Experiential Group Therapy Interventions with DBT

A 30-Day Program for Treating Addictions and Trauma

Allan J. Katz, Mary Hickam Bellofatto

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351183321
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Experiential Group Therapy Interventions with DBT provides group and individual therapists with proven experiential exercises that utilize dialectical behavior therapy (DBT) skills and original educational topics and have been successfully used nationwide to help treat patients with addiction and trauma. It introduces the advantages of using experiential therapy to facilitate groups for trauma and addiction and explains how DBT can help in regulating emotions and tolerating stress. This workbook contains concise plans and exercises for facilitating a group for a 30-day cycle. There is a theme for each day, original psychoeducational materials, experiential exercises, warm ups, and closing interventions.

1
Introduction to Experiential Group Therapy Interventions with DBT

Poem: Bidding farewell

By Allan J. Katz

How can I let go
Of the places I’ve never been!
To the exotic lands I read of when young
The people, the scenery, the fantasies I dreamed of when
I was born, and a new world was unfolding.

How can I let go,
Of the places I went, but wasn’t myself
Full of fear and trying to impress;
Busy living out expectations of others,
That nothing real was really occurring.

How can I let go,
Of the people I never did meet?
People I admired and longed for their friendship.
Kept away by fantasy, fears and unworthiness,
So I could never reach my potential.

How can I let go
Of those I did meet but wouldn’t let in?
So sure they wouldn’t see the real me,
So fearful of what they would say, think or do
That I kept all conversation to a minimum.

How can I let go
Of my potential that was never used?
The hero, the scapegoat, the
lost child, the chief.
Yes, beggar and shyster, the clown and thief
Locked in my basement by fear or by grief.

Hole in the Soul

Figure 1.1 Hole in the Soul

To the group leader: The above illustration is a lesson in itself. It encompasses the multiple layers of loss experienced with trauma, expectations, neglect, or abuse. The hole in the soul concept has four parts: Mental, physical, emotional, and spiritual, each with its own unique twist of the psyche causing shame, guilt, and distorted thinking. In the illustration, the positive elements to fill up the hole in the soul are shown in the red heart. When a person has negative thoughts, they can be traced back to trauma, expectations, abuse, rules, and roles, shown in the blue circle. What were the rules in the household that created a void? What was the role the client played in relationship to their family? These potentially traumatic negative thoughts can be conscious, pre-conscious or unconscious, each delivering a blow to self-esteem; leading a person to fill the hole in the soul with addictive substances, food, sex, gambling, shopping, video games, etc.

When a person agrees that he must reach unrealistic expectations set by others and the rules and roles shape his behavior and feelings about himself, he gives up his power to trauma and abuse. His life is hindered by perfectionism and procrastination and he lives recreating his past or worries about the future, placing his well-being in the hands and expectations of others. However, when he disagrees with the rules and roles he was taught and begins to set rational expectations of himself, while working to minimize the effects of trauma and abuse, he takes back his power. These negative emotions and unrealistic expectations cause guilt, shame, and remorse, caused by self or others until they can forgive themselves and others for the past trauma.

The illustration continues with the cognitive distortion triangle beginning at any point, showing the interaction between feelings, thoughts, and behaviors. It shows when a person lets go of negative thoughts and observes his feelings without acting out he can change his behavior.

Therefore, the problem is caused by distorted thoughts and feelings coupled with acting out behaviors. These present roadblocks leading to relapse when a person cannot or will not live in the present moment instead of reliving the past and worrying about the future. The solution is to use DBT skills along with contacting friends, having a sponsor, cultivating a relationship with a higher power, and going to self-help meetings.

Otherwise, relapse is possible.

DBT Skill: Act Dialectically

The word dialectic comes from the Greek word dialectic, which takes the position that two seemingly opposite ideas can co-exist, without diminishing one another. For example, it is possible to want to be sober and to still want to abuse substances. It is possible to love someone and be mad at them at the same time. It is possible to be happy about one part of your life and sad about another.

For the addict or trauma survivor, acting dialectically helps you get rid of black and white thinking, good or bad, right or wrong, perfect or imperfect while considering the gray area may be a more sensible choice to balance your life. We accept the fact that people may not believe what we believe, may not act like we think they should act, and begin to practice a more middle path, balanced approach to life, feelings, and relationships.

When you are experiencing a craving, you can use the dialectic to help you understand you may not end up using when you make the decision to surf your feelings like a wave in the ocean instead of acting on every impulse. Many addicts believe they need to act out when they experience a negative feeling. By using the dialectic, you simply ride the wave of the emotion, as it rises and increases in strength and then falls, all in a few moments.

Theme: The Relationship between Trauma, Addiction, and DBT

There is a mysterious connection between trauma and addiction. Addiction can be caused by many factors including genetics, emotional abandonment or neglect, or growing up in a very strict household where you feel you don’t have a voice to express feelings. For a small child, growing up not being able to express feelings or not having your feelings validated and comforted can be a traumatic experience. When trauma strikes, children utilize three options: Fight, flight, or freeze. Some children act out in school, others run away, and some freeze by going to their room and tuning out of reality into fantasy. Any response to trauma becomes a fertile field for addiction.

