Sunday, September 13, 2020

Coping Circle


Coping Circle

Introduction: This exercise is an interesting and interactive way to discuss a wide variety of coping skills as a group. The expected outcome of this exercise is for group members to help one another by sharing how to use various coping strategies while learning about new skills for areas where one may be lacking and need improvement. This is done through an open interchange of ideas as a group. This group can be done in person or virtually through telehealth. Also, this group can be done repeatedly over time because when clients come up with new problems to discuss, the outcome of using this group format changes from one time to the next.

Directions: First, everyone list a few stressors in their life to potentially discuss. Two or three is good for each person, but if someone is struggling, they should be able to try to contribute at least one. In person, the group leader can track the list of stressors on the board to make a master list. Done virtually over telehealth, everyone should message their ideas to the rest of the group using the chat feature. Everyone then can access the list by viewing the group chat box on telehealth

There are two recommendations for coming up with stressors to discuss:


Be specific – For example, don’t just say “Anger”, but instead elaborate specifically about what makes you angry, for example “Dealing with anger and frustration when my parents constantly nag me and make false accusations about me”

 

Format the wording of your stressor so that the group is prepared to discuss coping skills. Some suggested phrases for stressors are:

Coping with ______(Stressor)

Dealing with______

Handling_____

Finding ways to _____

Getting help for _____

Learning to cope with _____

(Etc.)

The counselor/group leader and others in attendance (co-facilitators/interns, etc.) should be invited to add to the list as well with some of their own ideas which will help the list grow so there are plenty of choices

Next, after everyone in the group has added at least 1 to 3 stressors to discuss to the overall group list, the group should begin discussing these issues in the following manner:

Everyone in the group is encouraged to participate and take their turn when it comes around. Start with a volunteer who is willing to go first. When it is someone’s turn, that person should review the overall group stressor list carefully and choose one that he or she feels proficient at using in their own life. Keep in mind what it means to be proficient. (Review this as a group)

Proficientadj – Skilled, advanced, competent

If someone is proficient in an area, then he or she should be able to explain it in simple terms so that others can understand it. Einstein said it well with the following quote:




Once the group member who has their turn has chosen a stressor to discuss, the floor is theirs and that person should be given a few minutes to explain how they cope with that stressor by describing what skills and supports they use and how they use them personally. Again, be specific and everyone should do their best to explain the coping skills that they use for the stressor in a way that others in the group can learn.

The counselor/group leader has the right of “Counselor Redirection” – This would only be necessary if someone gives unhealthy or unsafe advice to the rest of the group. An example of something unsafe: “I cope with work stress by drinking a pint of vodka then get on my motorcycle and go 100mph down the highway – The adrenaline really helps me get my mind off of things”. Another example of an inappropriate answer: “I deal with my emotions when my family is getting on my case by going out and either picking a fight with the first person who looks at me funny and beating them to a pulp or by randomly vandalizing peoples cars or houses”

Finally, it would be helpful if someone played the role of “tracker” by keeping track of some of the coping skills and supports discussed by the group. Also, it would be helpful to note which areas no one picked as areas of proficiency as possible areas for future group education

When enough people have had a turn sharing in the Coping Circle the group can process the following discussion questions at the end as a group:

First, the person who was tracking coping skills and supports discussed by the group should review the list with the group so the group can again get an overview of all the good skills everyone is already using effectively. Then answer the following questions as a group with everyone encouraged to share and participate:


How did it feel to share your expertise when it was your turn?

 

Did one of your personal stressors get picked as an area of discussion? If yes, what do you think about the feedback and advice given for that stressor? What did you appreciate?

 

What are some coping skills that you heard about today from anyone else in the group, that you may like to give a try yourself in the future?

 

Finally, what stressors did not get picked by the group. Discuss as a group how perhaps some of these areas can be future topics of education and discussion for the group


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Friday, September 4, 2020

Stability and Setback Prevention Self-Awareness Checklist



Being self-aware is key when it comes to staying on the right track in order to prevent relapse and setbacks when coping with substance use and coexisting mental health issues. To be truly self-aware, we need to be able to honestly ask and answer questions of ourselves and to objectively assess our true progress, insight and motivation. When we are honest and open our minds, we can learn where we need to make the improvements and adjustments needed to stay on a positive course and avoid going down the wrong path.

Setbacks, Relapse and The COVID Factor

Preventing relapse and setbacks any time is a challenge. The COVID pandemic has changed things a great deal. For this exercise we will call these changes ‘the COVID Factor” There are many challenges due to COVID factor when it comes to staying on the right path with substance use and mental health. However, there are some things that some individuals may find to be easier as well. This exercise is focused on making an honest self-assessment of strengths and areas needing improvement when it comes to preventing relapse and setbacks in progress while taking the COVID factor into consideration.

