AN EXPERIENTIAL AND NARRATIVE JOURNEY IN RESISTING SUBSTANCE MISUSE: A GROUP THERAPY PROGRAM by Robert May B.S.W., University of Northern British Columbia, 1995 PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF EDUCATION m EDUCATIONAL COUNSELLING THE UNIVERSITY OF NORTHERN BRITISH COLUMBIA April2005 © Robert May, April 2005 UNIVERSITY of NORTHERN BRITISH COLUMBIA LmRARY Prince George, B.C. Resisting Substance Use Program 11 Abstract This project is an intensive ten-session substance abuse treatment program for individuals who have established a minimum three months of being free of substance use. The program consists of an integration of experiential and narrative therapy. The program is intended to be flexible in order to be delivered on an outpatient basis. It is geared to work with those who have established some level of recovery from substance use and who need assistance to move into long-term, stable recovery. Recovery is accomplished by having participants address life issues that may be creating difficulties in their lives, even though they have managed to remain free of substance use for a period of time. This program utilizes experiential exercises followed by a narrative therapy approach to create self-awareness for participants, and so participants may deconstruct their experiences. The therapeutic goal is for participants to attain a stronger sense of self-identity, which will then assist them in moving forward in their recovery process. Resisting Substance Use Program m Table of Contents Abstract ... .... ...... ................................ ......... .. ... ...... .... ... ..... ... .............................. .............. ... ii Table of Contents ......... ...... ........ .... ... ... ...... .. .. .......... ...... .............. .... ..... ...... ........ ..... ... ..... .. iii Introduction ......................................................................................................................... 1 Background Information .. ......... ....... ..... ..... .... ........... ..................... .... .... ..... ............... . 2 The Suggested Program ................ ..... .. .............. .......... ............... ............... .......... ....... 4 Theoretical Overview ..... ................... ....... .... .. ...... .. ........... .................................. ..... .. .... ..... 5 NatTative Therapy ........................................................................................................... 6 Philosophy ...... .. ...................... ...................... ................ .... .. ... .... .................................. 6 Social construction of the problem ......................................................................... 6 View of people . ........................... ........... .. .............. ....... .................................... ... ... 8 Techniques Utilized in Narrative Therapy .................... ........... ..... ............ ..... ............. 9 The problen1 ........................... ..................................... .. ... .... .... ............ ..... ...... ........ 9 Reflecting teams ... .. .................. .. ................ .... .... ............... ....... ..... ......... ............... 11 Summary ........... ......... ................... ....... .. .... ............ ... ..... ......... ............................... ... 12 Experiential Therapy ..................................................................................................... 13 Philosophy ... ..................... ...... ...... ......... ............ ........ ................ .... ... .... ... ... ..... .......... 13 Theory ................ ............ ..... .. ... ... .. ........ ... ......... ........ ...... .......... .... .. .. ....... ........... ... ... 14 Process Theory .......................................................................................................... 15 View of People .... .... .... ..... ......... ........ ...... ........ ..... ... .... ........................................ .. 17 Techniques . .... .......... ......... ................... .. ............. .......... ..... .... ......... .... ....... ..... ...... 18 Integration of Theories ................. ........ ... ...... ... ....... ........ ........ ....... ......................... .......... 19 Rationale ..... ...... ... ....... .... ... .......... ..... ........ .... .... ...... ....... ... ... .... ............. ............. ..... .... ...... 21 Method ... ............... .. ... ..... .... .. ...... .. ......... ....... .......... ........ .... ........... ...... ...... ... .. ..... ............. 21 Objectives of the Project ..... .... ...... ... .... ............... .... ........ ........... ....... ...... ........ .............. 21 Population ................................................................................................................. 22 Procedures .. ..... ............ ........... .... ... ... ..... .... ........ .. : .... ...... ..................................... .... .. 23 Ethics ............. ....... ....................... ..... ....................... ... .. .. ... .................... ... ....... .... .... .. 24 Evaluation ..... ........... ............... ............ .... .. .... ....... .... .......... ........................................ ... 25 The Lessons .......... ......... .. ... .. ...... .................... ... .... .. .. .... .... ........... .... .... ....... .... ........ ......... 27 Session One: Opening Session ..... .... ..... ... .... ........ ..... ........ .. ............. .... .... ...... ..... ... ... .. .. 28 Session Two: Group Formation ... .... ....... ... ... .. ... ........ ............... .... ... ....... ............ .......... 44 Session Three: Reflecting Skills .. ....... ..... ............................. ........... ....... .... ........ .......... 54 Session Four: Experiential Experiences ... ..... ... .. ... ....... ......... .... .... ............ ... .. ............... 67 Session Five: Migration of Identity Metaphor ..... ......... ......... .... ...... .................. ..... ...... 77 Session Six: Creating Self ...... ................. .. .... ......... ..... ........ ...... ............... .... .. ........ ....... 87 Session Seven: Grief and Loss .......................... ... .................... ...... ............................... 95 Session Eight: Conclusion of Grief and Loss ..... ...... .... ....... .... ....... ...... ...................... 104 Session Nine: Relationship Connections ...... ..... .......... ....................... .... ...... ............ .. 111 Session Ten: Closure Session ..................................................................................... 121 References .. ... . .. .. .. . ... .. .. .. .. ... ... .. . .. .. .. ... . .. .. .. .. ... ... ... . ... .. .. . .. .. .. .. .. . .. .. .. .. . ... . ... . .. ... .. ... .. ... .. .. .. . 128 Resisting Substance Use Program IV Appendix A: Informed Consent Letter .. ... .. . . .. .. ...... ... . .... .... . .. . .. ... .......... .. .... 131 Appendix B: Participants ' Response and Feedback ...... ........ .......... ................ .... ... ...... .. 134 Appendix C: Features of Narrative Practice ........ ... .... ....... .. ... ......... ........ .. ....... ......... ... .. 136 Appendix D: Reflecting Team Guidelines ....... ......... ...................................................... 137 Appendix E: Introduction to Experiential Therapy .................... ....... .... .......... .. .. ...... ..... 139 Appendix F: Questions for Narrative Reflection .................. ..... ........ .................... ... ...... 141 Resisting Substance Use Program 1 Introduction Based on my experience as an addictions counsellor, I have noticed what I term "front-end loading" for people who are trying to reclaim their lives from substance misuse. Front-end loading refers to the high intensity engagement of individuals who are early into recovery: they attend counselling and support groups, and then are sent quickly to residential treatment for their substance misuse problem. However, residential treatment or therapy can be very challenging for individuals in the early stages of recovery from substance abuse. Individuals with substance misuse problems are at high risk of relapse if they are pushed too quickly. Further, residential treatment programs require the participant to leave their home to attend treatment for a period of up to six weeks, depending on where they go. For many people this can be very difficult to arrange. To respond to this problem this program outlines an intensive ten-session outpatient curriculum for the enhancement of participants who are recovering from substance use. The purpose of the program is to provide individuals in recovery from substance use time for therapy they may otherwise not have available to them. The program utilizes an overarching narrative therapy orientation with experiential exercises aimed at creating self-awareness of life issues for the participants. A period of time is allowed after each of the experiential exercises to deconstruct those experiences from a narrative therapy framework. The purpose of the program is to provide individuals in recovery from substance misuse time they may otherwise not have available to them. Resisting Substance Use Program 2 Background Information Residential treatment centres are under financial pressure to take people who are early into their recovery because facilities are funded on a per diem rate for the number of beds filled (R. Zeigler, personal communication, March 15, 2004). This leads to the facilities accepting people into their program who are not really ready for the intensive therapeutic experience that is offered. The impact of beginning to look at interpersonal issues can be challenging for people who have not been adequately prepared for the hard work encountered in intensive therapeutic residential treatment programs. This can result in premature termination of treatment for these individuals because they have not developed the ability to deal with the intense examination of life issues. Individuals need time to build personal support networks and to adjust to life without substance use and to prepare for the intensive therapeutic work that occurs in residential treatment facilities. Group therapy has been well documented to work with diverse populations and issues (Corey, 1995). Roberts and Ogborne (1999a) note that using a group format follows the practice guidelines set out in the proposal they prepared for the federal Department of Health. They maintain that group therapy is usually recommended: Group therapy was as effective as individual counselling and it was more cost effective. Group work allows the group participants to learn from each other as well as to develop social interactions outside of the group time (Corey, 1995). Participants in the group also experience modelling from the therapist and group members; they gain feedback and insights from group members with similar life histories and problems. As Corey (1995) points out, group formats can be easily adapted to serve a diversity of settings, populations, and issues. Specifically, the use of group therapy has Resisting Substance Use Program 3 been well established in the addictions field. In British Columbia a number of residential addiction treatment centres employ group work as the primary way of working with clients who attend these facilities. Although the majority of these residential facilities employ the Minnesota 12-step model (based on the 12 steps of Alcoholics Anonymous) as the framework for group work, others employ an intense therapeutic group format to help facilitate change in participants. As government-funded addictions services adjust to ongoing monetary constraints, it is becoming necessary to develop and deliver services in a cost-effective and therapeutically focused manner; making use of a group format is one way to do this. The Ministry for Children and Family Development (MCFD) and the justice system have required quick results from addiction services when these agencies have had reason to suspect alcohol or drug use. For MCFD, the time frame is usually within three months, as this is the court requirement for MCFD workers to come up with an operational care plan for the families with whom they are working. For the justice system, the time frame is usually linked to an individual's parole or probation conditions, which generally also falls within a three-month time frame. This creates a strain on addiction services as they are pressured to have people access residential treatment when they might not be ready for this level of treatment. A shift toward providing longer term supportive housing for people beginning recovery from substance misuse has occurred over the last number of years. Historically, a person would enter a supportive recovery home for a period of up to one month and then transition into a residential facility. This short turn-around time did not allow individuals to create stability and to build a support system, and led to drop out of Resisting Substance Use Program 4 residential treatment, and relapse into active substance use. Consequently, participants view this experience as another failure in their lives. Supportive housing is now being provided for longer periods of time; people are able to stay for up to one year in some cases. The longer time gives individuals time to create support networks to assist recovery as well as to create safe places for them to begin looking at underlying issues that may lead to relapse. However, some individuals may experience difficulty attending a residential treatment program. The Suggested Program The intention of this group program is to accommodate individuals who would otherwise find it difficult to take time out of their lives to attend a residential facility. It provides an alternative to having them enter residential facilities too quickly and without good support mechanisms in place. This program can be delivered on an outpatient basis at any agency which has, as part of its mandate, the direction to assist people with substance misuse issues. Individuals being referred to the program would already have established a working relationship with an addictions counsellor as well as have participated in other groups, such as Relapse Prevention or Self-Awareness, prior to entry into this program. Once an individual has completed the program they would continue to see their addictions counsellor for follow-up. Moreover, the short duration of this program-ten sessions-makes it easier to deliver. If the intensity of a program is high enough participants can achieve sufficient awareness to make changes in their core belief systems, thus allowing for positive change to occur. Resisting Substance Use Program 5 Roberts & Ogborne ( 1999b) have observed better treatment outcomes when clients have fewer problems and more resources. This is in accordance with the concept of this program, which will be delivered to individuals who have managed to reclaim some of their lives from active use of substances. This supports the expectation that this group would benefit from a relatively short and intensive program that will assist them in addressing their issues of substance misuse. As experiential and narrative therapies can be very powerful techniques, there is a caveat included in this program. This caveat is that only therapists trained in these experiential and narrative forms of working with people in a group format should utilize this program. Theoretical Overview The overarching theoretical orientation for this group will be an integration of narrative and experiential therapies. Experiential experiences will be utilized to facilitate the creation of "in the moment" self-awareness for participants, allowing them to further understand how their subconscious experiences have an impact on their lives. This newfound self-awareness will then be examined using narrative therapy to explore the meaning individuals have ascribed to these experiences. From this experience a new "storying" or meaning can occur. Resisting Substance Use Program 6 Narrative Therapy Philosophy Social construction of the problem. Narrative therapy is founded on a poststructuralist philosophical perspective on problems within people's lives; problems are a consequence of repression caused by socialization and enculturation (White, 1997). In essence, people's lives are a construct of the social, cultural, and political milieus in which they exist (Monk, Winslade, Crocket, & Epston, 1997). White created a new line of inquiry into the construction of people's lived experience and exposed how a dominant discourse within the many fields of human understanding has an impact on individuals' interpretation of their lived experience (White, 1997). Much of the dominant discourse forms a frame of "truths" that encourage individuals to accept these truths without an examination of what rules ground them. The role of narrative therapy is to deconstruct the implied truths behind the social construction of how people incorporate meaning from their lived experience. This deconstruction can then lead to alternative narratives that are more affirming for individuals than those held by the dominant discourse (White, 1997). It is in the conflict between what is socially prescribed and what people really want that problems can manifest themselves (White, 1995). White (1995) suggests the meaning people derive from social construction is not neutral in its effect on their lives: it influences which actions they will take in their lives. Culture, which is a social construct, specifies what is moral or right for individuals within that culture and forces them to respond in ways that may not be authentic to them (White, 1995). One's personal identity is constituted by what we "know" about ourselves and the ways in which we describe Resisting Substance Use Program ourselves as persons, but what we know about ourselves is defined by "cultural practices of describing, labelling, classifying, evaluating, segregating, excluding" (White & Epston, 1990, p. viii). In effect, what is considered "right" is culture specific (White, 1995). Through culturally specific behaviours of thought, relationships, and even gestures, individuals are forced to conform to dominant cultural beliefs (White, 1995). For narrative therapists engaging in therapeutic practice, there has been a paradigm shift in how problems are viewed. Historically, constructionist views of problems in families and in peoples' lives were that they served a function by allowing the family system to continue to exist. White and Epston (1990) proposed that the opposite may be true, that in fact the problem requires the cooperative inadvertent responses of families or individuals to exist. Through this concept a whole different perspective on problems and how to deal with them emerges. One of the stances a narrative therapist takes is exactly that implied by the word "narrative." An incorporation of a metaphor of lived experience is viewed as being like a story, and the telling of this story creates the meaning people make of their lived experience (White & Epston, 1990). Stories have beginnings, middles, and ends. They also have an author. From a narrative perspective, it is often useful to have people identify who was writing the script of their lives from a young age. In many cases the individual then followed this life script, and enacted the problem saturated identities that were embedded in their life experiences. When people are children they do not have the knowledge or power to write the dominant story of their lives, so they learn who they are from the people and situations in their environment. While these stories are the dominant ones, they are quite often not reflective of an individual's authentic self (White, 1997). 