“Drugs and alcohol, for the trauma survivor, can provide a way to quiet the mind and body which they can have control over; a sort of self-administered medication” (Dayton 2011). Triggers occur when the addict re-experiences the shaming thoughts he thinks about himself from past trauma and uses alcohol and drugs to protect him from further emotional harm. He doesn’t have to think about the emotional pain when he is drunk or high: “The more these substances or behaviors are used to quiet and calm unwanted feelings and sensations, the more dependent we become on them and the more convinced we become that we cannot calm down or feel ok without them” (Dayton 2011).

Dialectical Behavior Therapy (DBT) is all about training the mind to lessen emotional suffering. On one hand, DBT believes a person is doing the best he can do given his circumstances and he is accepted unconditionally. On the other hand, there is always room for change and growth. With consistent practice of the DBT skills, we learn to relate to our emotions and struggles in a different, more healthy way, learning to cope with life’s ups and downs that will inevitably occur.

DBT does not focus on right vs. wrong, good vs. bad, weak vs. strong. Instead, it’s about creating a life worth living, focusing on the results we want out of life. We practice being non-judgmental of others and learn to radically accept our past, ourselves and others, realizing we cannot change the past or predict the future.

According to Marsha Linehan (1993), developer of DBT, numerous scientific studies have found that DBT is effective in helping people manage their emotions, and decrease problem behaviors including substance abuse, suicide attempts, self-harm, and eating disorders. Linehan hypothesized (Koerner, 2012) that three factors contribute to a person’s vulnerability. First, people prone to emotion dysregulation react with high sensitivity. Second, they experience and express emotions intensely. Third, they experience a longlasting arousal that is more difficult to tolerate.

People suffering from trauma and addiction are more prone to experiencing these fluctuating levels of emotions. People with addiction tend to abuse substances when they experience any form of negative emotion. Some use a positive feeling of euphoria or good news as a rationalization for continuing their substance use. Trauma survivors experience a heightened level of emotional dysregulation including startle response, trauma bonding, and trauma repetition. DBT skills help a person regulate emotions, tolerate stress, live a more balanced life, and reach her goals through more effective interpersonal relationships.

Life will be more meaningful when you identify the character traits you want to change, how willing you are to change your emotional state, and what you want most out of life (dreams, goals, values, family, career, etc.).

Act Dialectically Experientially

Note to group leader: A spectogram is a linear imaginary line drawn on the floor from one end of the room to another. One side represents zero and one side represents 100. Or you can substitute numbers for “very much” and “very little” or any other combination of extremes.

In this floor exercise, set up one side as “very much” and the other as “very little.”

VERY MUCH-------------------------------------------------VERY LITTLE

Have group members stand at any point on the spectrum as you give them each one of these scenarios:

I am committed to change

VERY MUCH-------------------------------------------------VERY LITTLE

I believe in recovery

VERY MUCH-------------------------------------------------VERY LITTLE

I have what it takes to lead a better life

VERY MUCH-------------------------------------------------VERY LITTLE

I meet other people’s expectations

VERY MUCH-------------------------------------------------VERY LITTLE

I am accepting of differing opinions and beliefs

VERY MUCH-------------------------------------------------VERY LITTLE

I think in terms of situations being either black or white

VERY MUCH-------------------------------------------------VERY LITTLE

Ask each group member as they stand along the line why they are standing in that position. This engenders more group cohesion in understand differing viewpoints and beliefs.

Closing: Commitment to Change/ Angle of Opportunity

This structured psychodrama exercise was developed by Bill Coleman, MSW, TEP.

Each of Bill Coleman’s exercises are newly updated with additional material and can be found in the full-length book, The Illustrated Guide to Psychodrama, copyrighted, imprint 2017, to be published in 2018. For further information, please visit www.cwcolemanbooks.com and/or contact him by email at [email protected].

It can be used as an introduction to DBT by exploring a choice they have to make and a commitment to change. It is also a means of future projection, giving the client an opportunity to plan, dream, and prepare for a future without drugs and alcohol. This exercise is about behavior, not feelings or states of mind such as depression and anxiety. The purpose is to help the client explore the differences between living a future with substance abuse vs. a sober life without destructive behaviors.

Setting the Stage by Facilitator

If I could teach you a few tricks about how to not be so emotional, who would be interested in knowing? How do you deal with challenges in your life? What are the feelings associated with these challenges? Anxiety, anger, fear? What do you do when you get that way? Would you like to know a better way of dealing with those emotions? How does attitude protect you? Thank God you’ve got an attitude!

Set Up

Set up three chairs at an angle on the right side and three chairs on the left side in a “v” shape. Each chair represents a period of time, say 3 months, 1 year, 3 years. For addiction, you might want to use 30 days, 90 days, and 1 year.

Finding the person who has a choice

Who wants to exp...