions and situations, empowering them to make necessary life changes. It is a mechanism, which promotes acceptance of self, mental and spiritual growth. Individuals become aware that they have control over how they react to anything life throws at them, by living life on life’s terms. Typical groups topics will include the following:
Emotional Intelligence - Emotional intelligence refer to how well people read, understand and communicate with others, as well as how effectively control their emotions. Since a lot of the goals achieved through their individual treatment plans are based on the various aspects of emotional intelligence, the purpose of this group is to gage how comfortable they are with a specific topic and which we feel needs to cross over into their individual sessions as well.
Emotional Maturity - Substance abuse has a negative impact on emotional maturity. Individuals put themselves at risk of neuropsychological deterioration, making it difficult for them to recognise as well as process various emotions as well as stunting their emotional growth in terms of the relationships that they keep around them. We start by exploring this topic to create awareness around emotions and areas needed to be focussed on to eventually achieve emotional maturity.
Identifying Emotions - The way we perceive our emotions can play an important role in predetermining our thought processes and behaviour. The emotions we feel can compel us to take compulsive action and influence our decision-making capabilities. Mindfulness is key to understanding the three critical components of emotions, which are the subjective, psychological and the expressive/responsive component. Substance abuse is a form of emotional avoidance and escapism. From a consciousness perspective, it is the basic understanding of what we are feeling, while we are feeling, and why we are feeling a certain emotion.
Maintaining standards of honesty and integrity through managing our disruptive emotions and impulses allows for us to take responsibility for. Typical group topics will include the following:
Anger Management - Unresolved anger can lead to addictive or compulsive behaviours, as well as contribute to continued substance abuse, or be a cause of relapse once an individual is in recovery. Addressing anger issues through Anger Management therapeutic groups during treatment for Substance Abuse Disorder is essential for successful long-term sobriety. Unresolved anger issues also affects individuals’ interpersonal relationships, and displaced anger can be a volatile psychological stressor.
Distress Tolerance - We often talk about emotional discomfort or distress. Emotions we do not like, but experiencing uncomfortable emotions is a natural part of life. However, there is a difference between disliking unpleasant emotions, but nevertheless accepting that they are an inevitable part of life and hence riding through them, versus experiencing unpleasant emotions as unbearable and needing to get rid of them.
Defence Mechanisms - We use defence mechanisms to protect ourselves from feelings of anxiety or guilt, which arise because we feel threatened, or because our id or superego becomes too demanding. Defence mechanisms operate at an unconscious level and help ward off unpleasant feelings (i.e., anxiety) or make good things feel better for the individual. Ego-Defence mechanisms are natural and normal. When they get out of proportion (i.e., used with frequency), neuroses develop, such as anxiety states, phobias, obsessions, or hysteria.
Grief - At some point in life, we will all experience the loss of someone we dearly love and care about. It can be through sudden death, illness, or even a breakdown of a relationship. Overwhelming feelings follow, and the unprecedented feelings of loss can lead to substance abuse, or even trigger a return to past, addictive behaviour. Individuals are guided through the stages of grief, which are denial, anger, bargaining, depression and acceptance. For some, their drug of choice, has in many ways been an intimate, albeit dysfunctional and destructive relationship. The loss of a mind-altering substance, can in many ways be compared to the loss of a loved one, something that sounds ludicrous to anyone who has not been caught in the grip of full-blown addiction.
Honesty - Dishonesty or lying is more often than not, a habit developed by addicts out of fear of the consequences of their actions, used as a means to conceal their addiction, as well as a coping mechanism. It is also a prerequisite in order to finance substance abuse, and defined as a learnt behaviour, not a moral failing. Dishonesty is an unproductive coping tactic, although it is normal for an individual to own up to dishonesty. It leads to amplified feelings of guilt and toxic shame. Dishonesty traps people in addiction, and can make them feel trapped in recovery. Rigorous honesty is what prevents mistakes from turning into failures, and one of the fundamental spiritual principles of the NA Program globally. Honesty cultivates acceptance of one’s self and reality.