When considering factors that may impact setbacks and relapse, it is important to review the following:

Strengths:

·         What are your areas of strength?

 

·         How have you developed these strengths? What is working for you?

 

Areas needing improvement:

 

·         What areas do you identify as needing to improve?

 

·         How has the “COVID factor” contributed to these challenges in your life?

 

·         What can you start to do in order to improve in these areas?


FOR THE FULL LIST WAYS TO PREVENT RELAPSE AND SETBACKS FOR DISCUSSION

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If inspiration is the fuel that moves us forward, then progress is the mileage we accumulate along the road we travel on. The farther down the road we go, the closer we get to our destination and goal. Even if we go backward after a period of progress, the next time we travel that road moving forward we know the way a little better. Every time we try to move forward, we gain some experience and therefore make progress regardless of whether or not we reach our destination. All movements made in a positive direction are critical aspects of the upward change process.

-      Taking the Escalator 





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Saturday, August 22, 2020

Deep and Personal

 



This activity is in an icebreaker format, but it may be better for a more established group as the questions require group participants to share their thoughts on some deeper questions and then afterward try to make personal application. Each question starts with discussion on a more philosophical level which should be reviewed first. Afterward, there is a follow up probe which requires more individualized responses based on group members own views, thoughts and experiences. (Some of the items are based on existing quotes so when applicable the origin of the quote is provided when known)

Answer the numbered question first (in any order), then probe deeper with the follow up question below it:


What would you do if you knew you could not fail? (Not an original quote but exact origin unknown)

What is the deeper meaning behind this saying and how can you apply it in your life in a practical way?


What would you want to know if you could know for sure, one secret of the universe?

How do you imagine you would change your life knowing this information?


“Life can only be understood backwards; but it must be lived forwards.” — Søren Kierkegaard. – What does this saying mean?

How can you apply this in your own life and experience?


What is one thing related to “the big picture” that you think about in quiet introspective moments at night?

When you wake up, what do you do about it and if you aren’t doing anything, what can you start doing?


You get to go back in time briefly and talk to yourself at any age – What age “you” do you visit, what do you say and then what do you imagine that your life would be like when you return to the present?

How can you start the process of working toward this life that you want today?


You are in an airplane and your parachute is on and ready and the door is open. What do you say to yourself in your head to get yourself to jump (or not to jump)?

How can you apply this to situations in your life today?


What is one basic human truth you have discovered in your lifetime?

How does your knowledge of this truth impact your behavior and choices?


What is your secret or strange “superpower”? (Something you do unusually well for some reason)

If you don’t have one, how can you find or develop a special skill or talent? – Or, if you do have one, are you using this “power” to its full benefit?


He who is untrue to his own cause, cannot command the respect of others– (Albert Einstein) – What does this saying mean in your viewpoint?

What “cause” do you need to be “true” to in your own life today?


To live the right way in life requires that you are ready to handle that some people will think you are living the wrong way – What does this mean?

How can you apply this personally as you try to improve your own life?


Sometimes we say “I don’t care” when we really don’t care but other times we say “I don’t care” because we are afraid or embarrassed to let others know we really do care – Do you agree or disagree and why?

What do you care about that you should be more open and honest with others about?


An outward display of courage seen by others can build your reputation and fame, but inward acts of courage go unseen by others yet these build self-confidence, self-esteem and self-respect

What will help you increase your “inner courage” and how can you do this more in your life?


Are you afraid of the good you might do? Victor Hugo

If you can let go of your fear, what good would you do?


The issues we don’t face today can soon turn into barriers along our road to progress in the days ahead

What issues do you need to face in order to remove future barriers and enhance your progress?


You can choose to do whatever you want whenever you want to, or you can choose to try to have peace and stability in your life, but it is unlikely you will have them both at the same time

What things do you know that you need to limit or give up in order to increase peace and stability in your life?


Which is more important, to be in competition with others or to strive to be better than your past self?

How can you strive to be a better you today?


It isn’t the mountains ahead to climb that wear you out; it’s the pebble in your shoe. Muhammad Ali

Personally, what mountains do you need to still climb and what pebbles in your shoe may still wear you out?


It’s not how well you play the game; it’s deciding what game you want to play. Kwame Appiah

When it comes to life, what “game” do you need to play in order to succeed and what game do you want no part of?


