Wednesday, March 24, 2021

Icebreakers for Break Time

– Often substance use and co-occurring groups can be longer in length, especially in Intensive Outpatient Program and Partial Care and in some residential programs. In longer group sessions there is often time set aside for breaks. Quite often, depending on the rules of the program or the facility, some group members may use that time to smoke cigarettes or vape use other nicotine products. Rather than just standing around killing time smoking or vaping, the activities listed here can be given out as group assignments so that group members can use break time more productively. These break time assignments can then be later discussed and processed in the group therapy setting once group reconvenes.

Group Challenges:

Nicotine Free Challenge - Try not to smoke, vape or use any habit-forming product during the break. When you get back to group try to be ready to share what coping skills you used and what worked the best for you


No Complaint Break – Try to go the entire break only talking about positive things without complaining about anything going on in your life. Be prepared what it was like individually to go without complaining and how did this challenge affect the group as a whole while on break


Silent Break – Take a break where the entire group stays quiet and uses the time for quiet relaxation and self-reflection rather than talking. When back in the group be prepared to discuss if the group was able to do this successfully. If not, what went wrong and what was difficult. If you were successful, what was it like?


Share the Positivity – Everyone’s assignment is to spend break time being encouraging with one another. Everyone should try to focus their break time conversation on being supportive and upbuilding to other group members by letting others know what you believe they are doing well with.


Restricted Topics – The group should take break and agree not to discuss anything at all related to mental health or substances and just keep it to discussing personal interests and topics outside of the treatment goals of the program.


Individual Group Assignments:

Interview – During break time each member should spend a few minutes with another group member and do a brief interview session. When group reconvenes, everyone should discuss what they learned about someone else in the group


Interesting Discussion Ideas – Everyone in the group has the individual assignment to think of an interesting topic to discuss for the next part of group therapy after the break. When group reconvenes for therapy, there are two choices for follow up:


Ø  As a group vote on one topic that someone came up with and then discuss that topic for the next segment of group therapy time


Ø  Or rather than vote on one topic, divide up the remaining group therapy time and allow each person to discuss their topic for a few minutes (For example, each group members topic gets 5 minutes for discussion)


My Favorite – This should be an easy one. Everyone in the group should spend some time thinking about something that is their favorite (Favorite food, sports team, musical performer, etc.) Everyone should share what favorite they thought about while on break


Three Things Going Right in My Life – Everyone should come up with three things (no matter how small) that are going well in life at this time and then discuss them with the group when group returns for therapy


“I’ve Never Shared About…” – During break each person should come up with something that they have never shared in group before, but they are now ready to talk about. Discuss these when group therapy resumes


Unique – Every group member should try to come up with one or two things about themselves that they believe makes them unique from the rest of the group. Discuss when group reconvenes


I Never – Try to think of something that many people have done but you have never done that you are willing to share about when group continues


“You’re Not Going to Believe This…” – Try to think of something unbelievable that you have experienced or witnessed or know about and then discuss these as a group after break


I Don’t Know (But I Want To) – Everyone in the group should try to think about something that they are willing to admit that they don’t know or understand and then discuss these together as a group after break


Come up with an Example – Before group breaks, the group leader should come up with a topic or a descriptive word and then everyone in the group should come up with an example that they can discuss later after the break. (Some ideas – Come up with something: Weird, Funny, Puzzling, Inspiring, Fascinating, etc.)


You Lead for Five – When the group gets back together, everyone in the group will get five minutes to lead the group. Come up with an interesting way to use your five minutes where you oversee the group activity.


Cooperative Group Assignments – 

(Things the group should try to work on together during break)

Take a Vote – As a group come up with an interesting topic to vote on and then take an unsupervised vote on the topic and then discuss the outcome when group therapy resumes


Organize – This is an advanced challenge that is very wide open for a creative group. See if the group can organize by coming up with a shared idea everyone agrees with. This could involve the group coming up with any one idea (preferably something positive) that can be discussed when the group gets back together (Some examples “Lets make Taco Tuesdays where we all pool our money together and order Mexican food” or “Lets organize a talent show”)


Story Telling Idea – As a group come up with an interesting topic that everyone should be prepared to tell a story about when the group reconvenes. (For example, “Tell a story from your childhood about a time when….”)


Group Rule – As a group, come up with a group rule that will apply for the rest of the group when everyone gets back for therapy. It can be a serious rule or perhaps something amusing or anything in between as long as they group agrees on it and it is appropriate and reasonable


Commonalities – See if the group can have a discussion and make a list of things that everyone in the group has in common. Discuss the list when group resumes


Group Name – Work together as a group to come up with an interesting name for the group and then discuss this idea when group is back together


We Agree! – As a group come up with something interesting that everyone agrees on. Be prepared to discuss why you chose this answer and what it means to the group as a whole


Wednesday, March 17, 2021

Nicole Tierney on Forgiveness...

