Group Psychotherapy and Recovery from Addiction

Carrying the Message

Jeffrey D. Roth

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317788232
• Edition: 1
• Topic: Psicología
• Subtopic: Salud mental en psicología

Learn what it's like to be a member of an addiction recovery group! Group Psychotherapy and Recovery from Addiction: Carrying the Message is NOT a self-help book. Instead, it's a rare opportunity to sit in on a virtual therapy group and take part in a virtual Twelve Step meeting. The book's unique perspective lets you compare and contrast the experience of participating in a psychotherapy group and a Twelve Step group, including an examination of the Twelve Steps and The Twelve Traditions. The book demystifies the process of recovery, demonstrating all the important elements of the group process, including free association, resistance, transference, re-enactment, boundary management, interpretation, and confrontation. Rather than relate shared stories of addicts in recovery or present abstract formulations on the group experience, Group Psychotherapy and Recovery from Addiction takes you inside the experiential process of recovery that can't be achieved in isolation. Your experience as a group "member" will help solve the mystery of the group process and provide you with insight into the scientific elements of recovery as the book builds a bridge between the Twelve Step programs and a psychoanalytic model of group functioning. Group Psychotherapy and Recovery from Addiction examines:

• how the group carries the message of recovery
• the higher power of the group as a symbol of authority
• the development of prayer and meditation as group analytic functions
• addiction as a family disease
• making amends as an export process
• powerlessness and free association
• unmanageability and resistance
• surrender and transference
• inventory and re-enactments
• humility and working through
• The Twelve Steps and The Twelve Traditions of Alcoholics Anonymous
• and much more!

Group Psychotherapy and Recovery from Addiction: Carrying the Message is a unique resource for group therapists, addiction treatment professionals, and anyone else interested in group therapy—especially those who have personal experience with Twelve Step recovery.

Chapter 1

Addiction As a Family Disease

Did you read the preface? If not, please return to the preface before proceeding with this chapter. I make this request to raise awareness that in reading this book you are joining a group. You may choose to believe that you are reading this book alone, privately, in isolation. Alternatively, even if you are the only reader, I suggest that you and I have formed a group consisting of author and reader. Inevitably, you and I have been members of many different groups: our original families, social groups, work and professional groups, therapy groups, self-help groups, and other groups in which our membership may have occurred without intention or awareness. Because this book is first and foremost an investigation of group functioning, I want to make explicit that this group of author and readership is occurring with both intention and awareness.

If you accept that in reading this book you are joining a group, we have made a promising beginning in our investigation of group function. Specifically, we can now examine what factors facilitate healthy group function and what factors impair group function. I invite you to work with me in making explicit what is happening right now in this newly formed relationship.

Perhaps you have been thinking that my style in writing this book is unlike your usual texts. For my part I have been wondering if I can trust you to work with me in this difficult task. Take a moment to reflect on your doubts and reservations about joining. Instead of suppressing these thoughts, say them out loud so that you can appreciate their force and vitality.

In my experience, the process of joining a group is inevitably accompanied by ambivalence, and this ambivalence is located in the group even if only an individual or a subgroup within the group overtly expresses the ambivalence. I express my ambivalence about joining this group with you by withholding unconditional trust in your willingness and ability to work with me. By withholding trust I protect myself from feeling hurt and lonely in relation to my anticipation of rejection. Perhaps you protect yourself in similar fashion, perhaps differently.

If you are not aware of any ambivalence whatsoever about joining me, then you may trust that I am carrying ambivalence for both of us. Alternatively, you might conclude that you are simply a completely sane and rational individual confronted with a crazy author. In this latter case, we have now located your ambivalence about joining me in the notion that I am crazy.

The concept of an individual or subgroup carrying something on behalf of a group is central to group psychotherapy and Twelve-Step recovery. We will look at how a group carries the message of recovery in Chapter 2. First let us turn our attention to how our group carries the message of dis-ease (henceforth expressed in its more usual spelling, disease).