FOR A PRINTABLE VERSION OF THIS CLICK HERE




 

Monday, August 10, 2020

Pet Appreciation

 

Opening exercise: Complete the following questions below about a pet that you love. If you do not have a pet, you are still encouraged to participate by using a pet from your past. Another option would to be to use an animal in nature that you admire and appreciate. It could be a local animal like squirrels, birds or deer or an animal from around the world like a tiger or panda. Any animal that makes you feel good you can think of will work for this discussion

My Pet (or Favorite Animal) Profile:

Appearance -

Behavior Patterns - 

Personality - 

Likes/Dislikes - 

I am Drawn to (I Appreciate) - 

What this animal means to me personally on a deeper level - 


Process: Discuss your pet profile as a group. (If you did not use a pet, substitute pet with the word “animal”)

Some additional process questions:

What does your pet do for you emotionally? (or thinking about your favorite animal?)

How do you connect with your pet on a special level? (If your animal is not a pet, what is special to you?)

What are some things your pet does that you really appreciate? (Or things your favorite animal does)

How can your pet bring you out of an emotionally challenging situation even if it is just for a little while?

What positive adjectives come to mind when you think of your pet (Loyal, loving, sweet, unique, beautiful, etc.)

The following additional questions are pet specific and may not be able to be discussed by non-pet owners

One thing that my pet understands about me is

One thing that I understand about my pet is

One thing makes this pet special is

One thing that I truly and deeply love about my pet is

What do you do for your pet to make your pet feel special and loved?

What does your pet give to you?

How do you give back to your pet and how does that help you?

 

If this activity is being done via telehealth, a great follow up activity is to do a Telehealth Pet Show:

Telehealth Pet Show – Allow group members with pets an allotted amount of time to bring their pet on camera and talk a little about their relationship with that pet. For those without a pet, they can choose to bring a show a stuffed animal toy, a picture of an animal in their home, a picture from the internet or their phone, or a statue of an animal in their home of their choice instead of a live pet. Allow time for group members to ask questions. Process thoughts and feeling at the end of group.

FOR A PRINTABLE VERSION OF THIS CLICK HERE 


www.takingtheescalator.com



Saturday, August 1, 2020

UNG - Unnecessary Grief



UNG – Unnecessary Grief - There are many challenges in life that can be considered “maintenance” problems that are eventually bound to happen with time. This can be similar to the way when you own a car; even if you do everything you can to take care of it, at some point you will need to get maintenance (i.e. the oil changed, the brakes fixed and tires rotated).  Paying the rent, taking the kids to the dentist, doing your assignments at work/school, cleaning the house; these all fall under “maintenance” types of issues. It is a waste of time to get too upset about maintenance problems because they are inevitable and to be expected

Then there is another category of problems which are the direct result of “decisional circumstances” that are the direct consequences of the choices we make. These problems are the ones we have the most control over and are the most avoidable. Sometimes it is also those little irritable little things we do (or fail to do) which can cause ourselves what can be referred to as “UNG or Unnecessary Grief”. It can be incredibly frustrating how much “UNG” a person can generate when one is not careful.

 

Some behaviors which can result in UNG. Discuss these as a group and add to the list if needed – Also consider how the COVID-19 pandemic can impact these challenges and effect your decisions

Not knowing when to shut up

Lateness

Bringing up a subject you know will cause an argument

Gossiping

Not keeping promises

Not paying bills

Overspending

Overeating

Starting something, you know you cannot finish

Neglecting self-care

Not taking medication when you know you need it

Hanging out with someone you know is going to cause trouble

Getting back with the ex when you know from experience where that leads

Agreeing to things you will not want to do or be able to do later

Not saying no when you should

Debating with someone you know is foolish, dishonest or has no idea what they are talking about

Hanging out where you know trouble is

Breaking the law when eventually you’ll get caught

Taking shortcuts now that you’ll have to pay for later

Taking on too much

Moving too fast

Not listening to good advice

Trying to do something alone that you shouldn’t

Not knowing you limits

Making decisions or speaking your mind when in a heightened emotional state

Other?