Assertiveness - Assertiveness is being able to express your feelings, thoughts, beliefs, and opinions in an open manner that doesn’t violate the rights of others. The main effect of not being assertive is that it can lead to low self-esteem. This is a learned behaviour and thinking style.
Gratitude - Gratitude is an attitude, a positive outlook towards life. Both rich and poor can be grateful, it is humbling, and allows us to see the truth of our situations. Gratitude allows for constructive and unselfish behaviour. It can influence the behaviours of an individual, which can aid in leading a sustainable recovery-oriented life. Addiction is defined by self-centeredness, victimization, and depression. In early recovery, individuals are reminded of how much there is to be grateful for, and ultimately how much they still stand to lose through continued substance abuse. It promotes introspection and acknowledging how far the individual has come, as opposed to how far they still have to go. “It is impossible to be grateful and depressed in the same moment” – Naomi Williams
Forgiveness - In the context of addiction, forgiveness is an integral part of recovery, and being able to set aside past hurts is an important aspect of long-term treatment. The person holding a grudge is the person most affected by it, and the inability to let go/forgive, may inevitably lead to continued substance abuse or relapse. Addiction is fuelled by past abuse, trauma and hurtful actions by others. The majority of addicts struggle to forgive themselves for past bad decisions and actions. Self-loathing is addressed during the process of forgiveness, as the individual who is devoid of the power of love of self, is devoid of the power to forgive.
Guilt - Neurobiology categorizes guilt as a corrective emotion. An individual makes a mistake, guilt is experienced and corrective action or behaviour modification is affected. Addiction as a disease is progressive, and it breaks down an individual’s moral core value system in order to be able to justify and rationalize the abuse of substances. Individuals do things in active addiction that they will never even contemplate whilst being of sober mind. As a result, they are left with an acute sense of guilt, shame and loathing of self. The therapeutic process enables the individual to acknowledge that they can love the addict, but hate the disease. (Steps 1 – 5 restoration to sanity)
As part of our individualised approach, specialised groups are brought in for individuals who might face challenges with specific areas. These may include perfectionism, depression, anxiety, eating disorders, bipolar, etc.
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Goals pertaining to self-motivation is to look at their individual commitment, achievement dive, initiative and optimism. Group topics include the following:
Procrastination - Everyone puts things off sometimes, but procrastinators chronically avoid difficult tasks and deliberately look for distractions. Procrastination in large part reflects perennial struggles with self-control as well as the general human inability to accurately predict how we'll feel tomorrow, or the day after. "I don't feel like it" takes precedence over goals; however, it then begets a downward spiral of negative emotions that deter future effort.
Life Purpose - Addiction and recovery can be linked to two fundamental human concerns, meaning and life purpose. Meaning is a psychological experience, and a lack of opens a person up to the pain of meaninglessness, and a craving to find one or more meaningful substitutes – substances or mind altering experiences in order to fill the void. Substance abuse is all-consuming, robbing the individual of ambition, drive, purpose and even the most basic life skills. Addiction is fuelled by too few psychological experiences of meaning; recovery is supported by the active creation of such experiences. Purpose provides drive and direction, which translates to the individual who has a “why” to live, will inherently find the “how” to live a clean and sober life.
Motivation for Change - Denial is the first barrier to break through on a therapeutic level, with an individual in the grip of addiction. Bringing them to the realization that it is necessary to walk away from their most habitual patterns, possibly detach from a lifestyle that sustained them for a long time, and that their lives had become unmanageable, as a result of their substance abuse. Everyone has a different motivation for entering treatment that stems from different places depending on their circumstances. The main objective is to make the individual understand that it is a progressive disease, and the inevitable end-results are always the same; jails, institutions and death. They can create futures filled with meaningful relationships, whilst living productive lives, free from the suffering of addiction.