7 Resisting Substance Use Program 8 The stories people tell of their lives reflect the interpretation of meaning they have ascribed to events in their lives (White, 1995). View of people. Narrative therapists understand that the dominant discourse involves issues of power, where knowledge itself is a mechanism of power (White, 1997). In many therapies there is the sense of the therapist being the "expert," which leaves the client in a position of receiving some knowledge without being a participant within the process. Narrative therapy acknowledges that individuals have their own knowledge about themselves that is much more important than any type of expert knowledge the therapist might bring to the interaction (White, 1995). Narrative therapy honours the process of the client's story and enters into conversations that encourage the individual to participate in the telling andre-storying of their life events. It is through this collaborative process that change is created. As White (1995) explains, the individual is the expert on his or her own lived experience. Furthermore, narrative practitioners view the therapeutic interaction as being a two-way phenomenon. As we witness people overcome abuse in their lives, it challenges us as therapists to look at and resolve issues within our own lives (White, 1995). According to White & Epston (1990), many individuals do not recognize the impact of societal pressures such as issues of gender, homophobia, or ageism on themselves. Monk, Winslade, Crockett, and Epston (1997) point out that when individuals become aware that they are not the problem but rather that constraints imposed by social, cultural, and political factors help create oppression, it gives them an opportunity to explore the problem from a different perspective that is not centred in Resisting Substance Use Program 9 them being the problem. Through narrative practice, participants will become aware of and be able to begin tore-author their lives (White & Epston, 1990). Techniques Utilized in Narrative Therapy The problem. There are a variety of strategies which narrative therapists can utilize to help participants begin to view their life experience from a perspective based on strengths rather than on deficits. When beginning to work with an individual, it can be very helpful to externalize the "problem." The purpose of externalizing the problem is to allow people to view the problem as separate from them and not as them. Many people who seek assistance with life problems have a view that there is something wrong with tpem and that is why they have the problem they do (White, 1995). Much of this belief is constructed from messages from individuals who were dominant in their lives from an early age, such as parents, grandparents, school figures, and so forth. If the messages they experienced were negative, people come to believe they are as they have been described. Within narrative therapy this would be seen as the dominant story of their life (White & Epston, 1990). Individuals engaged in this type of therapy would be encouraged to view the problem as a separate entity from them and even to give the problem a name. For example, someone struggling with addiction might call this problem "THE SLICK," as it has a way of convincing a person of its power and influence in their life. Once this process of externalizing has occurred, other narrative strategies can then be employed against the problem. One of the strategies that can now be utilized is to have the individual take on the persona of the problem. The therapist can then begin to question the externalized problem Resisting Substance Use Program 10 to determine its influence in the person ' s life. Questions asked of the problem at this time would be designed to determine when and where the problem has the most influence as well as to explore times when the problem has less influence. For example, the problem might identify that on weekends it seems to have more influence on the person than during the week. Following on this, the therapist might ask questions to further explore the times when the problem seems to have less influence and why that might be. The purpose of this strategy is to discover what White and Epston (1990) describe as unique outcomes since this is when the influence of the problem does not seem to be present. Most of the time when individuals initially present as being concerned about problems, it is as if the problem has total control and they have little agency in their life in regard to the problem (White & Epston, 1990). Externalizing the problem and discovering when it is not present allows individuals to recognize that they do have agency in their lives. This becomes an opportunity for people to explore times of resistance to the oppression of the problem on their lives, creating a window of opportunity to reassess their relationship with the problem and to discern possible solutions out of this changed relationship (White & Epston, 1990). Resisting Substance Use Program 11 Reflecting teams. Narrative therapists have adopted the use of reflecting teams, which originated in family therapy practice (White, 1995). Reflecting teams help expand and uncover aspects of a person's lived experience that is an alternative to the dominant story of oppression with which individuals present (White & Epston, 1990). Reflecting teams can be made up of other counsellors, people who have a positive interest in the participant, or other members of a group. There are a number of guidelines that can be helpful for people participating as part of a reflecting team. First, members of a reflecting team need to be empathetic when witnessing the unfolding of a person's story (Pare, 1998). Secondly, the role of the reflecting team is to notice times in the telling of the person's story that the person had resisted the influence of the problem in their lives (Pare, 1998). Finally, they notice what ideas, values, contexts, and beliefs the person might be revealing that support the problem's hold on their life. It is not the role of the reflecting team to establish a "truth," deliver an intervention, problem solve, or create strategies (White, 1995). Their role is simply to observe times of resistance to the problem and then give a reflection of curiosity of what they have heard: a new or different story. Once the interview between the therapist and participant is finished, the therapist collects the reflections from the reflecting team and presents these to participant. There are a variety of ways to do this part of the reflecting team exercise. This reflecting back leads to a deconstruction of the dominant story, and allows alternative positive descriptions of a person's lived experience to emerge (White & Epston, 1990). A final strategy that narrative therapists employ as a reflecting tool is the utilization of written material. For example, an individual might write a letter to the Resisting Substance Use Program 12 problem outlining the impact and the individual's intent to stand against the influence of the problem (White & Epston, 1990). Other forms of written material could include letters that predicate change, letters for special occasions, letters of defence against problems, and so forth (White & Epston, 1990). Furthermore, the therapist can also write letters to the client where the therapist reflects any further thoughts they might have had concerning the problem the person had (White & Epston, 1990). The power of reflecting teams is twofold. First, having a number of people listening to and witnessing one's personal story can help to create a sense that one has value. In my work with people who struggle with addiction problems, issues of selfworth are a dominant theme. Secondly, the more people who are witnessing the dialogue between facilitator and participant, the more areas of resistance to the problem will be exposed. In any dialogue between two people it is difficult to notice or remember all the aspects of the conversation; thus more observers equates to more positive reflections. Use of reflecting teams has been shown to be an effective tool of narrative therapy.(White, 1995). Summary A common practice in narrative therapy is to use the metaphor of a person's life being similar to a book (White, 1995). A person has a name, which is a title; there is a beginning, middle, and an end to the story. The story also contains themes about a person's life similar to the themes in a storybook. There are authors both of lives and of stories. In the story of a person's life the authors can and do change over time. At the beginning of one's life the authors are usually members of the family, or other figures of Resisting Substance Use Program 13 authority such as teachers or clergy. Narrative therapy also includes culture and socialization as co-authors within a person's life. White and Epston (1990) observe that all of these authors help to create an identity or script of what will become the dominant story of who an individual is even before they are old enough to understand what has transpired. Many of these authors operate from a position of power and control that is exerted over the individual; this forms the basis of oppression (White, 1995). While there are dominant stories of a person's life, there are also alternative stories of a person's life that have been largely ignored by both the individual and previous authors of a persons' life story. It is these alternative stories that narrative therapy works to uncover. These are the stories of resistance to problems (White, 1995). Once these stories of resistance to oppression have been revealed, narrative therapists work collaboratively with the individual to co-author and "thicken" these alternative stories (White & Epston, 1990). From this experience the individual can create new meaning for themselves and move forward in a positive fashion in their life (White & Epston, 1990). Experiential Therapy Philosophy Experiential therapy rose out of humanistic therapy theories with roots in existential client-centred and Gestalt approaches (Greenberg, Watson, & Lietaer, 1998). Continued research in emotion and cognitive science has led to a new way of viewing human functioning and the process of how people change (Greenberg, Watson, & Lietaer, 1998). The existential humanistic approach purports that "as people develop they Resisting Substance Use Program 14 build self and world construct systems (SA WCS) based on their experience of themselves in the world" (Watson, Greenberg, & Lietaer, 1998, p. 4). According to Greenberg & Van Balen ( 1998), a basic tenet of experiential therapy is that people are complete, experiencing beings who strive to make sense of their lived experience, and that this experiencing is ongoing in every moment. Theory The use of the experiential process rose out of Rogerian Person-Centered theory, which emphasized the therapeutic traits of non-directive genuineness on the part of the therapist, and unconditional positive regard for clients (Watson, Greenberg, & Lietaer, 1998). Rogers believed that individuals have a natural need to develop capacities which function to maintain or create positive growth for the individual (Greenberg & Van Balen, 1998). Fritz Perls, who developed Gestalt therapy, also believed that individuals are active in the creation of themselves and are in a constant flux of interaction between self and the environment (Hatcher & Himelstein, 1976). The theoretical orientation of experiential therapy is that individuals create meaning as an ongoing process in the immediacy of the moment. In essence, people are much more than intellect and there is a melding between mind and body in the environment (Greenberg & Van Balen, 1998). Experiential therapists believe that our minds and bodies have more knowledge available than one is consciously aware of (Gendlin, 1981 ). Through self-awareness in the moment and insights arising from this, opportunities are created for people to revise their self and world concept systems, leading to different life choices (Watson, Greenberg, & Lietaer, 1998). For experiential therapists, the concept of self is central in Resisting Substance Use Program 15 defining human functioning (Greenberg & Van Balen, 1998). It is this self that is in constant contact and interaction with the environment, and with which experiential therapists engage during their interactions with clients. This has allowed for less emphasis to be placed on an individual's historical background and more on the immediacy of their felt experience (Hatcher & Himelstein, 1976). Process Theory One of the problems presented by experiential theory is that it tends to present one singular idea of how psychological problems are viewed (Greenberg & Van Balen, 1998). In response to this critique, experiential theorists developed a process theory to address this issue (Greenberg & Van Balen, 1998). Rogers (as cited in Greenberg & Van Balen, 1998), held the view that stability is not a constant but rather change is a constant, unfolding process that is not locked into some theme of what might constitute stability. People are in constant process that is free flowing and that is accepting of all feelings in the moment as being valid; what a person is experiencing moment-by-moment is self (Greenberg & Van Balen, 1998). Rogers (as cited in Greenberg & Van Balen, 1998) also thought that successful therapy is a process where a person makes meaning of their immediate experience leading to a different positive level of functioning. Gestalt therapists reasoned, like Rogers, that individuals are agents in their own lives who create meaning of their lived experiences on an ongoing basis when they interact with their environment (Greenberg & Van Balen, 1998). Furthermore, theorists such as Gendlin (1981) viewed the process of experiencing in the moment as a reference point from which individuals create meanings of their experiences and attach symbols to Resisting Substance Use Program 16 those meanings. Gendlin's (1981) thoughts were similar to Perls' (as cited in Greenberg & Van Balen, 1998) in that there was a need for integration between the inner sense of self and the environment. This puts the self on the surface in constant formation, where self continually redefines itself in its interaction with the environment and not in a deep unconscious well (Greenberg & Van Balen, 1998). Existential theorists argue that problems are more a lack of integration of aspects of self within the environment, and the goal of existential therapy is to resolve these disowned or "splits" in self that occur from ongoing interaction with the environment (Hatcher & Himelstein, 1976). Existential theorists view the self as being whatever one is experiencing in the moment (Greenberg & Van Balen, 1998). This is quite different from other theories of human functioning, which espouse the view that it is unmet unconscious forces that create problems or pathology, and these are acted out in one's environment. The existential therapists' view of the causality of problems is somewhat different from that of therapists practicing a more psychodynamic type of therapy. Rogers (as cited in Greenberg & Van Balen, 1998) saw problems arising for people when there was incongruence between their self-concept and their lived experience. Gestalt-oriented therapists believed problems would surface when the individual disowned or separated themselves from their actual experience (Greenberg & Van Balen, 1998). To resolve this incongruence or split, therapy needs to allow a deeper experiencing of what one is talking about in the moment to allow for hidden knowledge to come forward (Greenberg & Van Balen, 1998). What is important in this is that this disowning or incongruence is not itself pathogenic (Greenberg & Van Balen, 1998). Resisting Substance Use Program 17 View of People. Existential therapists view people as having the capability to learn how to trust their inner wisdom (Kurtz, 1991). In addition, the belief is that people are active in how they frame and organize their world and tend to move toward closure or completion of their experience (Greenberg &Van Balen, 1998). Thus, experiential therapists see people are seen as active in life and not determined by either their history or environment. Gestalt therapist Rhyne ( 1973) maintains that unless people are psychologically or physically crippled they are naturally creative in their lives and can create different choices for themselves. Experiential therapists believe that increased self-awareness leads to the ability to make better choices; one of the goals of experiential therapy is for individuals to achieve their highest potential through their choices (Greenberg & Van Balen, 1998). The avenue for achieving one's potential is through insight, which once revealed, allows for unhealthy attachments to be released and new, more nourishing beliefs to be incorporated; however, it is the client doing this process, and not the therapist directing them in this action (Kurtz, 1991). Experiential therapy is only the medium to help direct self-awareness so that individuals realize that it is them thinking, feeling, or doing any particular experience (Greenberg & Van Balen, 1998). Experiential therapy is similar to narrative therapy in that both view the client as the expert in their own life and view the therapist's role as one of bringing forward knowledge that is already there. The experiential therapist would assist the individual in becoming more self-aware in the moment, and the narrative therapist would engage as a co-author to help an individual explore the hidden themes of resistance that were not Resisting Substance Use Program 18 visible in the dominant life story. In both therapies, the premise is that the client is the expert in his or her own life. Techniques. Body work is one of the first predominant types of experiential technique that can be utilized when working with individuals or within a group setting (Martin, 2004). Body-oriented experiential therapists operate from a belief that trauma and negative beliefs are expressed through how one holds their body. Physical ailments and psychosomatic illness can be a manifestation of this (Kurtz, 1991). One technique is that of body experiential experiences, in which the therapist would note how a person carries himself or herself physically. This form of intervention can be more directive in practice than other forms of experiential work. Techniques used here could be experiments to minimize or expand on what the body is presenting. For example, if the person habitually sits with their head tilted to one side, the therapist might make note of this and then have the person try holding their head in a different and unfamiliar position, and have them pay attention to any changes in physical sensation in the moment (Martin, 2004). When the person has noted some physical sensation, the therapist would attempt to hold them in that moment of experiencing by asking questions that would hold them in the process. For example, they might ask if the sensation has weight, colour, feeling, or thoughts attached to it. These forms of questions help to create, hold, and expand on the "in the moment" experience (Martin, 2004). Another common form of experiential technique involves the use of art work (Rhyne, 1973. The use of art for experiential work can be a very powerful form to bridge between a person's inner and outer realities (Rhyne, 1973). The act of creating art is an Resisting Substance Use Program 19 in-the-moment experience that can reveal and make explicit what was implicit, perhaps even to the individual doing the piece of art work (Rhyne, 1973). This in-the-moment experiencing is the foundation that underlies all experiential therapy. The use of art work can be useful to create self-awareness for people, as blocked feelings, life issues, and areas of conflict can be expressed through the art without the screen of social controls being present (Rhyne, 1973). The art work itself changes nothing for the person, but the awareness that is created can assist them in making different choices and thus lead to the possibility of change (Rhyne, 1973). Each time a person draws or paints or expresses him or herself artistically, he or she is creating an in-the-moment experiential event (Rhyne, 1973). In this way, people are able to express things they would not normally express. Integration of Theories The purpose of this project is to integrate experiential and narrative theories in order to create a dynamic way of assisting members within a group to experience the opportunity to create positive change for themselves. In the first few sessions the focus is on creating group cohesion. In this early stage, experiential exercises are presented that give the opportunity for group members to learn what and how experiential exercises work. This could include projection exercises (a person may assume the identity of an object) or simple mindfulness exercises (becoming aware of internal dialogue). Also, in the first few sessions, group members will be trained in how to participate as part of a reflecting team. After instruction in the guidelines for participating in a reflecting team, group members will have an opportunity to give reflections on the interview the clinician will have with a group member. This will then form the basis of further sessions. Resisting Substance Use Program 20 The integration aspect of the program occurs when the clinician utilizes a narrative framework of questions when deconstructing people's individual experiences and process resulting from the experiential exercise just completed. Group members write out their reflections of the session and hand them in to the facilitator of the group. Opportunity is provided at this time for group members to do some verbal reflection on the activity and an opportunity for the person who had their experiential experience furthered by the therapist to respond to the group reflections. This process continues through the remainder of the program, with each member having at least one opportunity to have the clinician work with them, with other group members giving reflections. At the end of the program, the clinician will develop comprehensive narrative letters consisting of the reflections of group members, which will be given to the individual members. Underlying this overarching theme of narrative therapy will be a number of experiential exercises, some drawn from authors such as Cameron (1992) and Rhyne (1973), who use art to assist in the experiential experience, and some from Gestalt therapy (Stevens, 1971 ). These will include experiential exercises utilizing guided imagery, artwork, family and personal mapping, and so forth. These techniques will be presented in an effort to help people move through issues from the past that may be linked to familial history of trauma or other life events. Furthermore, these experiential interventions will be used to help people recognize and adjust to internalized aspects of self with which they struggle. This could include issues of self-esteem or other negative internalized messages from the past. Resisting Substance Use Program 21 Rationale In my experience working in the field of substance misuse I have noticed that there tends to be a high drop out prior to entry into a residential treatment facility and a further drop out once people have entered into the residential facility. This project can help alleviate this problem by making itself more adaptable to clients' needs. It can be delivered as a day program over a period of days or it can be used as a shorter version of intensive residential treatment while taking place in an outpatient setting. This project is designed to assist people who have achieved some level of sobriety and non-use of substances. Generally, in the first six months to one year, individuals are busy just focusing on being free of substance use and they have not had an opportunity to really address the personal issues that present themselves and cause difficulty for them in recovery. This ten-session program will help engage people who are ready to move to the next level of recovery and who have the stability needed to engage in this difficult work. Method Objectives of the Project