 

Below are some specific examples where a person caused UNG:  Review these and then try to come up with some of your own personal examples from your life where at times you may cause yourself UNG

 

“I’m broke again because I went out and spent too much of my paycheck the first weekend that I got it”

 

“My significant other is mad at me again because I stupidly brought up a topic that I knew beforehand was just going to cause a useless argument like it always does”

 

“I feel depressed and guilty because I didn’t take good care of myself emotionally or physically all weekend”

 

As a group, discuss your own personal examples like these


What can you do in order to prevent UNG? – Review the following list of ways to prevent and avoid UNG. Discuss these below as a group and try to choose a few of these strategies for yourself for one of your own personal examples of UNG. Explain how you will use these strategies to improve your situation in the future

 

Plan ahead and strategize before these situations arise

 

 

 

Learn to pause and think before acting or deciding: A few seconds can make a huge difference

 

 

 

Practice self-awareness so you can recognize when you may be making a decision based on emotion so you can wait until you are in a more calm and rational state of mind before deciding

 

 

 

Know your triggers and avoid them or at least prepare for them if they are unavoidable

 

 

 

Know your areas of weakness as well as “high-risk” situations for you personally

 

 

 

Do what you can to follow a structured plan for living to limit chaos and unforeseen challenges

 

 

 

Listen to your instincts and your conscience when you have that feeling like something is not worth the risk

 

 

 

Consult with others whom you trust and then listen to their advice when applicable

 

 

 

Bring others with you who are supports when you know you will be facing a challenge

 

 

 

Remember how it felt to experience UNG last time so you can motivate yourself to stop setting yourself up with the same situations and then stop repeating the same unnecessary mistakes

 

 

 

Seek therapy to better understand why you may be repeating some of the same choices and behaviors and causing yourself UNG and avoidable stress. (Identify self-destructive patterns)

 

 

 

 

WHAT ARE TWO OR THREE THINGS YOU WILL CONTINUE TO FOCUS ON TO AVOID UNG?



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Wednesday, July 22, 2020

Positive Vibes



This exercise is designed to get some positive sharing and discussion going with a group. This activity can work well in person as well as when using telehealth. There is a main version and an alternate challenge version.


Directions -

Everyone in the group should get one of the “positive vibes word topics”. The group leader can let people choose their own or assign them. One way to do this with telehealth is to cut and past the word definitions into messages using the chat function available on most telehealth platforms. In person, you can cut the words out and have people select from a pile at random or else pass them out. Its up to the group facilitator

Next, taking turns one by one, group members should share with the rest of the group about their positive vibes word topic. There is only one rule:


People can share any way that they want too as long as they keep it positive, but for those who may have difficulty with this, here are some suggested guidelines for sharing:

What does your word mean to you personally?

What are some examples of this in your own life?

What do you personally think helps to increase this positive thing in your life?


When each person is done sharing, to increase the positive vibes applaud if you want too. Then before the next person shares, process some of the group’s reactions and feelings about the presentation together as a group. Some suggested process questions for group members (optional):

What stood out to you about the presentation on this positive word?

Can you relate to anything you heard?

What can you use or apply in your own life with what you heard about this positive vibe word?

Version 2 – Challenge: Share, GUESS and Discuss

Version 2 is more of a challenge and may be better for a more experienced and cohesive group than version one which could work for just about any group.

Version 2 for this activity adds one challenge – The person sharing should not use their word in their presentation. Then, after the presentation allow group members to try to guess the topic based on what they heard. Then proceed with the follow up discussion as in Version 1


Positive Vibe Word Topics



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Tuesday, July 7, 2020

Therapy Tips for Telehealth



Using telehealth as a therapist can have its challenges. 

Here are some telehealth therapy tips to help:

Know your platform – Whatever telehealth computer system you are using, it makes sense to practice working with it so that you understand all of the features and nuances of the platform. Learn how to share your screen for instance and also make sure you know how to use comments and screen backgrounds. A lot of these features can be very helpful, especially in group therapy

Prepare your telehealth environment – Using telehealth is not usually physically as comfortable as sitting in an actual room with your client(s). So, it makes sense to prepare your telehealth setting ahead of time to make it as comfortable as possible. For example, if you are running a group make sure you have a drink handy, as well as a pad and pen to take notes if needed and even have things like pillows and blankets for your comfort especially with longer sessions like IOP groups which can be 3 hours or longer. It may make more sense to have two devices handy in case you need the extra screen to look something up during the session. Having enough outlets and chargers nearby is also something to consider. Of course, also make sure your environment is confidential in addition to being comfortable.

Log on to sessions early – When possible try to allow some extra time to make the online telehealth connection, send links, and troubleshoot problems when clients are unsure how to connect for the session on the telehealth platform. Its best to be the first to log on so you can anticipate problems ahead of time and be ready for them and then help others to walk through technical issues on their end.