In my first blog, I remarked how much advice I received from so many well-meaning people early in my journey.  One of the most consistent and popular messages was to forgive myself. 

Let the past go.  Focus on the future.  All I wanted to do was change and find peace and so I set out to follow this advice of self-forgiveness.  Moreover, honestly it made sense.  It would also be a relief. 

I hated myself.  I had done horrible, unspeakable, things which hurt the people I loved so very much.  While I fully understand that substance use disorder is a disease which has drastic effects on one’s brain and judgment, I could not reconcile even that acknowledgement with an abdication of the things I had done to hurt others. 

So I set out to master the task of self-forgiveness, acceptance, and love.  But like chasing a butterfly, the more diligently I pursued self-forgiveness,
 the more elusive it seemed.  

Because my default cognitive response is rumination, I became obsessed with self-forgiveness.  I attended meetings, read dozens of books, completed steps, made apologies, changed, followed any and all advice about forgiving myself and letting go.  None of it worked.  Not even remotely.  In fact, in some ways, the inability to forgive myself increased my self-hatred.  

Here I was being told they key to recovery is forgiving oneself and I cannot even do that.  I felt doomed to fail and was losing hope.  I read books about forgiveness and acceptance and even decided to read the Bible cover to cover because I thought where better to lean about forgiveness.  None of this searching shed light on how I could let go of my past.  How could I ever forgive myself for hurting and disappointment so many people I loved and who loved me? 

It was a dark night, I still was not allowed to see or speak to my children and my parents, with whom I lived at the time did their best not to show their disappointment and pain, but I could sense it.  I felt so lonely.  So afraid. I felt as though I would never again feel the love and respect of my family again, and frankly, I did not feel like I “deserved” it.  I remember hating myself and realizing that if something did not change, I would likely repeat behaviors of my past.  I did not think I could take another day trying to achieve the unachievable.  I wept.  I wept for the pain I had caused my children.  I cried for the hurt my family endured.  And for the first time, I cried tears for myself too.  While the pain I caused others was atrocious, I destroyed myself during those years too.  The proverbial scars from some things that happened to me during that period, some of the things I did, are still evident today.  I could not stop crying.  That night, ever so slightly I realized that my past was a part of me and always would be.  There would be no magic wand of forgiveness and healing.  There would be no successful blocking it out and focusing on the bright horizon.  I had to learn to let the present, my past, and my hopes for the future occupy my brain and my heart compatibly.  I still hated every single thing I did but I learned to appreciate all the results of my actions and not only focus on the bad that came from my past.  Likely you just had to reread that’s sentence.  I know it sounds counterintuitive, but in fact, out of the most horrible actions, came the most necessary, painful, yet beautiful growth.  

There was no way to not acknowledge that who I was today was based on who I was yesterday.  Balancing has never been (and likely will never be) a strong suit of mine.  But I had to learn how to have who I was, who I am, and who I want to be peacefully coexists with all parts be accepted.  There were days when too much of my brain and heart were filled with the negative parts of the past, and that was where the work needed to be completed.  

I needed to not to forgive myself for my past, but learn lessons, and use my past as motivation and a reality check at times.  I needed to thank my past too.  This realization about not having to forgive myself provided me so much peace, so much contentment.  It has taken years, but I realized so slowly that self-love has to be unconditional and genuine.  So while I do not love what I did (in fact I still hate it) I love myself.  All of myself and that includes the past.  

This is how I have reconciled hanging on an letting go.  Learning and living.  And most of all, continuing, always to grow.  

Follow up questions for groups:

What can you identify with from this reading?

If you are willing to share, what are some things you are working on when it comes to forgiving yourself?

What can you personally do today to work on self-forgiveness, letting go and increasing your ability to forgive and love yourself and who you are today?


Friday, March 12, 2021

Low Hanging Fruit

 Why not start with the easy stuff?

Intro – The focus of this activity is for people who are just getting started making changes toward substance use and mental health treatment goals. Start by discussing the following points about low hanging fruit

Low hanging fruit is a common metaphor that refers to doing the simplest or easiest work first. Just like the phrase sounds, fruit that hangs low on a tree is the easiest to grab with the least effort.


Especially with more difficult tasks or dealing with a long-term process, it makes sense to start going after low hanging fruit first. Why not try to go after and get what is within reach early on?


Successfully going after low hanging fruit can bring some quick results that can fuel motivation to keep going

Discuss and make personal application: In your personal situation, how can going after low hanging fruit help you personally to start to achieve all of these things?

Kickstarting motivation

Build up and increase early momentum

Fuels and stimulates important feelings of encouragement and inspiration

Empowering (Yes - I can do it!)