The objective of this experiential/narrative therapy program is to assist people in examining areas of their lives that could be creating problems for them. These areas could include family of origin, grief and loss, communication, and developing comprehensive relapse prevention strategies. By the end of the program, participants will have gained knowledge about the barriers that create difficulty in their lives and will have developed skills to help them further their recovery from substance use. Resisting Substance Use Program 22 Population This intensive therapeutic program is intended for adults aged 19 and over who have a history of substance misuse. Substances misused by these participants would include alcohol, opiates, marijuana, amphetamines, cocaine, over-the-counter medications, and prescription drugs. Participants will have achieved a minimum of three months of freedom from active substance use prior to participating in this program. Individuals who have managed to cut down and control their substance use would also be considered for the program, although they would have to be abstinent for the duration of the program. This would be due to the difficulty these individuals would encounter if they were withdrawing or feeling physically unwell as a result of use, thus preventing them from being fully involved with the program. Furthermore, it is necessary for participants to be abstinent for the duration of the program, as they might inadvertently give the message to other participants who are unable to control their substance misuse that it is acceptable to try controlled use. The group would be comprised of from eight to ten participants. This program could be facilitated with a single gender or with both genders as participants. There would be one facilitator for the group. Because some of the experiential and Gestalt techniques being employed could create distress for individuals who suffer from clinical mental health problems, under the ethical practice of "first, do no harm," it is necessary to limit entry into this group. People who would be excluded from this therapeutic group would be those who have been diagnosed with clinical mental health problems such as schizophrenia, bipolar disorder, or borderline personality disorder. Further, as this program is dependant on language, Resisting Substance Use Program 23 reading, and writing skills, those who are cognitively impaired or mentally challenged would also be excluded from the program. Procedures This program will run for ten sessions. The time frame for this program is flexible and the timelines of the program could to some degree be determined by what the group decides. Participants could choose that their group meets once a week or more oftenwhatever fits best for them- keeping in mind some of the physical constraints imposed by the facility delivering the setting. Each session will generally run for three and a half hours. Each session is linked to the material from the session before, but all interventions and homework are designed to create awareness for the individual. In addition, each experiential exercise is intended to further the group process and to fit for the stage of formation the group is in (Corey, 1995). Clients who choose to drop out of the group may continue to engage with their referring clinician and access other support mechanisms they had built up prior to entry into the program. Participants who choose to drop out of the program will also have an opportunity to meet with the facilitator of the group to debrief and bring some level of closure to their experience. During the initial forming session, under the topic of housekeeping issues, a discussion will be held regarding the issue of relapse. Group members will participate and have input into rules that will apply if someone relapses during the course of the program. For example, if it took three weeks to complete all sessions of the program, the group could choose options that could include exclusion from the group, or the stipulation, if there are days between sessions, that persons must Resisting Substance Use Program 24 not have used substances for two days prior. The group also decides how many times a person may relapse through the duration of the program before being excluded. The group itself creates these rules. It is not anticipated, however, that relapse will be a significant issue, as the people who are participating in this group will have achieved some stability in their recovery and will have been actively engaged with their counsellor prior to entry into the program. Ethics Ethics is a primary concern when working with individuals or groups of people. The impact of using experiential process within counselling can be very intense, and it is advised that facilitators trained in experiential and narrative therapy deliver this program. As well, good support for these participants is essential. The approach will be multilayered. First, referral to this group would be made through an addictions counsellor who has done an assessment of the needs and suitability of the individual for this program. This will ensure that the individuals seeking to participate will be appropriate for this intensive group. Secondly, this process will ensure that the person has prior and post suppmt mechanisms in place to further debrief the activities presented during the group. Thirdly, informed consent is necessary. This entails a full explanation of how experiential and narrative practice works in a therapeutic context, and an overview of the various types of experiential explorations. Finally, participants need to know this group will be highly interactive, with members fully participating in reflecting teams and experiential exercises. Additionally, participants will have to review and sign an informed consent Resisting Substance Use Program 25 form (see Appendix A, p.131). This will be done at a separate meeting between the participant and the facilitator prior to the beginning of group. For this group there are two levels of confidentiality. The first is the issue of confidentially within the group itself: members are asked to self-monitor in regard to this issue. Secondly, the facilitator must respect confidentiality and the limits of confidentiality. For example, by law the facilitator must report claims of physical, sexual or emotional abuse or neglect of children. Further, any disclosure of threat or risk of harm to self (suicide ideation) or report of harm to others must be reported to the appropriate authorities or social agencies. The facilitator will engage with the participant about the nature of the harm to self or others and create a plan of safety for the person or persons at risk. Finally, the facilitator may breech confidentiality if ordered by the courts to provide information. As experiential and narrative techniques can have significant emotional impact on individuals experiencing this form of therapy, the facilitator for this group must be experienced in these forms of therapy. This program is not designed to be utilized by inexperienced workers . Evaluation As this is an experiential- and narrative-therapy-driven program, the participants will be asked to evaluate the effectiveness of the program. This is in keeping with narrative therapy, where the participants are considered the authorities on their lived experience. Similarly, for experiential therapy the meaning individuals make of their experience can only be defined by them. It is the participants' experience of the meaning Resisting Substance Use Program 26 they make for themselves through this whole process that will determine the value of the program. To capture the responses of participants, they will be asked to respond to a written questionnaire at the end of the program. This questionnaire, called Participants' Response and Feedback to Group Therapy program, is given as Appendix B (p. 135). Resisting Substance Use Program A Group Therapy Process The Lessons 27 Resisting Substance Use Program 28 Session One: Opening Session Goals Group formation begins by having introductions, developing group norms and rules, and giving an overview of the content of the program itself. At this point group members will also identify what they hope to learn by being part of the group. Group members will also experience the first experiential exercise and develop group opening and closing rituals. Objective 1 Introduction, group rules, and issues of confidentiality. a) There will be an ice-breaking exercise to begin the group. b) The group will establish the rules and norms they will follow for the rest of the program. One of the main issues discussed is that of confidentiality. As a result of Objective 1, the participants will a) know each other's names b) have developed the rules and norms they will follow c) have an understanding of confidentiality and their rights in regard to this. Resisting Substance Use Program 29 Exercise 1: Name Game (Adapted from Nechako Centre program, 1308 Alward St, Prince George, BC V2L 3G7) ~ Purpose: This is a warm-up exercise that will allow participants to interact and become comfortable with each other as they engage in the exercise. ~ Procedure: 1) First the facilitator explains how the exercise works. The facilitator states that the person can find a word that starts with the same letter as their first name. For example, if their first name is Rob, they might link that to Rocket Rob. 2) Once an individual has established a name that begins with the same letter as their first name, the name game can proceed. 3) Generally, the facilitator starts first. He says, "My name is Rob, and I have chosen to go by Rocket Rob." The facilitator then repeats his first name and attaches to it the word that starts with the same letter as his name. 4) The next person in line says their own name and the word that symbolizes something about them, then says the name of the previous persons, and then their own name and word again. 5) This process continues all around the circle. Each person will need to remember the names of the people already mentioned. 6) At any time during this process, other group members can assist if people get stuck in either not having another word to fit with their own name or if they forget other details, such as other people's names. Resisting Substance Use Program 30 7) By the end of this exercise everyone will have a good idea of everyone else's names, or at least the identifying word individuals have used. ~ Materials Needed None ~ Time Frame 20 minutes Exercise 2: Establishing Group Norms and Rules ~ Purpose: To begin the discussion of group rules and expectations. This is to be inclusive of respect and an atmosphere of non-violence either implied or direct. Introduction to the Program At this phase of the interaction, the facilitator needs to engage in dialogue with the group about what will constitute group norms and rules and inform them that the group will run for three and a half hours with a fifteen minute break. It is suggested that the group come up with guidelines and rules that they feel they need to create a safe environment to do the hard work that will be ahead of them. Issues that can be suggested for the group to consider are group disclosure and confidentiality, issues concerning implied or direct violence, absences from group without prior notification, misuse of substances while participating in the group, and consequences which can result from participants choosing not to follow the established group rules. This activity begins the process of group formation by Resisting Substance Use Program 31 having the participants take some responsibility for what will occur within the group. As a specific rule, violence cannot be condoned, because it is important for the group to have a sense of safety in order to progress and grow as individual participants and as a group. Issues of substance misuse can be determined by group consensus. If a participant does relapse, it can be an opportunity for group learning, but it is also an action that can create a rift in the group and damage the sense of safety. The group can decide at the beginning of group what the consequences can or will be before the group begins. Times of program sessions will be defined with clear start and end times and the number of sessions for the program. There will be some latitude on the length of sessions, as there needs to be room at the end of each session for debriefing of the session. The normal time frame for each session will be three and a half hours. ~ Procedure: 1) Participants are encouraged to discuss and set group norms. These could include issues of tardiness, missed program sessions, relapses, and so forth. The intent is to have the group members form the content and structure for their group. 2) First, break the group up into three smaller groupings. Then ask one person of each of the small groups to be a recorder for the group. This person will record what the group members present as rules they believe would be useful Resisting Substance Use Program 32 to have for the program. Give participants about ten minutes to brainstorm ideas that they feel would be useful to have as group mles. 3) After ten minutes have the smaller groups re-form into one large group and have the recorders from the small groups present each of the rules that were arrived at through the small group discussion. 4) Record these rules on a piece of flip chart. Once this has been done have a general discussion with the large group to determine and review the list, making special note of mles that have been determined by all the small groups, for example issues of safety would likely be paran1ount within each small group presentation. 5) Once there has been a discussion of what mles the group arrives at through consensus as being pertinent, list these on a separate sheet. 6) Place the sheet of rules on the wall where it will be visible for the duration of the group. 7) Hand out informed consent forms for individuals to be completed and returned to the facilitator by end of session (Appendix A, p. 131 ). ~ Materials needed Flip chart for recording rules Appendix A Informed consent letters Writing tablets and pens for recorders ~ Time Frame 15 minutes Resisting Substance Use Program 33 Exercise 3: Confidentiality and Rights ~ Purpose: Have a review of the previously signed consent form to clarify for group participants of their rights to confidentiality and the limits of confidentiality. ~ Procedure: 1) From a legal perspective, inform the participants of the facilitator's limits in regard confidentiality. First, if there is any report of abuse or neglect of children, by law it must be reported. Second, if the participants are going to harm themselves or others it has to be reported. If there is a risk of suicide the facilitator will form a no-suicide contract with the participant, and with their consent, inform the participants referring agent for additional follow-up. If there is risk of harm to others revealed by participant the facilitator will engage in a plan to safeguard others, which may include report to authorities. Third, a court could subpoena either the written material generated from the group even the facilitator. Finally, case information may be shared in supervision of the case facilitator. 2) Discuss participants' rights to know the length of the program and the risks involved with participation. Participants will be told that experiential exercises can be very powerful, but experiences will be debriefed within the structure of the group. One of the risks is that participants may experience intense emotional feelings they had not been expecting. The benefit of participating in this group is that participants will have an opportunity to explore past blocks Resisting Substance Use Program 34 to their emotional well-being and move past them. This will allow them to view their lives from a more positive perspective and make positive changes for themselves. 3) Have clients sign the appropriate type of release of information that may be needed. For example, clients may be under the constraints of court orders or family services. If the program is being hosted at an agency, the consents required by that agency could be applied as long as they fit the necessary legal requirements. ~ Materials Needed Consent forms and release of information forms ~ Time Frame ~ 15 minutes Housekeeping: Describe a rough timeline of the day's events, such as start and end time of each day and anticipated break times. This timeline will be different depending on the circumstances of where and when the program is being held. Facilitators can do an overview of confidentiality, which would include a review of statutory and ethical considerations around the issue of confidentiality. There will be an opportunity at this point to have clients sign consent to release forms if this has not already been done by the referring counsellor. Resisting Substance Use Program 35 Objective 2 A brief description of narrative and experiential therapies and a furthering of group formation and initial exposure to experiential exercise. The following content provides a) a brief description of narrative and experiential therapy b) an experiential exercise c) a group formation exercise d) a group opening and closure ritual e) homework assignments. As a result of Objective 2, participants will a) have a beginning knowledge base of narrative and experiential therapies in order to develop the idea of reflecting teams b) have experienced an experiential exercise and have had discussion concerning this c) have worked together as a group d) have identified their goals for participating in this group e) have developed an opening and closure ritual for the sessions f) have homework assignments and outlines for the journaling exercise. Exercise 1: Review of Narrative and Experiential Methods ~ Purpose: To continue the process of group formation and give an overview of content in regard to narrative and experiential work and group expectations. Resisting Substance Use Program ~ 36 Procedure: 1) Distribute the handouts on features of narrative practice (Appendix C, p. 137) reflecting team guidelines (Appendix D, p. 138), and introduction to experiential therapy (Appendix E, p. 140). 2) Have a brief discussion about narrative material. Invite questions from group members with their thoughts about the narrative and experiential material. Discuss how these ideas relate to the group rules and norms already established, and ask if anything needs to be added to the rules already decided upon based on this discussion of narrative and experiential therapy and reflecting teams. ~ Materials Needed Handout on narrative features, Appendix C (p. 137). Handout on reflecting team guidelines, Appendix D (p. 138). Handout on introduction to experiential therapy, Appendix E (p. 140). ~ Time Frame 25 minutes Exercise 2: Experiential Projection Exploration (Adapted from Enright, 1976) ~ Purpose: To have participants gain knowledge of experiential explorations by expenencmg. Resisting Substance Use Program );> 37 Procedure: 1) Tell participants that they will now be doing an experiential exercise. To illustrate, the facilitator will model this exercise for the group. First, the facilitator will look around the room and pick an object, perhaps a TV. The facilitator will then tell the group they are picking the TV as their object and will now speak in the first person as if they were the TV, using "I" statements. For example, the facilitator might say, "I am square in shape and am made of a lot of plastic-like material and glass which is fragile. I have information pass through me, but I have no control over the content or purpose of the information. Others decide when I will be on or off. I cannot move on my own, I just am. Many different people can switch me on or off, change my content, or terminate me by unplugging me if they choose." 2) Ask participants to look around the room and pick out an object that attracts their attention. 3) Ask participants to silently imagine themselves as this object. 4) Ask participants to pay attention to what this object is. What material is it made of, is it soft, hard, or colourful? What is its function? 5) Have participants spend three or four minutes getting in touch with aspects of this felt sense of being this object and identifying themselves with it. 6) Then ask participants, one by one, to describe this object, but to use "I" statements when they do so. For example, if they picked a pen they might respond with, "I am round and hard. I am made of plastic with an inner piece of material that holds fluid that I can make marks with. I have the ability to Resisting Substance Use Program 38 write and say things silently without others noticing. I can say things others might not be able to read and understand . I can write what I think for some people but not others." 7) Have participants continue with self-identification with their chosen object until they have a shift in self-perception concerning how they operate in the world. Ask them the following questions: As you reflect on this experience, does it speak of parts of yourself that you were unaware of previously? How are you interpreting this meaning-making you are doing from this exercise? 8) Discuss what participants have experienced through this exercise. 9) Tell participants that they can utilize what they experienced in this exercise as part of their homework journal. );> Materials Needed None );> Time Frame 35 minutes Exercise 3: Banner Making (Adapted from Cameron, 1992). );> Purpose: To further group formation by having participants work together to create something as a team. Resisting Substance Use Program ~ 39 Procedure: 1) First, review group rules concerning interaction and safety, for example, no teasing or rude comments about others' artistic abilities. 2) Next, lay out on tables a sheet of newsprint approximately eight feet long by three feet wide. 3) Hand out art supplies, pastels, coloured pens, charcoal sticks, etc. A variety of materials can be used for this exercise. 