Two models prevail in our everyday explanations of human behavior, and these models are then applied to our understanding of disease and addiction. The first model asserts that our behavior is governed internally by free will; each individual operates autonomously and voluntarily. This moral model assumes many forms in different systems, including religious and humanistic. The second model asserts that our behavior is governed by some source that is external to our selves; each individual’s behavior is determined by some formula as yet unknown. This deterministic model likewise assumes many forms, including in some places that we might not expect. We might associate determinism only with a religious philosophy that posits a white-bearded controller of our destinies. However, in our current romance with molecular genetics, some of us unwittingly adopt a biological determinism in which DNA governs our behavior. Ironically, both the moral model and the deterministic models share a common feature. Disease in general and addiction in particular become manifestations of badness in the individual, either badness of conduct or badness of genes.

Neither of these models of human behavior accounts for the complexity of social systems. Let us return to our relationship in our group. Are you forcing yourself to read these words? Did you come to this book by yourself or were you influenced by your experiences in groups, your professional training, your recovery, or other social factors to enter this group with me? Is reading this particular book inscribed in your DNA? For me, writing this book seems to be a product of all of my experiences in groups. I was not ready to write five years ago. Did my DNA change in that time? I suspect that I am writing now as a way to attach to you, which I do with my own limitations, imperfections, and disease.

My attachment to you offers me a third alternative model to explain my behavior. Perhaps I am not writing this book by force of will, alone and independently. Perhaps I have a relationship with my editor and my publisher. I might share my writing with colleagues, friends, and family. These attachments might authorize and empower me to engage with you right now. You may likewise have been influenced to read this book by a direct or indirect relationship with the editor, the publisher, colleagues, friends, family, and me. What I emphasize here is the possibility that neither of us joined our group by ourselves, in isolation. You need me in order to read this book with me. I need you in order to write this book with you.

What other kinds of disease might interfere or disrupt our work together? If you authorize me to offer you some useful experience about groups, you might want my attention focused on our task. If I am at this moment drinking alcohol, using drugs, eating compulsively, preoccupied with sex, money, work, or my impaired family member, I might not be fully available to engage with or attach to you. If you become preoccupied with the idea that I am distracted in any of these ways, your preoccupation might disrupt your ability to engage with or attach to me. If we keep the focus on us as a group, rather than on either of us as individuals, then whatever is interfering with my ability to work with you may generate disease in our group, and the extent to which you become preoccupied with this interference may also be symptomatic of this same disease process.

I propose a thought experiment. Imagine: I am now polishing off a fifth of Scotch. My editor has been kind enough to correct my numerous typographical and grammatical errors; you cannot smell the alcohol on my breath through these pages, and you cannot see the glassy look in my eyes. I have succeeded in overcoming my overwhelming terror of writing this book, but I am paying for my intoxication with an irritatingly garrulous style. Are you reminding yourself that this is only a thought experiment? Are you wondering whether this mad author is desperately confessing his uncontrolled drinking?

If you can imagine yourself engaged in these thought processes, you may be able to appreciate the impact of alcohol entering into our group. If we extend this thought experiment, but now you are the one polishing off the fifth of Scotch, we might adopt a more inclusive attitude toward the presence of this third member of our small group, the fifth of Scotch. I suggest that to the extent that this fifth of Scotch impairs our work together, which one of us is doing the drinking is irrelevant. We may both suffer from the presence of this third member, this fifth of Scotch, this symbol of disease. We have encountered a group disease. If our group were a family, we would be suffering from a family disease.

You may object now, claiming that the question of who is drinking is of paramount importance. After all, you point out, only one of us will wake up tomorrow with a violent hangover. I respond (gently, I trust) that you are mistaken on two counts. First, that for the purposes of this particular moment, having a hangover tomorrow is irrelevant. I am only concerned with how we are functioning as a group right now. Second, even if I reluctantly allow you to drag me kicking and screaming into the future, both of us will suffer tomorrow from contact with our mutual friend alcohol today. If I have the hangover, you may need to question whether your time and energy has been well invested in reading about group function or intoxication. If you have the hangover, I may need to question whether my time and energy has been well invested in writing to someone in a blackout who may not even remember ever having picked up this book.

Let us pause here. I teased you just now about dragging me kicking and screaming into the future. Sometimes the process of joining a group may be experienced as dragging oneself or dragging someone else into a process kicking and screaming. I hope I have clearly stated my premise that this process of joining and attaching to a group is central to an understanding of addiction, recovery, and group psychotherapy. As a physician, I believe in informed consent. Therefore, as an author, I believe you deserve to know where I see us going together if you accept the premise that we are now in a group together. On the horizon I see us finding that:

1. Addiction is fundamentally a disease of isolation.

2. Isolation is defined in terms of the individual’s relationship to the group.

3. Isolation of any group member or subgroup reflects an impairment in the group’s ability to include that member or subgroup.