Decreases discouragement (Helps avoid the feeling of wanting to give up)

Identifying Low Hanging Fruit for Your Goals

Directions: Start by identifying two or three (or more) areas where you have goals for positive change (Substance Use, Mental Health, Relationship, Social, Employment/Education, Financial, Family, Health, Other)

Under each life area are some examples of low hanging fruit: (Things you can reach for early in the change process to start making progress). Discuss any that you may have already achieved and then choose a few more that you can strive for soon, from the examples provided or come up with your own ideas.

Substance Use 

  • Clear home of booze/drugs/paraphernalia
  • Delete dealers contact info from phone
  • Sober support- Try to go to a meeting or schedule time with someone who is doing well
  • Find and try a sober hobby
  • Medication Assisted Treatment (Suboxone, Methadone, Vivitrol etc.)
  • Other?

Mental Health

  • See a counselor for individual therapy
  • See a prescriber (APN/psychiatrist)
  • Practice a basic coping skill every day – Relaxation skills – Self-care – Stress management
  • Other?

Close Relationships

  • Basic conflict resolution skills
  • Assertiveness/boundaries (learn to say no)
  • Couples/family counseling
  • Other?

Social Functioning

  • Therapy to learn about self, manage anxiety, increase self esteem
  • Prescriber – medicine for social anxiety?
  • Learn and start to practice basic social skills


  • Schedule family therapy session
  • Increase daily effort to openly communicate your feelings with family peacefully
  • Other?


  • Go online and look at application process for school or training program
  • Research a course of study that interests you
  • Other? 


  • Work on a budget
  • Other? 


  • Start a job search
  • Fill out some applications
  • Other? 


  • Exercise
  • Join a gym
  • Research and start a healthy hobby
  • Plan a diet
  • Other? 

Basic life improvement – Other easy life improvement ideas?

  • Organize daily structure – Use a daily planner
  • Organize home environment and chore schedule
  • Other? 

Closing Discussion – Summarize your goals and go for it

Evaluate your successes: What are some examples of low hanging fruit that you are already doing well with?


Overcome obstacles: Be honest: What are some examples of low hanging fruit that you know that you really should be going after but for some reason you are not?


Consider and discuss some possible causes of not going after low hanging fruit. Do any of these apply in your situation?


Procrastination- (I’ll do it tomorrow)

Just not ready (hesitant, anxious or afraid of change?)

Headstrong/Unmotivated (I just don’t want to)

Denial/Lack of insight (Deep down I still don’t believe that I need to change)


Go for it: What are one or two (or three?) low hanging fruit goals that were discussed in this group you can commit to trying to start today?





Sunday, March 7, 2021

Should I See My Friend's Therapist? - Examining the Pros and Cons

[The following is a reprint of a popular Taking the Escalator article from another website (2014)]

Seeing a therapist for a mental health or substance abuse issue is quite common these days as more as more people are willing to try to talk to someone about their problems in today’s challenging world. People nowadays are often a lot more open to talking about their experiences when it comes to seeing a therapist, so asking a friend for a referral has become a highly valued method for finding one’s own therapist. As with anything, there are good points and bad points when it comes to seeing your friend’s therapist. Let’s examine a few:



Pros of Seeing Your Friend’s Therapist:

1) One of the most important factors that influence the success rate of therapy is the Therapeutic Alliance (The bond formed between client and therapist) In this regard, your friends often know you best and they can tell you right off the bat if they think that their therapist is someone that you can easily bond with. If your friend knows you well enough they may be able to help you find the right person to see for therapy.


2) Comfort Level - Going to a therapist can be anxiety-provoking at first. If you had a friend already try the therapist out, they can prepare you up for what to expect which can be a huge anxiety-reducer and thereby greatly increase your comfort level.


3) Frame of Reference - When going to your friend’s therapist, the therapist should already have a good frame of reference with regard to your social group because he or she has been hearing about your social group already from your friend for a while. This also can help with the therapist-client bond as the therapist may already kind of know where you are coming from.


4) Pre-Screening - When your friend already saw a therapist you can sort of "pre-screen" the therapist for qualities that you like and don’t like. For example, you can ask your friend questions such as - "Does the therapist have a sense of humor" ,"Does he/or she do those uncomfortable silences that everyone hates", "Does the therapist know a lot about ______. (Name a disorder such as anxiety, depression, addiction, etc.)


It is extremely helpful to be able to find out from a friend if the therapist is the right one for you because finding the right therapist isn’t always that easy and your friend can be a great resource. 

