The facility where we did most of our work is Nexus Recovery Center in Dallas, Texas, a well-respected, nonprofit inpatient facility that offers harbor and hope for women with active substance abuse concerns and mental health issues. Nexus is one of the few drug treatment facilities in the country that accepts pregnant women. The Nexus program uses a structured schedule, builds acceptance of personal responsibilities, and utilizes process groups, educational groups, and individual counseling. When working with groups there is the challenge, not unique to this program, to engage clients in active participation and to capture their attention in meaningful ways.
Nexus incorporates a cognitive behavioral approach and embraces twelve-step methodology, which is similar to the majority of programs offered in the United States. The center uses the broadly accepted Stages of Change model, delineated by Prochaska, Norcross, and DiClemente. Clients’ readiness for change is assessed on admission, and progress is encouraged in the direction of preparation, action, and maintenance. Most of the women who spend time at Nexus have made a commitment to sobriety and enter the program while in a preparation or action phase of change. Despite the brevity of the voluntary program, the residents generally express deep appreciation for the opportunity to redirect their lives and show promising behavioral changes with insight into their addictive patterns. A structured outpatient program is offered for integrated follow-up with discharge plans that include twelve-step work, referrals for counseling, medical and mental health services, job training, and educational and housing assistance as needed.
All the activities in this book were primarily tested on clients at Nexus Recovery Center, and some of the activities were tested in other local centers. In each case, if an activity did not go smoothly, it was modified and retried. Some of the activities were additionally tested with other types of groups. It is expected that many of the activities will be useful to a broad range of individuals who can benefit from self-awareness skills, not just those in recovery from substance abuse. It is anticipated that the activities have adaptability to settings of various orientations and groups of various sizes or skill levels.
Philosophically, we present a model for self-healing designed for clients to take with them and use for ongoing support in recovery. The experiential process offers what Ernest Rossi and Kathryn Rossi in their book, Creating New Consciousness in Everyday Life: The Psycho-Social Genomics of Self Creation, (see Introduction) call self-generating creative moments that facilitate new consciousness.
We express grateful appreciation to:
The individuals in recovery who shared their work illustrated here.
Cindy Seamans, PhD, for her constant support and encouragement of our professional creativity.
Nexus Recovery Center for providing a safe haven for women in recovery and allowing us to be part of the miracle.
The women of Nexus who gave us open, honest feedback, and inspired our ongoing efforts.
Andrew Barroso, Olivia Klein, and Cory Shipko for their contributions.
“Life relentlessly follows you, calling on you to change your point of view, to develop a deeper understanding of yourself and life.”
STEPHEN GILLIGAN
Welcome to Engage the Group, Engage the Brain. We hope you find the 100 group activities to be stimulating and rewarding when you try them with your client population.
Substance abuse remains one of the most pervasive and challenging problems faced by society. Professionals who work in the recovery field have a strong desire to generate change. In many cases this passion comes from personal experience with the devastating effects substance abuse has on individuals, families, and society. The belief of those who work in this field know that it is possible to make a difference, which is one of the greatest assets to the process. Persistently high relapse rates are as perplexing as they are discouraging. Problems arise with lack of consistency in evaluating successful outcomes. Most studies reveal estimates of relapse rates ranging from 40–60 percent.1,2
The vast majority of treatment programs in the United States are based on a twelve-step methodology and utilize cognitive behavioral approaches to facilitate change. The current understanding of brain neuroplasticity has opened opportunities for a broader look at the therapeutic process and for healing by engaging the mind and body in creative ways. We are now beginning to appreciate that the incorporation of a broader base of experiential activities into treatment may be one of the keys to enhancing success in this field.
The ideology we embrace here is that recovery can be fortified through engaging clients and nurturing neuroplasticity. New associations are generated through the stimulation of becoming involved in activities that offer decision making, problem solving, and choices in a nonthreatening, supportive environment. Through healthy engagement and participation in activities that allow for expression of insight but do not require it, the individual has the opportunity to explore belonging, participation, and success in a whole different manner.
While we, the authors, support a cognitive learning foundation as centrally important to recovery, our emphasis in this book is on experiential engagement. Our activities are designed to augment and enhance existing program offerings, including those based on cognitive behavioral, Stages of Change3, Motivational Interviewing4, and twelve-step approaches. This is not a stand-alone approach but rather an enrichment. Not all participants are able to learn the same way or to express themselves in a traditional classroom didactic setting. Some are not able to develop insight that can be expressed verbally. Learning that is dependent upon verbal expression is limited in its reach and capacity for change.5 We strive to go beyond the limitations of written or spoken language to reach into areas of learning that occur on an unconscious level, further than the reach of cognitive expressive learning. This book includes the application of activities that go past cognitive learning and stimulate self-reflective processes congruent with principles of neuroplasticity.
The philosophy and works of the psychiatrist Milton H. Erickson provide a framework of self-awareness and self-responsibility integral to overall health and well-being. Erickson’s creative approaches to psychotherapy and speculation that his unique success may be in a tangible way related to neuroplasticity, piqued our interest in exploring neuroplasticity as a central avenue to brain health. We found the work of others who also support this concept. We share an admiration for the work of neurologist Oliver Sacks, whose many books have shown that deeper understanding of one’s uniqueness is integral to health. Another book that influenced our thinking is The Brain that Changes Itself6 by physician Norman Doidge, in which Doidge emphasizes the personal triumph of overcoming limitations through challenging, ingrained, habitual patterns of perception and thinking.
We draw on the work of Mindfulness Based Stress Reduction (MBSR) as it was developed by Jon Kabat-Zinn, PhD, and the Center for Mindfulness at the University of Massachusetts Medical School. Clinical research strongly supports the positive effects of MBSR, which is being integrated into other therapy protocols.7 We are also inspired by Mindfulness-Based Relapse Prevention (MBRP), which uses empirically supported interventions