4) Have participants sit around the table. 5) Ask participants to begin drawing on the paper. It does not matter what they draw. 6) After approximately five minutes, have participants move one space over in a clockwise motion and continue drawing. Every five minutes, repeat this process until everyone in the group has moved around the drawing. 7) Once work has been completed, verbally debrief what was created as a team and their experiences of doing this exercise. 8) Ask participants questions such as the following: a) What was it like for you as individuals to work with others? b) Were you comfortable doing this or was it difficult? c) As you moved around the table doing your piece, was it hard to move on to the next section? d) What was it like for you if you were not able to complete the piece you were working on? e) What was it like to add to or change another's piece of work? Resisting Substance Use Program f) 40 What is one thing you learned about someone else in the group you didn't know before? g) What did you learn about yourself as you did this work? h) As you look at the completed work, what is your impression of it? 9) Hang the banner on the wall, where it will stay until the program has been completed. 10) Play some type of quiet background music. 11) Debrief the group process by asking questions such as the following: How did each member act to respect other members in the group? Now that you have accomplished a task as a team, how do you feel about the members of your group that is affirming for you? Are there any further rules or guidelines that we need to add to our list as a result of doing this exercise? What have you learned about working as a team or a group member? ~ Materials Needed Roll ends of newsprint or other appropriately sized paper Art materials, coloured pens, pastels, chalks, charcoal sticks, etc. Tables to put banner on Chairs Music and player to play it with ~ Time Frame 40 minutes Resisting Substance Use Program 41 Exercise 4: Identifying Personal Goals ~ Purpose: To help clarify for participants what they would like to get out of the program. ~ Procedure: 1) Explain to participants that this exercise is to help clarify why they initially decided to attend the program and what they would like to have shift for themselves by having been a part of this process. 2) Ask participants to write on a piece of paper the three things they would like to see change for themselves by having participated in this group. Invite people, if they feel safe and want to, to share some of their wants but to not have other comments by other members of the group. Allow a few minutes if other members would like to add one more thing to there list after hearing others ideas. 3) Collect the papers and put them into an envelope. These are to be returned to participants at the end of the program, at which time they will open them and be able to evaluate for themselves if they have achieved some level of what they originally hoped for. ~ Materials Needed Writing paper and envelopes ~ Time Frame ~ 10 minutes Resisting Substance Use Program 42 Exercise 5: Homework Assignment );;> Purpose: To review expectations concerning any homework assigned. );;> Procedure: 1) Refer to handouts on narrative features, reflecting team guidelines and introduction to experiential therapy (Appendices B, C, and D, pp. 135, 137, and 138), and ask participants to review them before the next group session. 2) Hand out journals and have a discussion about the journaling exercise. The focus of their daily journals will be on what participants experienced that day in regard to the session. They will write, draw, or use collages to express any thoughts or feelings they have and the meaning they are making of their expenence. 3) Ask group members to make a list of the activities done during this session so they will have them to reflect on while they do their journaling. );;> Materials Needed Journals that participants can use for the rest of the program. If at all possible, arrange funding to provide inexpensive journal books for participants. Time frame 10 minutes Exercise 6: Development of Opening and Closure Rituals );;> Purpose: This exercise is intended to help create structure for the group as well as to give participants an opportunity to become aware of their feelings in the moment. Resisting Substance Use Program Further, this exercise will become a part of a daily ritual, but also gives an opportunity for individuals to pay attention to their immediate felt sense of their expenencmg. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment, using a single word that resonates for them. 2) Participants can use words such as sad, happy, scared, tired, excited, etc., whatever word accurately describes their present moment of experience. 3) Next, ask each participant what experience or moment from the session led them to choosing their particular word. 4) Thank the participants for engaging in this experience. ~ Materials Needed None ~ Time Frame 25 minutes 43 Resisting Substance Use Program 44 Session Two: Group Formation Goals The goals of this session are to create a brief check-in format for discussing the previous session and homework assignments, which will be continued throughout the rest of the program; to further develop the opening and closing rituals which will start and end each subsequent session; to demonstrate and have group members participate in the reflecting teams. This will be a follow-up for the previous session' s homework, where participants will have reviewed reflecting team guidelines. Objective 1 Develop a ritual for opening each session. This is an opportunity for developing an opening and closing ritual. Once the opening session ritual has been done, conduct a short debrief of the previous session. As a result of Objective 1, participants will a) know the expectations for the beginning of each session and the ritual for starting and closing each session. b) know they will have an opportunity to talk about the previous session. Exercise 1: Opening Ritual ~ Purpose: To help create group structure as well as give participants an opportunity to become aware of their feelings in the moment. These rituals will become a part of Resisting Substance Use Program 45 each session, but also provide an opportunity for individuals to pay attention to their immediate felt sense of their experiencing. );> Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. );> Materials need None );> Time frame 10 minutes Exercise 2: Debrief of Previous Work );> Purpose: To discuss any concerns or questions participants may have regarding the previous session. );> Procedure: 1) Have participants sit in a circle, either on chairs or the floor, whichever they choose. 2) Ask participants to talk about the previous session. Questions that could be utilized to guide this process include the following: a) Now that you have had some time to process our last session, what stood out for you? Resisting Substance Use Program 46 b) What did you experience during the activity? c) Did you have additional thoughts or experiences you would like to speak of now? ~ Materials Needed None ~ Time Frame 20 minutes Objective 2 To give participants instruction and practice in being part of a reflecting team. There will be a review of the previous session's homework and reading on guidelines for being part of a reflecting team, and practice in being part of a reflecting team. As a result of Objective 2, participants will a) have a quick review of group rules b) have knowledge of what and how reflecting teams work c) have had experience in being part of a reflecting team. Exercise 1: Review of Homework ~ Purpose: To begin the discussion of what narrative practices are and start familiarizing participants with narrative practice. ~ Procedure: 1) Review the group rules with participants. Resisting Substance Use Program 47 2) Review and answer any questions regarding the previous night's homework of journaling. 3) Bring out homework of guidelines for reflecting teams (Appendix C, p. 137). Discuss the guidelines, going over each of the points and clarifying these for participants. ~ Materials Needed Appendix C (p. 137) ~ Time Frame 20 minutes Exercise 2: Interview With a "Problem" (Adapted from Level2 Narrative Intensive by David Pare, 1998. Available from Dr Pare, Faculty of Education, University of Ottawa, Canada.) ~ Purpose: To have participants learn about and practice being part of a reflecting team. ~ Procedure: 1) Ask for a volunteer to participate in setting up for participation in the reflecting team. 2) The volunteer will take on the persona of THE PROBLEM; for example, they might play the role of "THE ADDICTION" that had dominated their life. 3) Hand out writing tablets and pens to the other members of group, who will be part of the reflecting team. Resisting Substance Use Program 48 4) The reflecting team is to write the name of the person being interviewed and the date on the top of their notes, but not their own names. 5) The rest of the group (the reflecting team) will listen to the conversation between the facilitator and the problem and write out some of their reflections. 6) Their reflections should consist of noticing strengths the individual had in fighting against THE ADDICTION. Other things they might notice could include times of freedom from THE ADDICTION, strategies the person had employed against the tricks of THE ADDICTION, and who else was supportive of the individual being interviewed, historically and in the present. 7) In the interview, frame questions of curiosity that work to separate the person from the problem. Questioning begins by asking the "THE ADDICTON." a) When did THE ADDICTION first start hanging out with George (volunteer)? b) What sort of tricks has THE ADDICTION used to keep George involved with you? c) In what way do you, THE ADDICTION stop George from achieving his goals in life? d) How do you, THE ADDICTION, manage to get between George and his family? e) What exactly do you, THE ADDICTION, tell him in order to have this happen? f) Has there been a time when George was able to resist THE ADDICTION'S invitations? Resisting Substance Use Program 49 g) What was it like for you, THE ADDICTION, when George fought back? h) What are THE ADDICTION'S future plans for George, and is he okay with that? 8) The next set of questions can be used to clarify the previous inquiry. Instead of having the person speak with the voice of "THE ADDICTION," create room for the participant to challenge the role of addiction in their life. The following questions are adapted from Freedman and Coombs (1996): a) What happened that made you vulnerable to THE ADDICTION so that it was able to dominate your life? b) In what contexts is THE ADDICTION most likely to take over? c) What kinds of things happen that typically lead to THE ADDICTION taking over? d) What has THE ADDICTION gotten you to do that is against your better judgement? e) What effect does THE ADDICTION have on your life and relationships? f) How has THE ADDICTION led you into difficulties you are now experiencing? g) Does THE ADDICTION blind you from noticing your resources or can you see through it? h) Have there been times when you have been able to get the best of THE ADDICTION? i) Tell me about that time. What happened? Resisting Substance Use Program 50 9) Once this has been established, the next line of questioning is to have the participant explore and identify the differences from the two previous lines of questioning. The following questions are adapted from Freedman and Combs (1996): a) Has something shifted for you as a result of these lines of questions? b) As you process this interaction, what now seems possible to you? c) What still seems impossible? d) As you look to your future, what can you take from our conversation that will assist you in this endeavour? 10) This questioning process should continue for about 20 minutes, which is enough time to have some content to the conversation but not so much material that the reflecting team begins to lose focus. 11) At the end the of conversation between facilitator and volunteer, ask the volunteer to sit outside the circle of the reflecting team, but close enough to hear the conversation between the facilitator and the reflecting team. 12) The reflecting team will then proceed to express their reflections of what they have observed. 13) Once the initial reflections have been read, the volunteer will be asked to come back to the circle and give a response to the reflections they heard concerning their struggle against THE ADDICTION. Specifically, the team should comment on strengths, times of resistance, and times when THE ADDICTION was not present. Resisting Substance Use Program 51 14) Collect all the written reflections, which will be compiled and given to that particular volunteer at end of the session. 15) Keep copies of the reflections to be used in writing a final narrative summary letter for each individual. 16) Conduct a short debrief of the reflecting exercise, going over how reflections were used and any ideas or comments, in general, that might be used to make reflections stronger. This was only a learning practice for future sessions. 17) Debrief the group process by asking group members the following questions: a) How did this help you gain insight? b) What was most helpful about this process? c) How do you feel as a group after being part of this exercise? d) What did you find most helpful about this as an exercise? e) Do we need to add to our list of group rules and guidelines as a result of this exercise? 18) If time permits, have another person volunteer and repeat the above process. ~ Materials Needed Writing tablets and pens ~ Time Frame 2 hours Resisting Substance Use Program 52 Exercise]: Homework Assignment: Journaling ~ Purpose: This is to allow participants the mechanism for further processing of their experiences in group. ~ Procedure: 1) The focus of participants' daily journals will be on what they experienced that day in the session. Participants are to write out any thoughts or feelings they had and the meaning they are making of what they are experiencing. Participants can also utilize collages or other forms of artwork in their journals to express themselves if they choose. 2) Ask participants to list the things that transpired within the group this session. To assist them, review opening ritual, past issues, being part of a reflecting team or "volunteer," and closure ritual. 3) Now ask, are there any further guidelines or rules we need to add to our list? 4) To further participants' reflections on this exercise, ask them to take the eight questions outlined in question 8 from exercise 2 (Appendix F, p. 141) and write their own answers to these questions. ~ Materials Needed Appendix F (p. 142) and journals ~ Time Frame 15 minutes Resisting Substance Use Program 53 Exercise 4: Closure Ritual );> Purpose: The purpose of this section of program is to establish an end-of-session format. );> Procedure: 1) Ask participants to use a descriptive word to describe their present feeling, for example, hopeful, quiet, tense, scared, etc. Then have participants write out any thoughts or feelings that have led to this word, and encourage them to take that into their homework assignments. Then ask participants to think of what they learned today that they feel will stay with them after the program is completed. 2) Do a brief review of the session activities, opening ritual, debrief of previous session, review of homework, interview with a problem, and closure ritual. );> Materials Needed None );> Time Frame );> 10 minutes Resisting Substance Use Program 54 Session Three: Reflecting Skills Goals The goals for this session will give participants the opportunity to create context for their lived experience in regard to substance use. In this session participants will also gain further experience in working as members of reflecting teams. As participants develop more skill in using reflections, it will enhance and expand the content of the program in regard to their personal work in the group. Objective 1 To have participants use artwork to describe their past, present, and future. This exercise is designed to allow the unconscious to surface so that a noticing of their past, present, and future can be deconstructed and utilized to help clarify what constructed their beliefs. This can then lead to a shifting of perception concerning their negative beliefs and adoption of more positive, self-affirming beliefs. The following content provides an experiential art exercise that allows for an examination of a person's lived history. As a result of Objective 1, the participants will a) have an understanding of themes from their lived experience and its connection with their substance use b) how these identified themes may still be influencing their behaviour in regard to substance use. Resisting Substance Use Program 55 Exercise 1: Opening Session Ritual ~ Purpose: This ritual starts each session and allows for individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. ~ Procedure: Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. ~ Materials Needed None ~ Time Frame 10 minutes Exercise 2: Debrief of Previous Session ~ Purpose: To allow participants a further opportunity to debrief what has already transpired in group. ~ Procedure: 1) Have participants sit in a circle, either on the floor or on chairs, whichever they choose. 2) Ask them to talk about the previous session. Questions that could be used to guide this process are the following: Resisting Substance Use Program 56 a) Now that you have had some time to process our last session, what stood out for you? b) What did you experience during the activity? c) Did you have additional thoughts or experiences you may have written about in your journals or would like to speak of now? ~ Materials Needed Journals for participants to use for the rest of the program ~ Time Frame 20 minutes Exercise 3: Life Mapping Exercise (Adapted from Burton, 2004) ~ Purpose: In doing this exercise, participants will have an opportunity to express, through art, issues and barriers which may be interfering with their lives in the present. From this participants can develop alternative coping behaviours. ~ Procedure: 1) Explain that this is an art exercise that will look at three primary time periods in their life and what participants perceive as significant events for them within these time frames. The first art piece will be from early childhood through to the time of first substance use. The second art piece will be from Resisting Substance Use Program 57 the time of first substance use until the present, and the third piece of artwork will explore what participants hope for their future. 2) Let participants know that they do not have to be artists, that they can use symbols to represent the significant life events for the time period being represented by the piece of artwork. Symbols such as colour, shapes, and words can be utilized. 3) Give out art materials: large poster paper, paints, acrylics, pastels, etc. 4) Instruct participants to focus on just one time frame at a time. There is no right or wrong way to do this, just whatever seems to come forward for them as they think back into their lived history with a focus on significant events. These could be relationships, deaths, traumas, or positive events such as school success, holidays, etc., whatever the participant perceives as significant for them. For example, the facilitator can pick a time of loss and draw the first picture of prior to the loss, then one at the time of the loss and then the present in relation to that loss. Having the facilitator do this will give the participants a sense of what is required. 5) Tell participants that there will be only five minutes to do each piece of artwork. 6) It can be helpful to have some music playing in the background for this type of experiential exercise, but music is not mandatory. 7) Ask participants to start. 8) Monitor the time for each piece; after each period of five minutes, instruct participants to begin the next piece of artwork depicting the next time frame in Resisting Substance Use Program 58 the sequence. The sequences will be from early childhood moving towards the future for the final piece. 9) At the end of the allotted time, ask participants to collect together their three pieces of artwork and form a circle to prepare for the deconstruction of the experiential work just done through the reflecting team. );> Materials Needed Art supplies: acrylics, pastels, poster paper, watercolours, pencils CD player and CD of music );> Time Frame 90 minutes Objective 2 To continue with the development of narrative reflecting teams, utilizing the material from the life mapping exercise. The following content provides a) a further opportunity for participants to enhance their skills in being part of a reflecting team b) reflecting team material that will be used as feedback for the participant who has volunteered to be interviewed for this particular session c) an opportunity for deconstruction of participant's historic perceptions, leading to a reframing of beliefs through the use of the reflecting team. As a result of Objective 2, participants will a) have further developed their skills in being part of a reflecting team Resisting Substance Use Program 59 b) been given reflections from the rest of the group members c) achieved some level of clarity concerning their history and its influence on their use of substances d) had an opportunity to have personal strengths identified, of which they had previously been unaware e) had an opportunity to reframe their core belief systems, which may have been created through their historic lived experience. Exercise 1: Reflecting Team Feedback ~ Purpose: This exercise provides opportunity for clients to have reflections given back to them in regard their artwork, which will allow them to reframe the stories of their lives in a more positive, strengths-based manner. ~ Procedure: 1) Have participants form a circle. 