Have back up plan for technical problems – For example if the sound is not properly working, make sure you have a cell phone handy with a number that you are comfortable letting the client(s) know about. If using a personal cell phone and you don’t want the client to know your number, get a Google Voice number 

Be ready to do more listening than usual – This is especially if you are more of an active talker in session as a therapist. There may be a delay using telehealth at times, so it can be difficult to interject in sessions if that is something you are used to doing. It can be much more challenging to slip in follow up questions if the client is on a roll and for some reason the telehealth platform is not cooperating when you attempt to do so. You may find yourself having to carefully choose your moments to speak in session when telehealth issues disrupt the flow of the therapy communication.

Prepare, prepare, prepare! – Preparation is a good practice when it comes to therapy in general but during telehealth sessions preparing ahead of time has even more importance. This is especially true when using activities or other forms of media, as in group sessions. Everyone who has done telehealth so far has learned that some ideas that work well in person may at times not translate as well to telehealth – especially when the telehealth system is glitching or problematic. It is best to have back up simpler activities in case something you planned just is not working well. www.takingtheescalator.com has a lot of stuff to choose from including group activities, power points, podcasts, and some videos for therapy sessions.

Have some “go to” questions and phrases ready to keep things going when sessions are lagging or just not flowing ideally -  When using telehealth for therapy, it is important to increase your “awkwardness tolerance”  - There are bound to be more awkward and uncomfortable moments when using telehealth, as communication can at times be strained or challenging when compared to talking in person. Having some prepared questions and other ideas can help break through these moments. Some prompts to start these types of questions/statements that can break things out of a funk may be something like: “Can you give me an example of…”. “It would be great if you could show/describe/expound a little more about …”, “Do you mind if I ask you about…”, “I would be really interested to hear your thoughts/views on…” – The key point is to be ready to kick start communication when it hits a lull due to telehealth issues.

Take advantage of telehealth “letting you in” – We often never get to see our client’s homes. Why not use telehealth to allow them to show you around if they are comfortable? Let them show their pets, their children, their backyard, or anything that they want to show you that is appropriate. These types of things can enhance the engagement process and help with building the therapeutic relationship. A real-life example: A therapist was working with a challenging teenager via telehealth and the teen was preoccupied complaining of hunger. The therapist allowed the teen to go to the kitchen to make a snack while they talked. This flexible approach ended up really helping the session build momentum when otherwise it had stalled. Allowing a restless client to take the session outside can be another way to let telehealth work for you instead of against you. (Always keep confidentiality in mind by reminding the client of this when new locations chosen)

Get in the habit of being more descriptive and ready to follow up for clarity and understanding when needed  (But not too much, don’t overdo it)- Keep in mind that using telehealth doesn’t allow us as therapists to have access to nearly as many nonverbal cues in communication which can be a challenge. Therefore, it makes sense to be prepared to take the extra time to follow up and ask your client(s) about their level of understanding of whatever it is you are discussing in session. Motivational Interviewing skills such as empathetic reflection, open ended questions, and summaries are essential tools for therapists in telehealth. Lack of nonverbal cues often necessitates making sure you are connecting by following up a little more than you may be used too when compared with in person therapy when a client’s body language, gestures and facial expressions are much more clearly seen in context.

Be flexible and positive (even when you don’t feel like it) If clients complain about telehealth, it can be helpful to show empathy by validating their concerns and even sharing that you too would prefer to be in person. However, the overall attitude about telehealth that you express is one of the most important factors in its success in your therapy sessions. Even if you do not like telehealth, embrace the challenge with as much positive energy and enthusiasm as you can. By contrast, if you go into telehealth sessions with dread and apprehension, it will likely show to your clients. It can help internally to remember to be grateful that telehealth is allowing you to keep working when otherwise you may not have been able too. Always try to look at the bright side of things even when telehealth can feel like an emotional grind as well as a technological nightmare at times. Telehealth, with all its flaws is still a much better reality than a world with no telehealth in times of need, so it is important to keep that in mind. “Let’s all do what we can to make the best of this” is a great way to look at telehealth challenges both with yourself and with your clients especially when things may not be going as smoothly as planned in telehealth sessions.

Practice self-care – We tell our clients all of the time to use coping skills and to establish healthy outlets to get through challenging times. We, as therapists need to practice what we preach for ourselves, especially when using telehealth which can be stressful. Have a plan for mini “doses” of self-care throughout the day by taking “two minute vacations” and giving yourself time to refresh by breathing, getting up for a minute to walk around, having a healthy snack, or doing whatever you know how to do to relax and refresh your mind, body and spirit. Also, at the end of the day a routine of healthy self-care, fresh air, exercise as well as positive outlets to disconnect and detach so you can “recharge” can make such a difference in a telehealth therapy environment.

Taking the Escalator Tools for Therapists (Click to view)