If we accept these first three premises, we may also find that:

4. Addiction is a disease of the group.

5. Individuals do not recover; groups recover.

Now that I have put my cards on the table, you may have two reactions. The first reaction might be, what was all this fuss about? Nothing is controversial here yet. Okay, I am part of the group and let us get on with the matter at hand. The second reaction might be, do not tell me I cannot recover without a group. I may need others for some aspects of my life, but in other aspects I am doing very well by myself, thank you.

If you are not able to see yourself at this point as part of a group, I strongly recommend that you reconsider your decision to read this book alone. On the other hand, if you cannot identify with the wish to withhold a part of yourself from this project, you are the first perfect human being I have the honor to encounter. In case you are this perfect human being, and because we have paused for a moment anyway, I will share a story with you.

I was going to see a patient for the first time in consultation. The door to my waiting room from the outside hallway was made of translucent glass. When I opened the door from my consultation room to the waiting room, I saw that the waiting room was empty. I noticed, however, through the translucent door to the hallway, that someone was standing right outside the door. I invited the woman in, ascertaining that she was the patient whom I was going to see. Following this consultation appointment, I accepted her as a patient. After more than a year of treatment, I noticed that while she seemed to be able to associate freely (see Chapter 3), she did not respond to my interpretations and I realized that I was confused about why she was a patient. I decided to ask her why she was seeing me, and she replied, “I did not want to see you. The only reason I am here is because you invited me in.”

Unless you are also reading this book only by invitation, we may continue now with our examination of addiction as a family disease. I offer you what I consider to be some indices of healthy group function, contrasted with some corresponding indices of diseased group function:

1. A healthy group operates for the benefit of all of its members. Members are able to assume roles that fit their abilities, and all members receive support from the group to perform their tasks. Consider the group that resides in each cell of our body. This group includes a nucleus, ribosomes, mitochondria, a cell membrane, and other cell constituents. Each member of this group has a role suited to its structure and composition. No member is superfluous; all members need one another’s participation to maintain adequate healthy cellular (group) function.

The group becomes diseased when any member is unable to carry out its role in supporting the group effectively. Suppose that the cell is in a body that is smoking a cigarette. The cell is exposed to nicotine, a metabolic poison, which interferes with the mitochondrion’s role of transforming fuel into energy. The other members of the cellular group gradually adapt to the presence of its nicotine-impaired mitochondria by making demands for more fuel, and the body that is smoking cigarettes finds itself burning its stored fat (losing weight) or increasing its food intake.

As long as we are considering the impact of nicotine on the cellular group, we may as well look at its impact on groups of humans. Two groups of humans in particular have suffered from the impact of nicotine’s psychopharmacological effect on interpersonal chemistry. Ironically, these two groups are mental health professionals and substance abuse treatment providers, as well as many of the clients that both groups treat. Nicotine is an emotional poison, which interferes with the individual’s ability to transform experience into emotion. An illustration of this mode of action of nicotine is available in the group consisting of condemned prisoner and firing squad. The prisoner is offered a cigarette prior to execution to short-circuit his terror. The firing squad can then kill the prisoner without risk of identifying with him, because the emotional glue that holds the group together as a family of human beings has been dissolved.

Continuing with the theme of addiction as a family disease, the disruption by nicotine of intimacy in the therapeutic relationship is equally effective whether the therapist or client is under the influence of nicotine. I suspect that the use of nicotine has protected generations of therapists and clients from the intimacy that arises effortlessly in the therapeutic encounter. Thus, whether I am smoking while writing this book or you are smoking while reading it, in either case we are both enveloped in a cloud of smoke that will interfere with a clear examination of our feelings, and therefore interfere with our attachment.

2. A healthy group has the capacity to regulate its boundaries effectively.

I wrote this last sentence about an hour before two hijacked airliners crashed into the World Trade Center. I am now leaving my downtown Chicago office early respecting my powerlessness over my nation’s inability to regulate its boundaries, and respecting the love of family and friends who wanted me away from tall buildings. I have called each of my patients to cancel our appointments for today; making contact with them as best I can reflects my commitment to these relationships, as leaving downtown Chicago now reflects my commitment to relationships with family and friends. How then do I respect the commitment I have made to you, the commitment to write to you and share the process of joining this group with you?