2) Ask for a volunteer who would like to work with the facilitator. It is important that it be someone who has not already had an opportunity to have reflections given by the team. The goal is for everyone to have at least one opportunity to have reflections given back by the end of the program. 3) Start the process of deconstruction of the volunteers' life maps, starting from birth to the age of first substance use. 4) Have the rest of the group make notes on the conversation between the conversation between the facilitator and the volunteer. Emphasize that they Resisting Substance Use Program 60 are looking for strengths and historic resistance to negative themes with the volunteer's telling of their lived story. 5) Begin the process of deconstruction by noting times THE PROBLEM might be presented in the piece of artwork. This could be significant colours, symbols, or space and relationship to other symbols that stand out for the facilitator. Then begin the inquiring by asking about what the group noticed, which leads into the use of narrative framed questions. 6) Questions that could be used to highlight the social construction of problems could include the following: a) What happened in your past that made you vulnerable to THE PROBLEM that it was able to dominate your life? b) Who had power in your childhood? c) Who were the dominant people in your early life and what role did they play in the construction of the story of who you were? d) What were some of the messages you received about who you were in the world? 7) Once some of the historic context has been identified, begin to ask questions which will tend to "map the exception" of the problem on the person's life. Sample questions: a) What is significant about this event you are describing? b) Who was supportive of you at this time in your life? c) What do you think they saw in you that they would have valued? d) What meaning are you making from this? Resisting Substance Use Program 61 8) As the story emerges from the conversation, themes may develop that need to be followed up on. This process is fluid; it is important to remember not to get stuck into any one externalization, as this process is very back and forth (Pare, 1998). 9) After about ten minutes of conversation, have the volunteer move into talking about the second piece of artwork. 10) As this next piece of artwork is more focused on the time period of active substance use, more externalizing styles of questions could be utilized: a) What made you vulnerable to THE ADDICTION so that it was able to take over so much of your life? b) What impact have substances had on your relationships, and how do you feel about this? (Pare, 1998). c) If you were to write a story about how you resisted the influence of substances, what would you name it? Perhaps the COURAGE? d) What does it say about you that you have chosen to fight back against the influence of substances in your life? e) What are some of the ways you have resisted THE ADDICTION in the past? f) Who is supportive of you in your fight against THE ADDICTION? g) Are there times when you do not allow THE ADDICTION to have control of your life? Resisting Substance Use Program 62 11) Continue with externalization of the second piece of artwork for about ten minutes, and then move into the final piece of artwork, which is focused on the future. 12) Questions that could be utilized to deepen the hopes for the future include the following: a) As you look to the future, how do you see your relationship with THE ADDICTION being different? b) As you move into a future without THE ADDICTION, what benefits will you gain? c) As you look to your future and begin to write your own story of who you truly are, whom do you want to include in the story? d) What is it that makes them important to your story? (Pare, 1998). Continue this form of questioning for about ten minutes. 13) Throughout this sequence of questions, it is necessary to remember that the conversation is fluid and can shift direction at any time. It is important for the facilitator to follow any themes or directions the conversation moves towards and continue to use questions that are reflective of a narrative therapy stance. A multitude of questions can be utilized for this purpose, and the facilitator needs to be familiar with this form of inquiry. 14) Once the interview has been completed, have participants form a circle again and ask the volunteer to sit outside the circle. Resisting Substance Use Program 63 15) Now ask the reflecting team to speak about the reflections they noted while listening to the conversation between the facilitator and volunteer. This should take about ten minutes. 16) Ask the volunteer to speak about any further thoughts they had concerning the reflections they have just heard. 17) Once the volunteer has spoken about the reflections they have heard, collect the written reflections taken by the reflecting team. These will be used to develop a narrative letter to be given to the volunteer at the end of the program. 18) If time permits, have another volunteer through the above process. );> Materials Needed None );> Time Frame );> 30 minutes Discussion At this point there can be a brief discussion about the reflecting team with an emphasis on how to make the reflections stronger. Ask participants: what manner of the reflections did each of them find the most useful? How can we frame our interviews in the future that will make them stronger? );> Materials Needed None Resisting Substance Use Program ~ 64 Time Frame 15 minutes Exercise 2: Homework Assignment: Journaling and letter writing ~ Purpose: The purpose of this assignment is to allow participants the mechanism for further processing of their experiences for each session. The letter writing is to be used in an experiential exercise next session. ~ Procedure: 1) Review the session's content: debrief of previous session, opening ritual, life mapping exercise, reflecting team feedback, discussion on making reflections stronger, and closure ritual. 2) The focus of participants' daily journals will be on what they experienced that day in the session. Participants are to write out any thoughts or feelings they had in regard to the session and the meaning they are making of what they are experiencing. Participants can also utilize collages or other forms of artwork in their journals to express themselves if they choose. 3) In this homework assignment participants will write a goodbye letter to THE ADDICTION, or other name they feel would fit better for them. Participants are asked to break the letter into components. The first section will include when they first experienced substance misuse, what that experience was like for them, positive or negative. The second section will speak about the role THE ADDICTION played in their lives up to the point where problems from Resisting Substance Use Program 65 hanging out with THE ADDICTION began to happen more often. Also, in this section they could speak of the positives they received from being involved with THE ADDICTION. In the final section participants are asked to write about how THE ADDICTION began to overcome them in their lives. At this point they could note the costs of hanging out with THE ADDICTION, for example, lost jobs, lost relationship, court costs, family impact, accidents, violence, whatever has a strong connection for them. The more depth participants put into the letter, the more impact it will have for them later, so encourage participants to put in as much detail as they can while keeping the letter to about two pages. );;> Time Frame 10 minutes Exercise 3: Closure Session Ritual );;> Purpose: This ritual will end each session and allows individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. );;> Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. Resisting Substance Use Program 66 2) Then ask participants what experience or moment from the session led them to choosing their particular word. 3) Ask if there are any changes that need to be made to guidelines and rules as a result of today's work. 4) Thank the participants for engaging in the experience. Materials needed None Time Frame 10 minutes Resisting Substance Use Program 67 Session Four: Experiential Experiences Goals The goal of this session is to have a furthering of experiential experiences through the application of experiential experiments. This will help to increase participants' selfperception, leading to more self-awareness. Objective 1 To have participants create a further separation of THE ADDICTION from them, thus creating room for the participants to re-examine their relationship with substance use. As a result of Objective 1, participants will a) have gained an awareness of strengths they could use to resist the influence of THE ADDICTION. Exercise 1: Opening Session Ritual ~ Purpose: This ritual starts each session and allows for individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. ~ Procedure: Ask members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use Resisting Substance Use Program 68 words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. ~ Materials needed None ~ Time Frame 10 minutes Exercise 2: Debrief of Previous Session ~ Purpose: To allow participants an opportunity to further speak of what happened in the previous session. ~ Procedure: 1) Have participants sit in a circle, either on the floor or on chairs, whichever they choose. 2) Ask them to talk about the previous session. Questions that could be used to guide this process are the following: a) Now that you have some time to process our last session, what stood out for you? b) What did you experience during the activity? c) Did you have additional thoughts or experiences you may have written about in your journals or would like to speak of now? ~ Materials needed None Resisting Substance Use Program ~ 69 Time Frame 20 minutes Exercise]: Gestalt Experiment (Adapted from Corey, 2000) ~ Purpose: In doing this exercise, participants will have a further opportunity to separate themselves from THE ADDICTION. This will then give them an additional tool to fight back against substance misuse in the future. ~ Procedure: 1) Ask participants to take out the letters they had written to THE ADDICTION as part of their previous homework. 2) Form the group into a circle and place two chairs within the circle. 3) Ask for a volunteer. 4) Have the volunteer sit in one of the chairs in the circle. 5) Instruct other members of the group to become the reflecting team. 6) Now ask the volunteer to imagine that in the empty chair in the middle of the circle his/her ADDICTION is sitting. 7) Now ask the volunteer to take some time and try to visualize THE ADDICTION in whatever form they like. They might imagine it as a bottle or a needle or something else. The following questions may help with this: a) Does it have colour or texture? b) Is it slouched in the chair or sitting erect? Resisting Substance Use Program 70 c) What is ADDICTION'S mood: angry, hurt, resentful, humorous? 8) Give the participant a little time to create this visualization in the empty chair. 9) Now ask the participant to read aloud the letter they had written to THE ADDICTION sitting in the chair opposite them. 10) Once the participant has finished reading their letter to THE ADDICTION, the facilitator will enhance the awareness of the participant by reflective questioning. These questions could be as follows: a) What did you experience as you read your letter to THE ADDICTION? b) What else would you like to say to THE ADDICTION? c) How is THE ADDICTION paying more attention to you now? d) Do you have some say in what THE ADDICTION plans for you? Could you say more on that? e) Are there any further comments or thoughts you would like to say to THE ADDICTION? 11) Now ask the members of the group if they have any questions they would like to pose to THE ADDICTION. 12) Ask the volunteer to return to the circle and then ask for another group member to come forward to read their letter to THE ADDICTION. 13) Have half of the members of the group to participate in this exercise. Follow the previous procedure for each of them. ~ Materials needed Participants' goodbye letters Chairs Resisting Substance Use Program ~ 71 Time Frame 1 hour Exercise 4: Fantasy Journey Experiment (Adapted from Stevens, 1971) ~ Purpose: This exercise is designed to have participants experience aspects of self which have been concealed from their consciousness. Through participating in this exercise, participants will gain a deeper understanding of themselves. This exercise will also allow for a level of vulnerability between group members, leading to greater group cohesion. ~ Procedure: 1) Explain to participants that the exercise they are about to be part of makes use of the imagination and that they will be asked to create several visualizations during this exercise. Tell the group they will be guided through the exercise by questions that will help them create the imagery requested. 2) Ask for a volunteer from the half of the group that did not participate in the earlier exercise. 3) Ask the volunteer to be comfortable in their chair and focus on their breathing and getting relaxed. 4) After a few moments, when it is apparent the volunteer has settled, ask them to close their eyes and begin the guided imagery exercise. Resisting Substance Use Program 72 5) Now instruct the volunteer to imagine they are a stump. Become the tree stump. Take a few moments to get the feel of what it is like to be a tree stump. The following questions can further this: a) What kind of stump are you? b) What is your shape? c) Try to really experience being a stump. What is your existence like as a stump? d) What kinds of things happen to you as a stump? 6) Now move into a furthering of the imagery by telling the volunteer that near this stump is a cabin: "As you had experienced being a stump, I would like you to now become a cabin, and again I would like you to get the sense of what it is to be a cabin." Questions to further this piece of the imagery include: a) What sense do you have of what it is like to be a cabin? b) What are some of the characteristics of being a cabin? Do you have walls, roof, doors? c) What type of material are you made of? d) Are you old or new? e) What do you have inside you and what happens to you? Just take a few moments to get in touch with being a cabin. 7) Move into the final piece of the imagery work. "Now imagine that there is a stream near this cabin and now become this stream." Further questions to deepen this are the following : Resisting Substance Use Program 73 a) As a stream, what kind of existence do you have? b) What kind of stream are you? c) How do you feel as a stream? d) What kind of experiences do you have as a stream? e) What are your surroundings like? 8) "Now as the stream, I would like you to speak to the cabin and imagine that it speaks back." Questions to further this are the following: a) As the stream, what do you say to the cabin and what does the cabin say to you? b) Now become the cabin again. What does the stream have to say to you? c) Now become the stump again and speak to the cabin. What would you say to the cabin? 9) Continue this dialogue between the stump, stream, and cabin for a few moments, utilizing previous questions and substituting appropriate objects of stump, stream, or cabin. 10) Allow a few moments for the experience to filter for the participant and then ask them to say good bye to the stump, stream, and cabin. 11) Ask the volunteer to open their eyes when they are ready and psychologically come back into the group. 12) Now have the volunteer relate their experience in the first person. For example, as the stump, they might say, "I am short but strong and feel well rooted in the earth." Keeping reflections in the present and first person deepens the experience. Also, the facilitator can use reflective questions to Resisting Substance Use Program 74 help the volunteer expand and deepen their experience. Encourage the volunteer to use "I" statements. Some example questions to assist in this are as follows: a) I noticed that you mentioned something on the right side of the cabin; what was on the other side? b) Could you expand on what you had noticed about being a stream using an "I" statement? 13) Now ask for another volunteer from the group who has not already participated for this session. 14) Repeat the above process until the half of the group who had not done the previous exercise have had an opportunity to participate in this session. );> Materials needed Comfortable chairs );> Time Frame 1 hour Discussion: At this point there can be a general discussion about the previous exercises. The facilitator will explain to the group that what they expressed through their imagery were likely aspects of themselves they had not acknowledge before (Stevens, 1971). For example, if one of the participants said that as the stump they felt small and chopped down, it might indicate that this is the view they held of themselves. Also, tell the participants that if they had experienced some negative emotions or thoughts during this Resisting Substance Use Program 75 exercise, it does not mean that they will carry this for the rest of their life; it simply indicates that there is an issue the individual needs to deal with (Stevens, 1971). ~ Materials needed None ~ Time frame 25 minutes Exercise 5: Homework Assignment: Journaling ~ Purpose: The purpose of this assignment is to give participants further opportunity to process their experiences from the day by writing about them. ~ Procedure: 1) The focus of this night's journaling will be on what they became aware of about themselves through doing the experiential exercise during this session. 2) Encourage participants to do more of the imagery work on their own to further their experience. ~ Materials needed None ~ Time Frame 10 minutes Resisting Substance Use Program 76 Exercise 6: Closure Session Ritual ~ Purpose: To allow for group members to become centered after the experiential exercise from this session. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. 2) Then ask participants what experience or moment from the session led them to choosing their particular word. 3) Thank the participants for engaging with their experiences in session. ~ Materials needed None ~ Time frame 10 minutes Resisting Substance Use Program 77 Session Five: Migration of Identity Metaphor Goals The goal of this session is to further assist participants to separate themselves from a negative, problem-saturated story to one of a future with hope and expectations. The exercise employed in this session will highlight for participants old patterns consisting of rules and beliefs that substance use may have utilized to keep them captured. By creating a migration of identity metaphor, participants can achieve clarity on the role that substance played in their lives and learn how to begin constructing a life without substances. Objective 1 To have participants identify the rules and constraints imposed by substances on their lives. The purpose of this objective is to have participants achieve some measure of clarity on their core values and belief system and to realize the impact of substances on those attitudes. The following content provides an experiential exercise to assist in clarifying values, beliefs, and attitudes. As a result of Objective 1, participants will a) have an understanding of the values, beliefs, and attitudes they have incorporated during their lives, an understanding of the values and beliefs they would like to keep, and those which are no longer useful to them. Resisting Substance Use Program 78 Exercise 1: Opening Session Ritual );;;> Purpose: This ritual starts each session and allows individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. );;;> Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. 2) Ask participants what experience or moment from the previous session led them to choosing this word. Was there material from their homework that is reflected in their word? );;;> Materials Needed None );;;> Time Frame 10 minutes Exercise 2: Debrief of Previous Session );;;> Purpose: To allow participants a further opportunity to debrief what has already transpired in group. Resisting Substance Use Program ~ 79 Procedure: 1) Have participants sit in a circle, either on the floor or on chairs, whichever they choose. 2) Ask participants to talk about the previous session. Questions that could be asked: Now that you have had some time to process our last session, what stood out for you? What did you experience during the activity? Did you have additional thoughts or experiences you may have written about in your journals that you would like to speak of now? ~ Materials Needed None ~ Time Frame ~ 15 minutes Exercise 3: Migration of Identity Metaphor (Adapted and developed from Smith & Winslade, 1997) ~ Procedure: 1) Distribute sheets of art paper and art supplies. 2) Explain to participants that this exercise will involve a piece of artwork that will help them identify the rules, messages, and beliefs that have allowed substances to control their lives. In going through this exercise, participants will be able to identify behaviours and attitudes that substances utilized to keep them captured. This then will allow them to choose what they want to carry forward in their lives and what they wish to leave behind. Resisting Substance Use Program 80 3) Instruct participants to take a pencil and draw a circular shape on one half of the art paper. This will represent an island. They can draw trees or other objects on this "island" if they choose. On the second half of the paper they are to draw a line that represents the shoreline of a different country. At this point participants are asked to name the respective halves of the drawing paper. For example, they could name the island the land of addiction and the opposite portion of the artwork the land of freedom. The facilitator would quickly draw this to demonstrate to participants exactly what is meant. 