Developing social skills:
This is one of the more intense areas focussed on in the program as it covers a wide area of topics that is important to explore. Typically it will include areas such as influence, communication, conflict management as well as building bonds. Group topics include the following:
Boundaries - Personal boundaries are the imaginary lines we draw around ourselves to maintain balance and protect our bodies, minds, emotions, and time from the behaviour or demands of others. Personal boundaries allow us to be in the driver’s seat of our own lives. Without healthy boundaries or with very weak boundaries, you simply cannot have healthy relationships. You give up a part of yourself to be available or accommodating. Or you become so entangled with another person and their needs (co-dependent behaviour) that you lose your own identity.
People Pleasing - It is a difficult habit to eradicate if being compliant was a means of avoiding conflict during formative years. Social pressure and a history of abuse subconsciously program individuals to navigate conflict, and is a learnt behaviour in future interpersonal relationships. The addictive personality also uses it as a manipulation tool in order to avoid consequences and feed his/her addiction. In early recovery, a lack of boundaries, assertiveness skills, guilt and low self-esteem continuously leads to some form of people pleasing as individuals feel the need to over-compensate for past mistakes and actions.
Communication Skills - Communication is, on its most basic level, a way to create and make changes in relationships in our lives. It is also an important factor in helping build confidence. Good communication skills, whether it be verbal or non-verbal, allow people to effectively work with others in relationships, education, and work. The ability to interact effectively with others can go a long way in building this much needed level of confidence. If a recovering addict is still feeling intimidated by the presence of others, they are more likely to isolate and revert to using, or relapsing.
Conflict Management - It is safe to say that individuals with addictive personalities experience conflict on a much deeper level, because of their obsessive and compulsive nature. Conflict is an inevitable part of life, and the resolution thereof is a crucial life skill to master. Conflict can be damaging, if handled ineffectively it leads to breakdown of relationships, resentments, emotional bullying, the use of force, or threat to abuse and aggressively dominate another individual. Benefits of effective conflict management are increased productivity and accomplishment of goals in the workplace, strengthening interpersonal relationships, a greater sense of self-worth, and emotional well-being.
Support Systems - Part of the last stage of Rehabilitation Treatment is focusing on support systems. In early recovery, individuals have acquired the knowledge and coping skill sets to rebuild their lives. For the transition of reintegrating into life at large successfully, a strong support system is essential. A strong and pro-recovery support system offers the individual accountability, lifeline during temptation, an opportunity and freedom to voice frustration, resources and advice and socialization to avoid isolation. Sober family and friends, like-minded individuals in recovery, therapists and sponsors all have a role to play in an individual’s support system. It prevents the individual from falling back into old habits, but also assists the individual in identifying and avoiding troublesome patterns and behaviour.
Relationships - During the first twelve months of sobriety, individuals may struggle to effectively grasp and identify, own and process their emotions and feelings, which directly affects the quality of newly forming relationships. Developing healthy relationships in recovery is desirable, and can be achieved successfully. This process helps build self-awareness, enables forming a sober support system, and cultivates the emotional capacity to survive in a world that can pose challenging for an individual in early recovery. The focus in early recovery should include understanding one’s own needs, expectations, and feelings before embarking on forming new relationships.
Love Languages - The most common issue in any relationship is the communication barrier. Everyone experiences love differently, and it is easy to miss the mark when it comes to showing that one cares. Love languages offer individuals the awareness to identify the root of conflicts, to give, and receive love, in more meaningful ways. It emphasizing that love is the absence of judgement. The realization that we are all worthy of love is a revelation for any individual who has struggled with addiction, due to the feelings of guilt, shame and low self-esteem.
Developing a healthy self-esteem:
When a person has low self-esteem, they may be more influenced by the world around them and their resulting actions. For example, a person with low self-esteem may have trouble overcoming negative thoughts or feelings and therefore turn to outside experiences or activities to change those negative thoughts into positive ones. Drugs can be one of the outside activities they turn to in a negative situation or state of mind. Through these groups, we look at negative core beliefs, negative life experiences, negative self-evaluations and unhelpful rules and assumptions. Moreover, after exploring these we focus on self-compassion and create a self-management plan to use as a mechanism of taking responsibility for our own behaviour and well-being.