Now Here Are the Cons of Seeing Your Friend’s Therapist:

1) The Possibility of Being "Pre-judged" - There is a benefit to being a "clean slate" when seeing a new therapist, however when seeing your friend’s therapist, your friend may have mentioned some things about you that may put you in a negative light. (For example, maybe back in high school you stole your friend’s boyfriend, now the therapist thinks you are a scandalous boyfriend-stealer when in reality that was a onetime incident a long time ago)


2) Confidentiality - When two people with an outside relationship see the same therapist, there is always the chance of confidential information getting leaked out by accident. Therapists are ethically bound to confidentiality however accidents do happen especially during the course of conversation. For example, let's say you did something that you don’t want your friend to find out about. Your friend could ask the therapist "Did my friend who used to see you ever _________?” (Fill in the blank with the thing you don’t want your friend to know about) The therapist is supposed to keep that answer confidential however when caught by surprise, sometimes the therapist’s reaction, face and body language can give away the secret unintentionally.


3) Possibility of a Distorted Frame of Reference - Your friend who saw your therapist prior to you may have explained things to the therapist in a way that is completely different than your experience. Your friend may have even lied. Your therapist then may have a hard time seeing things clearly from your perspective because your friend who saw your therapist before you may have painted a completely different picture of things that you are trying to explain leaving the therapist not knowing who to believe.


4) Conflict of Interest - This can occur especially when two friends see a therapist at the same time. One friend may share information that could compromise the treatment of the other friend. This is an extreme example but imagine what it would like to be the therapist listening to one person saying he is going to propose to his girlfriend while the other friend is talking about how he is sleeping with the same girl behind his friend’s back. That could throw everything out of whack and put the therapist in an impossible situation.

Coming to a Conclusion:

Overall, in some cases, the pros can outweigh the cons, particularly if both friends have a trusting and cohesive relationship and they aren’t doing anything really secretive or scandalous behind one another’s backs. If its two friends who have a history of being loyal, open and honest with each other, then seeing the same therapist shouldn’t be a problem at all. Other people might reason that it is just better to start with a clean slate with someone new rather than see a friend’s therapist. What is most important, is that for your individual, unique situation, it is best to first take time to weigh the pros and cons.

Wednesday, March 3, 2021

Flipping the Script on Addiction

Introduction (Read) - So often in substance use treatment we focus on all the harm caused by addiction. It is not unusual to discuss the damage caused by substance use and the consequences suffered by a pattern of addiction. This can be helpful because the desire to avoid future consequences can be very motivating. However, another important way to build motivation is to seriously consider how life without substance misuse can be so much better. Focusing on the positive aspects of lifestyle change can be extremely beneficial. This is the focus of this exercise.

Next - Start by watching one of these two videos as a group. Both have a lot of the same content. For this exercise, while watching the video, please focus primarily on the part about “Rat Park” - After the video, the group will be discussing the rat park experiment and making real life application

Choose one of the following videos and watch as a group – (There is a short or a long version):

Video links:

Shorter – “Addiction” – 5 minutes 41 seconds - -


Longer – “Everything You Think You Know About Addiction is Wrong” – 14 minutes 31 seconds -

(Same video – YouTube Version) -

Process – Discuss the following as a group:

What are some aspects of the video you can identify with personally?


The part of the video about “Rat Park” emphasizes the value of improving our surroundings and our connections (our “cage”) as a positive way to escape addiction – How do you think this can help with the recovery and positive change process for you personally?


Improving My “Cage” (Improving my day-to-day lifestyle, my surroundings, my environment, and my connections)

Read: Obviously, improving our surroundings, connections and overall lifestyle can be challenging especially when you may have limited resources. Still, it is important to set goals to have something to strive for even if things may be difficult right now. Think about what is worth reaching out for

Next – Discuss as a group the following question: What do I need in order to improve my “cage”? (For example, consider your surroundings, connections, environment) – Keep your personal goals in mind. Be creative and open minded. The sky is the limit. Consider a wide range of key life areas such as: Family, social life, employment, education, health, meaning, purpose, etc.…

To improve: What do you need?

Keeping it Real

Read – Achieving goals will take time and effort, but it is well worth it if your goals are positive. Discuss the following:

From the previous discussion question, pick one or two of your goals that you can start working on today in order to improve your “cage”. Even if your actual goal may seem a far way off, think about the smaller steps you can start moving forward with. Think about:


What can I realistically start doing right away?

Example – Goal: “I want to be financially independent” – Maybe that this is still a long way off (perhaps due to a lack stable housing and employment) – Then a realistic goal may be “I can enroll in a Supported Employment program to start getting help looking for a job which can be a start toward financial independence. I can work with a case manager to find a more permanent housing situation than my current boarding home I am living in”


Discuss as a group some realistic things you can start doing to achieve your goals and improve your cage


Closing discussion question – How does it feel discussing these positive life goal for the future? (Hopefully, it feels inspirational, encouraging, motivational, which is the purpose of this exercise) – What is your plan to start making some of these positive changes you have discussed?