4) The participants will be asked to imagine that the island they have drawn is a representation of where they have lived up until the present. They are then to imagine that they are going to take a journey to a new land. They will in effect be migrating to this new land. For the purpose of this exercise, the participants are to imagine that they like many people who emigrate, have to leave many of their possessions behind. As they will be allowed only a small suitcase of things to take with them, they must choose carefully what they will take. The possessions they choose to take or leave behind will consist of their values, beliefs, and attitudes which substances have used against them as well as ones the participants feel they need to keep. 5) Ask participants to list the values, beliefs, and attitudes they have and write them on the "island." They can use symbols or words, whichever fits for them. Ask them to list negative values, beliefs, and attitudes as well as positive ones. Negative values and beliefs could be ones that substances may have forced them to use to survive in the world of active substance use. Examples of these Resisting Substance Use Program 81 include dishonesty with self and others, lack of trust, and poor self-image. These negative beliefs and values could be countered with more positive ones such as honesty, trust, family, friends, and work ethic. 6) Ask participants to choose which of their values, beliefs, and attitudes they would like to take with them, understanding that they have limited room on the small boat that will take them away from the island. 7) Once participants have chosen which values, beliefs, and attitudes are important to them, have them list them on the half of the paper representing their land of the future. 8) Encourage participants to take their drawings home with them and hang them up where they can see them so as to have a visual reminder and symbol of the future direction they are choosing to take. 9) Once the participants have completed this exercise, ask them to re-form into a group again, bringing with them their pieces of work. ~ Materials Needed Large sheets of drawing paper A variety of coloured pens or chalks ~ Time Frame 20 minutes Objective 2 For participants to identify and incorporate the values and beliefs which better fit for them as they move into the future; to assist participants in the deconstruction of how Resisting Substance Use Program 82 they acquired their present belief and value system and to assist them in making choices about which ones are still useful and which ones they can leave behind as they move toward a different relationship with substances. There will be an opportunity for several of the group members to have reflections by the reflecting team. These reflecting debriefing exercises provide an opportunity for the participants to gain more awareness through each of the reflecting team processes, which will enhance their own experience. As a result of Objective 2, a) participants will have discovered what their core belief and value systems are and where they originated. b) From the deconstruction and examination of their core values and beliefs, participants will be have the support of the reflecting team in expanding the possibilities of shifting their values and beliefs and retaining those that are useful and letting go of ones that are no longer valid. Exercise 1: Working With a Reflecting Team ~ Purpose: To provide insight and awareness for participants of how their values and beliefs shape their perceptions and behaviours. ~ Procedure: 1) Ask for a volunteer to come forward to work with the facilitator. This must be a person who has not yet had an opportunity to work with the facilitator. Resisting Substance Use Program 83 2) Instruct the rest of the group to act as a reflecting team following the previous guidelines, i.e., taking notes of positives and possibilities and parts of the conversation that resonate for them. 3) Begin a narrative frame of questioning concerning the values and beliefs the participant had written on their drawing of the migration metaphor. 4) A variety of narrative framed questions can be used to deconstruct the values and beliefs that individual participants may have acquired over their lifetime: a) As you look at your island containing a listing of your values, beliefs, and attitudes, which ones stand out the most for you? b) Why are those ones important to you? In what way did substances force you to act against your values? c) In what way did substances influence how you feel about yourself? What did substances promise you that allowed you to continue associating with them? d) What sort of reputation did substances help create for you? How well does this reputation fit with what you want in your future? e) How would you prefer to be viewed? Will migrating from the land of addiction help you achieve your goals? f) What does it say about who you are in the world that you are choosing honesty and trust as things you wish to take on your trip? g) Who would be the most happy that you are migrating to a new land? h) What is it that these people appreciate about you the most? i) What does it mean for you that you are making this choice to leave the old story of who you were behind and to embark on this journey of freedom? Resisting Substance Use Program 84 j) What are some of the beliefs and values you would like to leave behind on the island, and which ones are necessary for you to take on your migration? k) How are these different? 1) If you were to develop a plan to prevent substances from stowing away on your trip, what do you think you would need to have in place? 5) Continue with the questioning to create further externalization of values, beliefs, and attitudes for about 15 minutes. As there are a variety of questions that could be utilized to follow themes that may emerge, be flexible in the framing of questions. 6) At the end of the time have the group form again and ask the volunteer to sit outside the circle. 7) Then ask the reflecting team to highlight one or two of the reflections they had noted. 8) Once the team has given their reflections, ask the volunteer if they have any further comments or reflections on what they have heard. 9) Collect all the written reflections, which will be used to develop an individual narrative letter at the end of the program. 10) Have a brief discussion about the reflections, highlighting how they could have been strengthened or expanded on. 11) If time permits, select another volunteer and repeat the above process. It is anticipated that each additional person who goes through the process will strengthen and clarify for the rest of the group the rules, values, beliefs, and attitudes that substances used to keep them trapped. Resisting Substance Use Program ~ 85 Materials Needed Writing tablets and pens ~ Time Frame 2 hours Exercise 2: Homework Assignment: Journaling ~ Purpose: The purpose is to allow participants the mechanism for the further processing of their experiences in group for this session. ~ Procedure: 1) Do a review of this session so participants can write items down and perhaps utilize them in their homework. Review and debrief the previous session, migration of identity metaphor, working with a reflecting team, and closure ritual. 2) The focus of their daily journals will be on what they experienced that day in the session. Participants are to write out any thoughts or feelings they had about the session and the meaning they are making of what they are experiencing. 3) Participants can also utilize collages or other forms of artwork within their journals to express themselves if they choose. ~ Materials Needed None Resisting Substance Use Program ~ Time Frame 20 minutes Closure Ritual ~ Purpose: To continue with structure for the closure of sessions. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. 2) Participants can use words such as sad, happy, scared, tired, excited, etc., whatever word accurately describes their present moment of experience. 3) Next, ask each participant what experience or moment from the session led them to choosing their particular word. 4) Thank the participants for engaging in this experience. ~ Materials needed None ~ Time frame 10 minutes 86 Resisting Substance Use Program 87 Session Six: Creating Self Goal The goal of this session is to further participants' perception of themselves. Using modelling clay, participants will be encouraged to create several shapes that will symbolize aspects of self, both positive and negative. The experiential exercise will then be deconstructed making use of a narrative framework. As this will be a more personal self-reflection, the debriefing session will be more personal, without the use of a reflecting team. Objective 1 To utilize an experiential exercise to assist participants in achieving a higher degree of self-awareness that builds on the previous day's work. The purpose of this session is to give participants an opportunity to allow their subconscious to express itself through artwork, and then to explore the meaning they make of this work. As a result of Objective 1, participants will a) have done an experiential art exercise b) have an opportunity for the participants in the group to explore the meaning they are making of the artwork they have created c) have increased their self-awareness of some core beliefs concerning who they are in the world. d) have an opportunity to have some conversation and feedback concerning what they have perceived for themselves from doing this piece of work e) have an opportunity to pose some narrative reflections to their art work. Resisting Substance Use Program 88 Exercise 1: Opening Session Ritual ~ Purpose: This ritual starts each session and allows for individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. 2) Ask participants what experience or moment from the previous session led them to choosing the word they did. ~ Materials Needed None ~ Time Frame 10 minutes Exercise 2: Debrief of Previous Session ~ Purpose: To allow participants a further opportunity to debrief what has already transpired in group. ~ Procedure: 1) Have participants sit in a circle, either on chairs or the floor, whichever they choose. Resisting Substance Use Program 89 2) Ask participants to talk about the previous session. Questions that could be utilized to guide this process include the following: a) Now that you have had some time to process our last session, what stood out for you? b) What did you experience during the activity? c) Did you have additional thoughts or experiences you would like to speak of now? );;;> );;;> Materials Needed None );;;> Time Frame );;;> 15 minutes Exercise 3: Rediscovering Ourselves (Developed from material by Rhyne, 1973) );;;> Purpose: This exercise is designed to have participants connect with internalized subconscious aspects of self, which will lead to awareness and thus opportunity for change. );;;> Procedure: 1) Hand out lumps of modelling clay. Resisting Substance Use Program 90 2) Inform participants that they are to make several shapes or forms out of the clay. They will make a shape that represents something good about them and a shape that represents something they do not like about themselves. 3) Ask participants to simply form the question of positives and negatives of themselves and then let it go. 4) Encourage participants to allow whatever comes forth in the work to just happen, without trying to analyze, judge, or solve problems. 5) Inform clients that there is no right or wrong way for this exercise. 6) After 20 minutes, have the group form a circle to start the next component of the session. ;;.. Materials Needed Modelling clay );;> Time Frame 30 minutes Objective 2 To create time and a forum for individuals to talk about what this experience was like for them. This objective will clarify and help participants integrate what they have learned about themselves from the art exercise. As a result of Objective 2, participants will a) have increased their self-awareness about aspects of self, positive and negative, which they can now integrate into their self-concept Resisting Substance Use Program 91 b) be in a position to take responsibility for making positive changes in their lives. Exercise 1: Debriefing of the Experiential Exercise );> Purpose: The purpose is to assist participants with the processing of their experiential exercise leading to increased self-awareness and insight. );> Procedure: 1) Have the group re-form. 2) Ask if there are any volunteers, again choosing someone who has not had an opportunity to have their work debriefed. 3) The focus of this part of the session is to assist the volunteer in exploring what meaning they are making from this experiential exercise. This can be achieved through asking questions such as the following: a) As you experience your works of art, what feelings arise for you? b) As you were making your artwork, what thoughts or memories might have arisen for you? c) What are some of the aspects of yourself that came into your awareness as you worked with the clay? d) What is important for you to take away with yourself from this work? e) Was this a pleasant or unpleasant experience for you? Resisting Substance Use Program 92 4) Have the participants take on the roles of their pieces of artwork and speak from that perspective, answering these narrative framed questions: a) When did THECLA Y first start hanging out with George (volunteer)? b) What sort of tricks has THECLA Y used to keep George involved with you? c) In what way do you, THECLA Y, stop George from achieving his goals in life? d) How do you, THECLA Y, manage to get between George and his family? e) What exactly do you, THE CLAY, tell him in order to have this happen? Has there been a time when George was able to resist THE CLAY'S f) invitations? g) What was that like for you, THECLA Y, when George fought back? h) What are THE CLAY'S future plans for George, and is he okay with that? 5) Inform participants that they can choose to take their artwork home with them or re-form it into a ball. It is their choice. 6) After about 20 minutes or when the volunteer has expressed all they need to in the moment, ask for another volunteer and go through the process again. 7) The facilitator will continue to ask for volunteers until the time for this session IS Up. ~ Materials Needed None ~ Time Frame 2 hours Resisting Substance Use Program 93 Exercise 2: Homework Assignment: Journaling ~ Purpose: The homework assignment is utilized for further processing the session' s content. ~ Procedure: 1) Ask group members to make a list of the session activities to assist them in their journaling. Review the day' s session, including debrief of the previous session, opening ritual exercise, rediscovering ourselves exercise, debrief of experiential exercise, and closure ritual. 2) The focus of their daily journal writing will be on what they experienced that day in regard to their experiential experience. Participants can use other forms of artwork within their journals if they choose. ~ Materials needed None ~ Time frame 10 minutes Exercise 3: Closure Ritual ~ Purpose: To further develop cohesion of group and the emphasize need for ritual in one's life. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can Resisting Substance Use Program 94 use words such as hopeful, tired, tense, scared, whatever word accurately describes their present moment of experience. 2) Ask participants what experience or moment of the session led them to using the word they chose. 5) Next, ask each participant what experience or moment from the session led them to choosing their particular word. 3) Thank the participants for engaging in this experience. ~ Materials needed None ~ Time frame 10 minutes Resisting Substance Use Program 95 Session Seven: Grief and Loss Goals The goals of this session are to provide an opportunity for participants to resolve some of the grief and loss issues. In my experience of working with individuals who struggle with substance use, I have noted that they have, almost without exception, significant grief and loss issues. This component of the program will explore some of the dynamics and impact of grief and loss on people' s personal experience. Initially, there is an experiential exercise that will help identify significant losses people have experienced. Second, there is a narrative component that gives group members the opportunity for some level of closure on their grief and loss issues. Objective 1 To give participants an opportunity to explore the impact of losses and the resultant grief, which has previously been unacknowledged on a conscious level. This objective will utilize a piece of artwork that will incorporate symbols that represent losses participants have experienced in their lives. As a result of Objective 1, participants will a) be able to recognize how unresolved issues of grief and loss may be a contributing factor in their substance use. Exercise 1: Opening Session Ritual This ritual starts each session and allows for individuals to become present in the moment and to pay attention to their immediate felt sense of experiencing. Resisting Substance Use Program );> 96 Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. 2) Ask participants what experience or moment from the previous session led them to choosing the word they did. );> Materials Needed None );> Time Frame 10 minutes Exercise 2: Debrief of Previous Session );> Purpose: To allow participants a further opportunity to discuss any concerns or questions they may have regarding the previous session. );> Procedure: 1) Have participants sit in a circle, either on chairs or the floor, whichever they choose. 2) Ask participants to talk about the previous session. Questions that could be utilized to guide this process include the following: Now that you have had some time to process our last session, what stood out for you? What did you • Resisting Substance Use Program 97 experience during the activity? Did you have additional thoughts or experiences you would like to speak of now? ~ Materials Needed None ~ Time Frame ~ 15 minutes The following content provides an experiential exercise highlighting areas of grief and loss in individuals' lives. Exercise 3: Defining Grief and Loss Through Artwork (Developed by Robert May) ~ Purpose: This exercise is designed to assist participants in identifying and exploring grief issues. ~ Procedure: 1) Inform participants that they will be using artwork to explore issues revolving around grief and loss. 2) Explain to participants that grief and loss include a variety of components, for example, loss of childhood through abuse, loss of family members, jobs, relationships, self-respect, or honesty, whatever the participants feel was a loss for themselves. Resisting Substance Use Program 98 3) Hand out pieces of art paper and materials such as acrylics, charcoals, or pastels. Participants can chose whichever medium they wish to work with. Then have participants go to tables that are set up, or allow them to work on the floor, however they feel more comfortable. 4) At this point, ask participants to reflect back on their lives and begin drawing on their piece of paper symbols that are representative of different losses they have experienced in their lives. 5) Have some form of soft music playing in the background, as this will tend to create an atmosphere of quiet contemplation. 6) Allow about half an hour for people to work. After the half hour is over, ask group members to come back together in a circle. It is at this point that the second, more intensive part of the session begins. ~ Materials needed Art paper, drawing materials (e.g., crayons, pastels, water colours, pencils) ~ Time frame 30 minutes Objective 2 This is an opportunity for participants to process grief and loss through the debriefing of their pieces of artwork. By allowing themselves to experience some of the emotional content of past losses, the individuals may experience a letting go with the result of corning to closure of a particular grief or loss. If an individual is able to let go of Resisting Substance Use Program 99 some of this, it will lessen the desire to use substances as a coping mechanism for the historic losses they have experienced. As a result of Objective 2, participants will a) have an opportunity through the debriefing of their artwork to connect with their issues of grief and loss b) be able to understand the grief process and the connection of grief and loss with substance misuse c) have an opportunity to resolve some of their grief and loss issues d) have gained some sense of the value others in their lives have held for them. The following content contains a) debriefing of the participants' artwork on the theme of grief and loss b) debriefing and reframing of participants' grief and loss issues through the use of a reflecting team. Exercise 1: Debriefing of Participants' Artwork ~ Procedure: 1) Ask the group to come together to begin the next part of the process. 2) Ask who would like to go first; anyone could go first in this session, as everyone will have an opportunity to have their work debriefed. 3) Now have the reflecting team form, and hand out writing tablets and pens. Again the reflecting team is to notice strengths and positives and write them Resisting Substance Use Program 100 down. Have the reflection team use only two or three reflections to avoid overwhelming the volunteer. 4) Invite the volunteer to begin exploring the meaning and connections between their piece of artwork and their lived experience. The following questions could be used for this: a) What do the different shapes and colours represent? b) What relationship did you have with them? c) Why were they important to you? 5) If the volunteer has noted a loss such as a job or a place, then the questioning could invite them to explore the significance of these losses as well: a) What was significant about that particular job or place for you? b) With whom do you associate that job or place? c) Why is that significant for you? d) Who supported you through your loss? 6) Continue with this theme of questioning, which is designed to create a richer, more contextual story of the volunteer's experience. 