Join me then, in what is now my present time, what will be the near or distant past for you: Tuesday, September 11, 2001. I suspect that wherever you are today, at this moment, that you are like me, in shock. People around us share the widest range of feelings. Many of us feel terror. Some react to the terror by shutting down, becoming numb. Others are becoming hypervigilant. A few people are feeling sadness, crying. Some are enraged or outraged. As in the case of many crises, most of us are a little more sensitive to other people, and we reach out cautiously, not wanting to be isolated ourselves in the intensity of our feelings.

Then, still in shock, or emerging from shock, we look for some meaning, some way to make sense of the chaos and overwhelming emotions. As I write this description to you, I am aware that one way for me to cope with the assault on our national boundaries is to focus on the task at hand, my one small piece of reality that would otherwise be totally consumed by this catastrophe. The challenge at this moment is the same challenge that any group faces, whether experiencing calm or crisis.

How do we regulate the boundaries of our group so that these boundaries remain semipermeable? A semipermeable boundary retains within the group and brings into the group the components and support that the group needs for survival. The semipermeable boundary also protects the group from harmful or toxic effects, and eliminates toxic products from the group. With an impermeable boundary the group starves for nourishment and suffocates in its own waste.

At least two aspects of our nation’s boundary regulation are relevant here. First, an enormous amount of energy has been invested in preventing airline hijacking, not to speak of preventing the use of such airplanes to perpetrate wholesale slaughter and destruction. Yet we have maintained, and we will likely continue to maintain, boundaries that are permeable enough to allow the unthinkable to occur. Second, and perhaps more significantly, we expend much of our emotional energy directed toward defending ourselves from attack from the outside, leaving ourselves vulnerable to the more probable attack from within us. I suggest that multiple layers of collusion on our part exist as necessary ingredients to this tragedy. I suggest this not in the spirit of blaming ourselves, but in the service of maintaining semipermeable boundaries. I watch today as most of my immediate environment is shutting down. Flags are flying half-mast. In tandem with needing to pause, rest, and recover from the shock, we must also maintain hope that our connection can persist intact.

3.Hope for the future is an experience that we might associate with generativity and reproduction, which provide a third index of healthy group function. A healthy group has the capacity to import new members across semipermeable boundaries. These new members are assimilated into the group. As the group enlarges, it prepares for reproduction by generating a differentiated membership that can fill all of the necessary roles for two separate groups to function.

Returning to the cellular metaphor, when the cell is reproducing during mitosis, each component of the cell must be replicated so that each offspring has a nucleus, ribosomes, mitochondria, cell membrane, and the rest of the complement of cellular constituents. Ideally this succession occurs collaboratively, each cellular constituent supporting the process of reproduction. Similarly, in a well-functioning group, members support one another in developing the necessary skills to provide leadership, direction, boundary regulation, and reproductive capacity for the offspring of that group.

Sterility is one symptom of diseased group function. The group expresses its ambivalence about joining together by failing to cooperate and support each member in accomplishing the tasks necessary for group function. Boundaries may be vague and porous to the point of leaving the group poorly defined, or so rigid that the group is unable to import new members to support succession. Note that group reproduction does not necessarily entail creation of two separate groups. Sometimes reproduction may simply look like replacing a group member with another member. This substitution alters the original group, and we may consider this...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• A Note About the Fonts
• Acknowledgments
• Chapter 1. Addiction As a Family Disease
• Chapter 2. How the Group Carries the Message of Recovery
• Chapter 3. Powerlessness and Free Association
• Chapter 4. Unmanageability and Resistance
• Chapter 5. The Higher Power of the Group As a Symbol of Authority
• Chapter 6. Surrender and Transference
• Chapter 7. Inventory and Reenactment
• Chapter 8. Humility and Working Through
• Chapter 9. Making Amends As an Export Process
• Chapter 10. Continuing the Inventory and “Self-Analysis”
• Chapter 11. The Development of Prayer and Meditation As Group Analytic Functions
• Chapter 12. The Twelve Traditions: Boundaries and Containment
• Appendix A. Twelve Steps of Alcoholics Anonymous
• Appendix B. Twelve Traditions of Alcoholics Anonymous
• Bibliography
• Index