Relapse prevention is an essential part of a successful treatment program. Many areas are explored to assist an individual to identify key areas on their road of recovery. The content of these groups are also brought into their aftercare plan. Some topics discussed during groups include the following:
Cross-Addiction - The addictive personality has the capacity of shifting from mind-altering substance, to mind-altering experience, defined as cross-addiction or substitute-addiction. It is consistent with many strict disease models of addiction where individuals are unable to make rational choices based on neurobiological research on the Brain Reward System and dopamine levels. It reinforces the notion that individuals with a history of substance abuse are more vulnerable to developing cross-addictive habitual behaviours such as gambling, virtual, shopping and sex addictions to name but a few.
Stages of Relapse - There is a common misconception that relapse is a single moment when someone a substance use disorder returns to their drug of choice after a period of complete abstinence. Relapse is in fact a process, and there are three classified stages, which are emotional, mental and physical relapse. Understanding the stages and identifying the warning signs is essential in preventing relapses.
Triggers - Internal and external cues that causes an individual in recovery to crave his/her drug of choice, and the desire to revert to using. Triggers are generally classified under emotional, mental, environmental, people, places and things. Individuals become more aware of their triggers as they progress during treatment, and are asked to identify it whilst doing relapse prevention plan.
Social Pressures - Social acceptance and peer pressure are powerful forces in the world of alcohol and drug abuse, as we derive our identity in part from our belonging and acceptance in and to social groups. The refusal to these mechanisms may result in isolation and lack of identity as such. As the use of substance increases, and the addiction process advances, the amount of interactions with non-addicted individuals decreases. Social anxiety, fear of rejection and judgement are issues that individuals in early recovery have to deal with.
Consequences - As humans, we have the freedom of choice, but we are not free from the consequences of those choices and decisions. Addiction is a family disease, and the addict’s decisions affect everyone close helped full measure of the addiction, which are the consequences, unmanageable life, broken relationships and collateral damage. Individuals become aware of the importance of not acting on impulse, and to consider not only all the options before making a decision, but also the possible outcome and consequence of every decision they make in the future.
Balance in Recovery - In active addiction, the substance or drug consumes the individual’s entire existence, and in severe cases, it leads to loss of employment, financial ruin, marital problems, poor health and hygiene. In early recovery, balance is avoiding extreme highs and lows. It also means paying attention to tendencies of focusing and obsessing too much on one specific activity. Balance is simply enjoying living without the need to over intensify all our experiences, honouring everyday responsibilities, and channelling the newly found energy towards healthy and productive activities.
Relapse Prevention - Self-awareness and mindfulness are key to relapse prevention, combined with being aware of one’s triggers. Real life stress, as well as psychological stress are major contributing factors to relapses, but a balanced lifestyle and solid support system minimize the risks involved. Individuals are introduced to the NA 12 Step program and fellowship whilst in treatment. The 5 pillars of sponsor, step work, meetings, service and a loving higher power has, and is keeping people clean and sober right across the globe.
1st Year in Recovery - Research has proven that the first twelve months of sobriety poses the highest risk of relapse for individuals in recovery. Every one of the 47 group modules that an individual is presented with during treatment has been designed and formulated to mentally prepare him/her for life after treatment. Being clean and sober does feel alien at first, but if the knowledge and coping skills are applied, there is every chance of succeeding at the new way of life. Like any form of learnt behaviour, sobriety becomes a lifestyle, which is wholesome and fulfilling. Individuals are able to live life on life’s terms, knowing that they are unable to control what life throws at them, but they are in full.
Lastly, it is essential to know how our physical well-being has been affected and the possibility of further risk or damage. These groups are educational in nature and includes nutrition, sexually transmitted diseases, physical effects of different substances as well as healthy sleeping habits.