7) Once the context and richness has been developed it is time to move into what White (1998) describes as a remembering rather than a shutting down of expression concerning grief and loss. The questions used in this section are adapted from White's work (1998). These types of questions represent a relational style of questioning, such as the following: a) What was it this person valued the most about you? Resisting Substance Use Program 101 b) If you were to see yourself through this person's eyes today, what would you notice about yourself that you would appreciate? c) What do you know about yourself that you are awakened to when you bring alive the enjoyable things that this person knew about you? d) How would you let others know you have reclaimed some of the discoveries about yourself that were clearly visible to this person? e) How would being aware of that which was not visible for the past number of years be of assistance to you as you move forward in your life? 8) Continue with this line of questioning until the volunteer seems to have reached some sense of positive connection with the loss and has described how they can use this information to assist themselves in reclaiming their lives from substance use. 9) This can be a very emotional experience for participants, so it is important to pace the questions and allow participants to experience whatever it is they are experiencing. 10) Once this process is complete for the participant, ask the reflecting team to come together in a circle again. 11) Ask the volunteer to sit outside the circle, and then ask members of the reflecting team to speak about their reflections and note briefly why they were important to them. 12) Once the reflections have been given, ask the participant to come back into the circle. Then ask this person if they have any final reflections concerning what Resisting Substance Use Program 102 they heard from the reflecting team or any further awareness they may have come to through this process. 13) Ask for the written reflections from the reflecting team. This written material will be used when writing the final narrative letter for this particular participant. 14) Now ask for another volunteer, and continue this process until the time frame for the day is up. This session will likely go for four hours rather than for the usual three hours. 15) It will be necessary to have at least half of the group go through this process in this session. The rest of the group will go through the process in the next sesswn. );;;> Materials Needed Writing tablets and pens );;;> Time Frame 2 hours Exercise 2: Homework Assignment: Journaling );;;> Procedure: 1) Ask participants to list the activities of the session in order to use them in their journals if they so choose. The day's session included debrief of the previous session, opening session ritual, defining of grief and loss through artwork, and debrief and closure ritual. Resisting Substance Use Program 103 2) Instruct participants to write or draw in their journals any meaning or awareness that came through for them today in the session during their examination of their personal grief and loss. );;> Materials needed None );;> Time frame 10 minutes Exercise 3: Closure Ritual );;> Procedure: 1) Have the participants form back into a circle as a group again. 2) Ask participants to use a descriptive word to describe their present feeling. Given the content of today' s session, it would not be unusual to have words associated with grief be dominant, such as sad, quiet, or sorrow. 3) Ask participants what experience or moment in the session led them to choosing the word they did. 4) At this point remind participants that there are only three sessions left before end of program: );;> Materials Needed None );;> Time Frame 10 minutes Resisting Substance Use Program 104 Session Eight: Conclusion of Grief and Loss Goal The goal of this session is to provide the opportunity to have everyone in the group to process grief and loss. As the processing of grief and loss is intense, it is not likely everyone within the group will have had an opportunity to do their personal work within the previous session. Objective 1 This session is designed to give enough time for everyone in the group to have an opportunity to have a debriefing done concerning their artwork, which is symbolic of their grief and loss issues. The following content provides the debriefing of the artwork participants have developed from the experiential artwork they completed last session. As a result of Objective 1, participants will a) have had an opportunity to process grief and loss issues, which may have been impacting on their substance use problem. Exercise 1: Opening Session Ritual ~ Procedure: 1) Have the group members come together in a circle, either sitting on chairs or on the floor, whichever is most comfortable for them. Resisting Substance Use Program 105 2) Now ask the participants to use a single word that describes their presentmoment feeling. This word can be sad, angry, happy, excited, or any other single descriptor they choose. 3) Pick one member to start and then move around the circle in a clockwise direction, asking each individual in turn what their descriptive word is and what was it that made them chose that particular word. Materials needed None Time frame 10 minutes Exercise 2: Debrief of Previous Session Discuss any concerns or questions participants have regarding the previous session, but note that the session today will also be focusing on grief and loss. ~ Purpose: The purpose of this exercise is for further processing and deepening of participants' experiential experience. ~ Procedure: 1) Have participants sit in a circle, either on the floor or on chairs, whichever they choose. 2) Then ask the participants to speak about the previous session. Questions that could be used to facilitate this process include the following: Now that you Resisting Substance Use Program 106 have had some time to think about our last session, what stood out for you? What did you experience during the activity? Did you have any additional thoughts or experiences you may have written about in you journals that you would like to speak of now? 3) Inform the participants that, as this is a continuation of last session, there will be a further opportunity to debrief more of their experiences later as well. ~ Materials Needed None ~ Time Frame 20 minutes Exercise 3: Continuation of Debriefing of Grief and Loss ~ Procedure: 1) Ask the participants to form a circle. They can choose to sit at tables or on the floor, whichever is more comfortable for them. 2) Inform the participants that the group will be following the same guidelines as for the previous session in order to give everyone an opportunity to have the experience of having their grief and loss work processed. 3) Now hand out writing tablets and pens to the group members who will be part of the reflecting team. 4) Instruct the members of the reflecting team to notice any strengths or resistance to the struggles the person may have encountered in their lives that Resisting Substance Use Program 107 are elicited through the conversation between the person being interviewed and the facilitator. 5) Ask for a volunteer to engage in conversation with the facilitator to debrief the volunteer's artwork. This volunteer is one who did not have their piece of artwork debriefed the previous session. 6) Invite the volunteer to begin exploring the meaning and connections between their piece of artwork and their lived experience of grief and loss. The following questions might be useful: a) What are the different shapes and colours representative of? b) Who were these people in your life? c) What relationship did you have with them? d) Why were they important to you? If the volunteer has noted a loss such as a job or a place, then the questioning could invite them to explore the importance of this event in their life: e) What was significant about this event for you? f) Whom do you associate with that job or place? Continue with this theme of questioning until a richer, more contextual story has emerged. 7) Once the richer context has been established, begin asking questions with an emphasis on what White ( 1998) describes as a remembering rather than a shutting down of expression in regard to grief and loss. These questions, which represent a relational style of questioning, can include the following: a) What was it this person valued the most about you? Resisting Substance Use Program 108 b) If you were to see yourself through this person's eyes today, what would you notice about yourself that you would appreciate? c) What do you know about yourself that you are awakened to when you bring alive the enjoyable things this person knew about you? d) How would you let others know you have reclaimed some of the discoveries about yourself that were clearly visible to this person? e) How would being aware of that which was not visible for the past number of years be of assistance to you as you move forward in your life? 8) Continue with this theme of questions, looking for strengths and uncovering of times when the volunteer was able to resist negative influences in their past, and build on these threads. Continue questioning until the volunteer has reached some sense of positive connection with the losses they have experienced and can now use the information rediscovered about being valued to move forward in their life. This can be a very emotional experience for participants, so it is necessary to pace questions and allow participants to process their experience fully. 9) Once this process is complete for this individual, ask the reflecting team to come together in a circle again. 10) Ask the volunteer to sit outside the circle, and then ask members of the reflecting team to speak about the reflections they have noted and briefly describe them. 11) Once the reflections have been given, ask the participant receiving the reflections to come back into the circle. This person will then be asked if they Resisting Substance Use Program 109 have any final reflections concerning what they heard from the reflecting team or any further awareness they may have come to through this process. 12) Collect the written reflections from the reflecting team. This material will be used when writing the final narrative letter for this particular participant. 13) Now ask for a volunteer and repeat the above process until the remaining participants have all had the opportunity to work through their pieces of artwork. );;> Materials Needed Writing tablets and pens );;> Time Frame 2 hours and 25 minutes Exercise 4: Homework Assignment: Journaling );;> Procedure: 1) Ask participants to write out the content of today's session, which includes debrief of the previous session, continuation of grief and loss work, and closure ritual. 2) Instruct participants to write or draw in their journals any meaning or awareness that came through for them in today's session in regard to their examination of their history of grief and loss. );;> Materials needed None Resisting Substance Use Program ~ 110 Time frame 10 minutes Exercise 5: Closure Ritual ~ Procedure: 1) Have the participants form back into a circle. 2) Ask the participants to use a descriptive word to describe their present feeling. as this will have been an emotional session, words such as sad, quiet, or sorrow may come up. 3) Ask participants what exercise or moment led them to choosing the word they did. 4) Remind participants that there are only two sessions left and one of them is the closure session. ~ Materials Needed None ~ Time Frame 10 minutes • Resisting Substance Use Program 111 Session Nine: Relationship Connections Goals The goals in this session are to have participants further examine the interrelationships they have with significant people in their lives and the impact of substance use on these relationships. This session includes an experiential exercise designed to highlight the significant people in participants' lives. A narrative reflecting team is used for the deconstruction of the meaning making participants are discovering about these interpersonal relationships. Objective 1 To allow participants to explore the connections they have with the predominant people who have been or are still in their lives. An experiential exercise is used to facilitate this learning and awareness. The purpose of this objective is to allow the subconscious to express the meaning people make in regard to the people they see as being significant in their lives, past and present. The following content provides an experiential exercise that will bring forth significant relationships within participants' lives and the influence these relationships have had on their lives. As a result of Objective 1, participants will a) have developed a comprehensive landscape of the significant people in their lives. White (1997) describes this as what actions these people took in a person's life, how they shaped a person's self-identity, and what their intentions for the person were. Resisting Substance Use Program 112 Exercise 1: Opening Session Ritual ~ Purpose: To enhance and continue the structure initiated at beginning of program. ~ Procedure: 1) Ask group members one by one to describe what they are experiencing right at this moment by using a single word that resonates for them. Participants can use words such as sad, happy, scared, tired, excited, whatever word accurately describes their present moment of experience. 2) Ask participants what experience or moment from the previous session led them to chose the word they did. ~ Materials Needed None ~ Time Frame 10 minutes Exercise 2: Debrief of Previous Session Discuss any concerns or questions participants have regarding the previous session. ~ Purpose: To allow participants a further opportunity to debrief what has was done in the previous session. Resisting Substance Use Program ~ 113 Procedure: 1) Ask participants to sit in a circle, either on the floor or on chairs, whichever they choose. 2) Ask participants to talk about the previous session. The following questions could be used to help this process: a) Now that you have had some time to process our last session, what stood out for you? b) What did you experience during the activity? c) Did you have any further additional reflections or thoughts that you may have written about in your journals that you would like to speak of now? 3) Remind participants to attempt to keep this short as there is only a short time to spend here. ~ Materials Needed None ~ Time Frame 15 minutes Exercise 3: Relationship Mapping (Developed by Robert May) ~ Procedure: 1) Inform the participants that the work they will be doing in this session will involve exploring significant relationships in their life through an experiential exercise. Resisting Substance Use Program 114 2) Pass out art materials: large art paper, chalks, acrylics, charcoal, or other art media. 3) Now instruct the participants to think of all the people in their lives, past and present, which were significant to them in a positive way for whatever reason. This can be friends, family, extended family, or any other person they feel was significant to them in some way. 4) Ask the participants to find a space on a table or the floor, whichever they choose, and to begin by drawing circles on the piece of art paper and putting the name of the person this circle symbolizes within or next to the circle. For example, they may make a small circle up in one corner symbolizing an aunt and put her name next to it and then further circles with other significant people from their life. No further instructions are necessary, as a component of this exercise is to determine the significance of who and where they put the symbolic circles on the paper and their relational significance. 5) Put on some type of quiet mood music to facilitate a sense of contemplation. 6) Allow about half an hour for this process. 7) At the end of the allotted time, ask participants to finish up and come back into the group circle. ~ Materials Needed Large art paper, preferably 24" by 32" A variety of drawing materials, such as chalks, acrylics, coloured pencils, charcoal Some form of quiet music and a CD or audio player Resisting Substance Use Program 115 Tables and space to work on ~ Time Frame ~ 30 minutes Objective 2 This objective will allow for the deconstruction and processing of the piece of relational work the participants have produced from the above exercise. Further, this objective allows participants to gain a sense of who is important in their lives and why. This gives participants an opportunity to reaffirm their connections with these people as well as recognizing the value these people had for them, leading to a more self-affirming sense of themselves. As a result of Objective 2, participants will a) use the reflecting team in debriefing the relational exercise to provide feedback to the participants in regard to the themes which emerge from the debriefing b) explore and make meaning of the significance of the relationships the participants have with the people they have identified through their relational mapping. Exercise 1: Debriefing of the Experiential Exercise ~ Procedure: 1) Ask participants to come back together in a circle. Resisting Substance Use Program 116 2) Inform the participants that the group will be following the guidelines from the previous sessions. 3) Hand out the writing tablets and pens to the group members who will form the reflecting team. 4) Instruct the members of the reflecting team to notice any strengths or affirming themes that may occur during the conversation between the facilitator and the volunteer. 5) Ask for a volunteer, preferably someone who has not yet had an opportunity to have a debriefing done. 6) Employ an initial frame of questioning that brings the volunteer's attention to aspects of positioning and size of the circles. Sample questions could include: a) I notice that you have drawn most of your circles on one half of the paper; do you think this has any meaning for you? b) I have noticed that some circles are small and some big; is this related to the significance of these people in your life? c) I have noticed that you have clustered a number of circles in one area; is this significant for you, and if so, in what way? 7) A common thread is that many people forget to include themselves on the piece of art. If that is evident, bring that forth and ask, Are you curious about why you have not included yourself on the drawing? Continue with this frame of questioning until the person has some sense of the depth and complexity of the relationships in their life. Resisting Substance Use Program 117 8) At this point there will be a shift to a more narrative frame of questioning, designed to elicit histories of lived experience that affirm the importance of the roles relationships have played in the participant's life. This form of questioning is adapted from Pare (1998). First have the volunteer pick one of the circle symbols of a significant person in their life to talk about. 9) Begin using questions such as the following: a) What did this person appreciate in you the most? b) How did they know this about you? c) How was their life different for having known you? d) What stories could you tell me about this relationship that would help me understand its significance? 10) Continue with this theme of questioning, always looking for affirmations of the person through the retelling of their lived experience of being with the significant person they are speaking of. When these affirmations occur, bring them forward through such questions as the following: a) Does it surprise you that this person valued you in this way? b) What does it mean for you to know that you were valued in this way? (Adapted from Pare, 1998.) 11) Once there has been some awareness concerning the volunteer's connection with the significant person being spoken of, repeat the above process by asking about the significance of another of the symbolic circles. Spend about 30 minutes going through as many of the significant people symbolized on their artwork as possible. Resisting Substance Use Program 118 12) Once this has been done, ask the volunteer to become an observer outside the circle and ask the reflecting team to come together in a circle to give their reflections. 13) Once the reflecting team has given their one or two reflections, noting strengths and affirmations for the volunteer, ask the volunteer to rejoin the group and give any final thoughts on what they heard from the reflecting team. 14) Collect the written reflections that the reflecting team members have compiled. These are to be used in the final reflecting letter provided after the end of the program. 15) Once this has been done, ask for another volunteer and repeat the above process; have as many volunteers debrief as time permits. 16) Have a ten-minute debrief of what this exercise was like for the group as a whole. This could include the following questions: a) Was there anything significant that happened for you as you listened to the conversation between facilitator and volunteer? b) Is there any final thoughts you would like to express about this experience at this time? ~ Materials Needed Writing tablets and pens ~ Time Frame 2 hours Resisting Substance Use Program 119 Exercise 2: Homework Assignment: Journaling );;> Procedure: 1) Ask participants to make a list of the content of today's session that they can utilize for their journaling homework. The day's content includes debriefing of the previous session, opening ritual, relationship mapping, debriefing of the experiential exercise, and closure ritual. 2) Instruct participants to write or draw in their journals any meaning or awareness that came up for them during this session. 3) As this is the final intense working session, ask the participants to create a drawing that symbolizes the work they have done as participants in this whole therapy group. 