Sunday, May 14, 2023

Why Be Honest? - Talking About Relapse and Setbacks


Why be Honest? – Talking About Setbacks and Relapse – VIDEO:


Opening Exercise – Relapse Role Play


Directions – Choose a volunteer in the group to share a fictional relapse story. The volunteer can feel free to make up the details for this imaginary scenario. For a few minutes as an icebreaker for this topic, the group should role play providing support for this fictional relapse. When the group has completed this brief icebreaker, discuss the following questions:


·        What are some challenging feelings that someone may experience when opening up to the rest of the group about a setback or relapse? (Try to identify some feeling words such as fear, anxiety, guilt, etc.)


·        After sharing about an actual relapse with the group, what are some feelings that someone may experience after receiving support from the group? (Ex. Relief, encouragement, gratitude, etc.)


Everyone in this group has probably heard this before:  Sharing openly about life situations, even difficult ones, is helpful and good for our personal process of positive change and recovery. Yet, still in substance use treatment groups, hiding the truth or even lying about relapse still may occur. Why?


Most people know the importance of honesty for therapy and treatment to be truly effective. Still, even knowing that, why do deception and dishonesty still happen sometimes in groups? Discuss some of the thoughts and feelings that may trigger dishonesty in therapy.


What are some common reasons for dishonesty in groups? – Discuss the following list as a group:


Misguided Pride – It is normal to want respect and dignity which we all deserve. However, our opinion of ourselves can prevent us from being honest about our mistakes. Pride can lead someone to hide the truth about a relapse based on the thinking that “I do not want people to think less of me, so I won’t tell them about my mistakes.”


Habit – Sometimes lying can become automatic if someone does it enough. It is important to learn to break the “lie when I get caught” habit if that is the case. A person who habitually hides the truth can re-learn the process of being honest even when things are difficult. It may take practice, but people can learn to be honest.


Shame – Similar to pride, sometimes a person may hide or lie about a mistake because of shame, which is an uncomfortable, sometimes even painful, feeling that can arise when something is perceived as “bad” or “wrong”. It is important in group therapy that people should feel comfortable sharing mistakes without being “shamed” by others. People recover in different ways and setbacks may be a normal part of the process in many situations.


Ambivalence – Someone may present in group as wanting to change substance using behaviors but internally still have “mixed feelings” about actually following through. Change is often easier said than done so a person may choose to hide their substance use from the group due to a need to still work on internal motivation for lifestyle change. Group therapy can help with the internal motivation building process.


Avoidance/Procrastination – This can become a cycle which works something like this: A person experiences a setback or relapse but decides not to share it with the group because of reasoning “I’ll tell the group about it next time (but not this time)”. The problem with this is that when the next relapse happens, that person may say it again “next time I’ll get honest” or “I’ll be honest tomorrow” but tomorrow may never get here


Lack of trust - Sometimes people may hide the truth to put up a barrier so others cannot know who they really are (aka the “real me”). Some people have difficulty trusting others enough to share openly about mistakes and weaknesses. It is important for a group to be a place where people can learn to build trust with one another.


Fear – This common reason for hiding the truth about a relapse often is linked to consequences of substance use. For example, a person with a legal situation may be afraid to reveal a slip or relapse for fear of legal repercussions. As harm reduction is becoming more widely accepted, many legal authorities are more accepting of relapse, especially when a person with a legal situation is making an effort. Counselors can help advocate for clients in legal situations as well, especially when overall progress is being made.


Chronic Shyness – Similar to lack of trust, some people are naturally shy and private so opening up may not come easily. Again, a group needs to be a place where people are encouraged to be honest and open even when a group member is shy or reserved by nature.


People pleasing – A person in group therapy may like the group to the point where there is a fear of disappointing others by sharing mistakes or relapse. It is important for the group to express unconditional positive regard for one another even when relapse happens.


Thrill – Getting away with something can be exciting for some people. A person may actually enjoy the “thrill” of getting away with using without others finding out. Sadly, this does not usually end well when there is a substance use problem as eventually repeated deception can catch up with a person over time.  


Denial – If a pattern of deception becomes persuasive, a person can lie to themselves by denying or distorting reality. Minimizing is an example of denial where a person may reason “it wasn’t that bad, so I don’t need to tell anyone else.” Justifying is another example where a person may reason “I deserved to use and not tell anyone because my life is hard, and I am going through a lot.” We all know that denial is not a healthy way to cope but rather working on self-awareness, openness, and honesty surely leads to better outcomes in the end.



“I relapsed and I don’t know how or am afraid to talk about it” – What to do.


Suppose you are in a situation where you experienced a relapse or a setback or you have something else you need to share but you are not ready or don’t know exactly how, here are some suggestions.


1.     Talk to a counselor first – A counselor can provide coaching or guidance on how to share about a relapse, setback, or other challenging topic. A counselor can help you introduce the topic in group.


2.     Just do it – Sometime the only way to share difficult news is to just say 1,2,3 and go! – Let it out. There might be no easier way than just blurting it out and getting it over with. It often feels better when it is out.


3.     Choose an optimal time – In an IOP or inpatient setting there may be a certain time of day that may be the best time to share about a relapse. Get to know your program and when open sharing is encouraged then also prepare (which is the next step)


4.     Prepare – Practicing what you want to say and how you want to say it can make it easier to be honest.


5.     Remember you are not alone – Most people understand relapse so it is important to stay aware of the fact that it is okay to be honest as others in the group (and your counselor) Most others will surely understand. Group is a place of empathy, compassion, and support, not of shame, fear, or judgement.


6.     Forgive yourself and remember honesty is for your own good – It is important to work past feelings of inappropriate pride, shame, or a desire to please others and instead focus on the reality that even if you made a mistake, the best way to get better is to just be open about it. The healing will only increase with the truth being out there to discuss. Relapse can be a powerful learning process when discussed openly in a supportive environment.

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