4) At this point give back the letters the participants wrote in the first session outlining their goals for being part of this group. They may wish to use these prior statements to help them form their closure piece of artwork. 5) Inform participants that the next session is the final session, and so there will be a small closing potluck. Ask participants to bring some simple snacks that can be shared at the end of the session. );;> Materials Needed . The goal-setting letters from first session );;> Time Frame 10 minutes Resisting Substance Use Program 120 Exercise 3: Closure Ritual ~ Procedure: 1) Have participants form back into a circle. 2) Ask the participants to use a descriptive word to describe their present feeling. As this "re-membering" process can be very emotional and affirming for participants, it is likely there will be a range of responses from sadness to elation (Pare, 1998). 3) Ask participants what experience or moment from today's session led them to choosing the word they did. 4) Remind participants that the next session is the final closure session. ~ Materials needed None ~ Time frame 10 minutes Resisting Substance Use Program 121 Session Ten: Closure Session Goals The goal for this session is to enhance participants' awareness of what they have experienced and achieved through being part of this program and to have some form of symbolic closure to emphasize their achievements. Objective 1 Participants will be able to qualify their experiences and will have developed alternative positive ways of viewing themselves. This learning they will take with them as they move forward in their lives. As a result of Objective 1, participants will a) have an opportunity for group members to further enhance the positive selfperceptions they will have discovered through this process b) have reflections given by each member of the group as to their experience of being in this group c) have had an opportunity to receive further affirmations and reflections from other group members. Exercise 1: Opening Session Ritual ~ Purpose The purpose of this ritual is to continue the group structure and provide a means of focusing on the current session leading to closure. Resisting Substance Use Program ~ 122 Procedure: 1) Have the group members come together in a circle, either sitting on chairs or on the floor, whichever is most comfortable for them. 2) Ask the participants to use a single word to describe their present moment feeling. The word can be sad, angry, happy, excited, or any other single word they choose. 3) Now pick one member of the group and ask them to speak out loud the word they have chosen for themselves. Then ask that person what from their experience in the group led them to choosing this word. 4) Ask each group member to express the word they have chosen for themselves, moving in a clockwise rotation around the group until everyone has stated their feeling word. ~ Materials Needed None ~ Time Frame 10 minutes Exercise 2: Group Reflection ~ Purpose: To have a discussion which will give participants a further opportunity to reflect on and process the previous sessions' work. This will also be an opportunity for group members to express any thoughts or feelings they have in regard the whole process they have been involved with through the course of the program. Resisting Substance Use Program ~ 123 Procedure: 1) Have participants sit in a circle, either on the floor or on chairs, whichever is most comfortable for them. 2) Ask participants if they have any further thoughts concerning the previous work that has been done. The following questions can be helpful here: a) Now that you have had some time to process our last session, what stood out for you? b) What was your experience of being part of this group? c) Did you have any additional thoughts or experiences you may have written about in your journals you would like to speak of now? 3) As this is the final debrief, about one hour will be allotted to give participants ample time to talk about their experiences and what this has meant for them. ~ Materials Needed None ~ Time Frame One hour Objective 2 This objective is designed to create closure for participants. The following content provides a banner-making exercise As a result of Objective 2, participants will a) have worked together to complete a banner that symbolizes the work they have done to this point Resisting Substance Use Program 124 b) have an opportunity to mix and socialize before the termination of the program c) have joined together in community by sharing snacks and talking with each other about their experience d) have completed the evaluation forms for the program. Exercise 1: Banner Making ~ Purpose: To create a symbol that is representative of the members of the group individually and collectively. ~ Procedure: 1) Ask the group members to bring the tables together in order to lay out the banner paper. 2) Tell the participants that they will now make another banner; this one to symbolize the work they have done while being part of this group. 3) Ask participants to sit at the table and prepare to draw on the banner paper. They can draw whatever they choose. 4) Now pass out drawing materials: chalks, pastels, charcoal, or other print media that are available. Inform group members that they will have about five minutes to work on each section. 5) After five minutes have passed, ask group members to move one chair to the left and then begin drawing again. Continue this process until there has been a Resisting Substance Use Program 125 complete rotation around the table, giving everyone an opportunity to work on each section. 6) While group members are drawing, have some quiet music playing in the background. 7) Once the drawing is complete, have it put on the wall next to the original banner that was created during the first session. 8) Once the banner is hung, ask participants to come back together as a group. Ask them to examine and reflect on the two different banners. The following questions could be posed to facilitate this process: Do you notice anything different between the two banners? Are there different themes or colours? Do you sense anything within yourself as you look at these symbols of the work you have done in this group? 9) Give the group about ten minutes to reflect and comment on anything they notice about the banners. ~ Materials Needed Banner-making paper Drawing materials such as acrylics, chalks, coloured pencils, pastels, charcoal Tables to put poster paper on Some type of softer music and CD or audio player ~ ~ Time Frame Approximately 45 minutes Resisting Substance Use Program 126 Exercise 2: Final Evaluation );;> Purpose: To collect impressions from participants about the utility of the program and what they perceived as good or bad, to enhance any further offerings of the program. );;> Procedure: Hand out evaluation forms (Appendix B, p. 135) Ask participants to please take a few minutes to complete the forms. );;> Materials needed The evaluation forms );;> Time frame 20 minutes Exercise 3: Sharing of Food and Final Thoughts );;> Purpose: This is an opportunity for group members to casually talk with each other without the structure of process. );;> Procedure: 1) Set up tables in buffet fashion along one wall. 2) Put snacks and refreshments that participants have brought onto tables. 3) Invite the group members to go around and serve themselves and mingle. );;> Materials Needed Tables for serving food The potluck food that participants have brought Resisting Substance Use Program Disposable plates and utensils ~ Time Frame 1 hour 127 Resisting Substance Use Program 128 References Burton, A. (2004). Rainbow of Desire: Therapeutic theatre workshop. Program proposal presented to Prince George Alcohol and Drug Services, April 1, 2004. Cameron, J. (1992). The artist's way. New York: Jeremy P. Tarcher/Putnam. Corey, G. (2000). Theory and practice of group counselling (5th ed.). Scarborough, Ont. Canada: Brooks/Cole. Corey, G. (1995). Theory and practice of group counselling (4th ed.). Pacific Grove: Brooks/Cole. Enright, J. (1976). Thou art that: Projection and play in therapy growth. In C. Hatcher & P. Himelstein (Eds.), The handbook of Gestalt therapy (pp. 470-476). New York: Jason Aronson. Freedman, J. , & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: WW Norton & Company. Gendlin, E. (1981) . Focusing (2nd ed.). New York: Bantam Books. Greenberg, L. S., & Van Balen, R. (1998) . The theory of experience-centered therapies. In L. S. Greenberg, C. J. Watson, & G. Lietaer (Eds.), Handbook of experiential psychotherapy (pp. 28-57). New York: Guilford. Greenberg, L. S., Watson, J, C., & Lietaer, G. (Eds.). (1998). Handbook of experiential psychotherapy. New York: Guilford. Hatcher, C., & Himelstein, P. (Eds.) (1976). Handbook of Gestalt therapy. New York: Jason Aronson. Kurtz, R. (1991). Body-centered psychotherapy: The Hakomi method. Mendocino, CA: LifeRhythm. Resisting Substance Use Program 129 Martin, D. (2004). The Hakomi method. Workshop presented at Nechako Centre, Prince George, BC, Canada, April14 & 15,2004. Available at www.hakomi.ca Monk, G., Winslade, J., Crocket, K., & Epston, D. (Eds.). (1997). Narrative therapy in practice: The archaeology of hope. San Francisco: Jossey-Bass. Pare, D. (1998). The fundamentals ofnarrative therapy. Prince George, BC, Canada. Available from author at Faculty of Education, University of Ottawa. Rhyne, J. (1973). The Gestalt art experience. Monterey, CA: Brooks/Cole. Roberts, G., & Ogborne, A. (1999a). Best practices substance abuse treatment and rehabilitation. Ottawa, ON: Office of Alcohol, Drugs and Dependency Issues, Health Canada. Roberts, G., & Ogborne, A. (1999b). Profiles substance abuse treatment and rehabilitation in Canada. Ottawa, ON: Office of Alcohol, Drugs and Dependency Issues, Health Canada. Smith, L., & Winslade, J. (1997). Consulting with young men migrating from alcohol's regime. In M. Raven (Ed.), New perspectives on addiction (pp. 16-34). Adelaide, South Australia: Dulwich Centre Publications. Stevens, J. 0. (1971). Awareness: Exploring experimenting experiencing. Moab, Utah: Real People Press. Watson, J. C., Greenberg, L. S., & Lietaer, G. (1998). The experiential paradigm unfolding: Relationship and experiencing. In L. S. Greenberg, C. J. Watson, & G. Lietaer (Eds.), Handbook of experiential psychotherapy (pp. 3-27). New York: Guilford. Resisting Substance Use Program 130 White, M. (1995). Re-authoring lives: Interviews and essays. Adelaide, South Australia: Dulwich Centre Publications. White, M. (1997). Narratives of therapists ' lives. Adelaide, South Australia: Dulwich Centre Publications. White, M. (1998, spring). Saying hello again: The incorporation of the lost relationship in the resolution of grief. In C. White (Ed.), Dulwich Centre Newsletter (pp. 29-36). Adelaide, South Australia: Dulwich Centre Publications. White, W. & Epston, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton & Company. Resisting Substance Use Program 131 Appendix A: Informed Consent Letter Consent to Treatment Name of Client: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Address of Client: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ The nature of the treatment: The treatment for this program utilizes Experiential and Narrative therapies and is conducted using a group format. This is not inclusive of individual sessions. Benefits of the program: There are a number of benefits that may occur for you if choose to participate in this group format. These can include an enhanced awareness about problems that may have an impact on your substance misuse, and strategies then can be developed that will assist you in resisting the influence of substance misuse in the future. Further, you will gain insight into your behaviours that will allow you to choose changes that will lessen the impact of these behaviours in the future. The experiential therapy that will be employed in this program will focus primarily on the use of artwork. There is no need for you to have knowledge of artwork as the artwork you do will be designed to tap into parts of yourself of which you may not be consciously aware. As such, "knowing" how to do art is not necessary. The narrative therapy used within this program can be described as talk therapy. You are viewed as the expert in your life. Further, reflecting teams with the other Resisting Substance Use Program 132 participants will be developed in order to provide more positive options for you . You then decide which reflections that the team gave are useful to you . Risk of therapy: I, ___________ (participant' s name), have been advised that there are risks in being a participant within this group. As with any therapy, there are no guarantees. Further, experiential and narrative therapies are both known to evoke strong emotions during the process of group interaction. Responses to historic or current abuse may arise as a by-product of being involved with this group. Although there is time within the sessions for debriefing these issues if they come up, I recognize that I have a connection with an ongoing support person, such as my referring counsellor, to further process these issues if needed. I understand that it is up to me to advise the facilitator promptly if I have any questions or concerns during group interaction. Consent: I have been advised of the benefits and risks inherent in participating in this group. I give my consent to address the issue of substance misuse and relevant factors that may have been a part of my substance misuse history. Further, I understand that I can choose to drop out of the group at any time. Limits of Confidentiality: The facilitator has advised me that he or she will uphold confidentiality within the limits described below but cannot guarantee that others will do the same. While there is Resisting Substance Use Program 133 an expectation that all participants will honour confidentiality, this cannot be guaranteed, and it is my responsibility to self-monitor the information I choose to share. Further limits of confidentiality: 1) If there is a report of abuse of children-- sexual, emotional, physical, neglect-- it is mandatory by law to report this. 2) Action must be taken to prevent a participant from harming him- or herself. 3) If a participant is a threat to others, action must be taken to prevent harm to others. 4) If there is a court subpoena, the records or materials from group could be called upon. Further, the facilitator could be called to testify. 5) The facilitator may also have their supervisor view the content and progress of the group as part of a regular supervision activity. Acknowledgement and Consent: I_ _ _ _ _ _ _ _ _ _ _ _ _ _ , acknowledge that I have read and understood the benefits/risks and limits of confidentiality as outlined in this document. I have also had an opportunity to discuss any concerns I may have in regard with these issues. Further, I acknowledge the information in this document and I consent to the treatment as outlined as of _ _ _ _ _ _ _ _ day of ___________ , and have been provided with a copy. Signed: _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ _ __ Client Signed: _ _ _ _ _ _ _ _ _ _ __ Witness Date: _ _ _ _ _ _ _ _ _ _ _ __ Resisting Substance Use Program Appendix B: Participants' Response and Feedback to Experiential/Narrative Journey in Resisting Substance Use Question 1: What was most helpful for you in participating in this program? Question 2: What was least helpful for you in participating in this program? Question 3: How have your perceptions concerning your relationship with substances changed? 134 Resisting Substance Use Program Question 4: Is there anything you would like to see changed in the program? Question 5: Are there any further thoughts or comments you would care to make? 135 Resisting Substance Use Program 136 Appendix C: Features of Narrative Practice 1) Separation of the person and the problem. 2) The problem is the problem ... not the person. 3) A view of the person as an authority on his or her own experience, an expert on his or her own life. 4) A direction guided by the person's preferences, rather than by normative ideas of mental illness and mental health. 5) Language is critical: Careful attention to the way language constructs expenence. 6) A posture of curiosity, driven by questions, rather than a position of certainty, driven by statements. 7) A focus on the social context of problems, and the structures which support problems in persons' lives. 8) A profound belief in the person's resources and competence. Pare, D. (1998). Fundamentals of Narrative Therapy, Prince George, BC Canada. Available from author Faculty of Education, University of Ottawa. Used with permission of Dr. David Pare. Resisting Substance Use Program 137 Appendix D: Reflecting Team Guidelines Reflecting teams are a powerful means for a number of people to both witness reauthoring and to engage in it collaboratively with group participants and the primary therapist. The three main tasks of reflecting are 1) To develop an empathetic understanding and to convey it to the group members-to truly join with the participants. 2) To notice preferred stories which don't fit the dominant problem narratives 3) To notice beliefs, ideas, or contexts that support problem-saturated descriptions, and to deconstruct these. While some of the reflecting team's richness comes from the multiple points of view it offers, we believe these tentative guidelines help to keep the reflecting more on task in a way that is congruent with a narrative worldview, and both respectful and supportive of clients. Maintain an optimistic, competence-focused outlook. Our reflections generate experience. We wish to generate constructive and helpful experience. Reflect to other team members-not the primary therapist. When teams reflect to each other, it offers the chance to be a "fly on the wall," and gives clients more freedom to accept or reject comments. Resisting Substance Use Program 138 Ensure that all group members are included in reflections. It can be distressing for clients when reflecting teams appear to align with one particular group member, or to ignore certain members' competence and overlook others'. Be tentative and curious. A generally "not-knowing" stance keeps the conversation open to further possibilities, and honours the client's uniqueness. Situate reflections in your own experience. This keeps us true to the view that not just client stories, but therapist stories as well, come from particular contexts. Transparency reduces the hierarchy and avoids the impression of corning from a position of expert certainty. Keep reflections brief and focused. Reflecting teams typically generate a wide range of ideas. Keeping reflections to one or two clear ideas helps to keep focus and avoid overwhelming the recipient of the reflections. Fundamentals of Narrative Practice: Level 2 Narrative Intensive. March 4-8, 1998. Prince George, BC, Canada. Available from author at Faculty of Education, University of Ottawa Used with permission of Dr. David Pare. Resisting Substance Use Program 139 Appendix E: Introduction to Experiential Therapy The experiential exercises that are incorporated in this program will assist each of you to come to know parts of yourself that have been hidden. The philosophy behind experiential therapy is that people are continually making meaning of their lived experience in the moment. In essence, the experiential exercises allow a person to tap into hidden knowledge that is expressed through symbolism in the artwork. In using artwork or other forms of experiential exercises, what was once hidden from an individual's awareness can surface. The theoretical orientation of experiential therapy is that individuals create meaning as an ongoing process in the immediacy of the moment. People are much more than intellect, and there is a melding between mind and body in the environment. Using of art for experiential work can be a very powerful form to bridge between a person's inner and outer realities. The act of creating art is an in-themoment experience that can reveal and make explicit what was implicit, perhaps even to the individual doing the piece of artwork. This in-the-moment experiencing is the foundation that underlies all experiential therapy. The use of artwork can be useful to create self-awareness for people, as blocked feelings, life issues, and areas of conflict can be expressed through the art without the screen of social controls being present. Each time a person draws or paints or expresses them selves artistically, they are creating an in-the-moment experiential event. There is no right or wrong way to do the exercise. All that is required is for the person doing the artwork or experiential exercise to have intent or question they would like to explore. This will then come through in the piece of artwork they create. There is Resisting Substance Use Program 140 no need to be an artist to do this work; colours, symbols, and words just form on the paper in the manner they need. All that is required of the person doing the exercise is to trust that what comes through is exactly what was meant to come through. It is not necessary to have a clear picture to do this: there is no right way. Resisting Substance Use Program 141 Appendix F: Questions for Narrative Reflection In the interview, frame questions of curiosity that work to separate the person from the problem. Questioning begins by asking THE ADDICTION, "When did THE ADDICTION first start hanging out with (your name)?" Some other questions that can be used to further this process are the following: a) What sort of tricks has THE ADDICTION used to keep (your name) involved with you? b) In what way does THE ADDICTION, stop (your name) from achieving your goals in life? c) How do you, THE ADDICTION, manage to get between (your name) and your family? d) What exactly does THE ADDICTION tell you in order to have this happen? e) Has there been a time when you have been able to resist THE ADDICTION'S invitations? f) What was it like for THE ADDICTION, when you fought back? g) What are THE ADDICTION'S future plans for you and are you okay with that?