RecoverMe - June 2014
RecoverMe - June 2014
SAOL Project
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Contents
Page
Foreword
Acknowledgements
The SAOL Project
004
005
007
Introduction
008
Section 1:
Section 2:
Introduction to RecoverMe
Using the Manual
010
032
Module 1:
Introduction
042
Module 2:
070
Module 3:
As Simple as ABC
086
Module 4:
I Disagree
100
Module 5:
116
Module 6:
130
Module 7:
146
Module 8:
Embracing Success
160
Module 9:
Facing Fear
172
185
204
218
Bibliography
231
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5
Appendix 6
Appendix 7
238
239
240
241
243
244
245
Attendance Sheet
Emotions Diary
Drug and Alcohol Diary
Grounding Meditations
Safe Plan
Feedback form/Evaluation Scale
Certificate
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Foreword
I am very proud to be Chair of the SAOL Project as we launch another important
manual that is going to improve the rehabilitative treatment for people in recovery
from addiction throughout Ireland and beyond. As attention turns to recovery in the
political discourse about substance use treatment in Ireland, it is timely that SAOL
presents a programme that looks squarely at this issue and offers a creative
response for projects, supporting them in helping people in the early days of their
recovery. Built around three of the best evidenced-based interventions known,
(C.B.T., Motivational Interviewing and Mindfulness) RecoverMe is a powerful tool for
recovery workers.
Recovery is often a long and difficult course with slips and relapses as part of the
process. Yet are all those slips and relapses necessary? If those in recovery knew
earlier that their thought processes were likely to be adding to their problems and
that greater awareness of their daily lives and the triggers inherent therein might lead
to quicker recovery, would their choices be different? And for workers, if they had
easily accessible tools that could help this process to occur more quickly, would that
help? SAOL and RecoverMe believe so, and that is why this manual has been
created. Inter-agency dialogue in recovery work must include sharing resources and
that is why SAOL shares RecoverMe willingly today.
Fittingly, it could not have been completed without the help and support of other
addiction services, and to them I offer my heartfelt thanks. These agencies, that
bring their skill and insights to this field, are a key resource for recovery and should
be treasured as such. The current environment in Ireland, where services are being
continually undermined due to insecure funding and threats to relationships with
funding agencies, is harmful to this resource and more particularly, to the recovery of
our clients and requires serious attention.
Continued social deprivation among our client groups also undermines recovery; this
requires immediate attention and action. As the call for greater emphasis to be
placed on recovery is made, we should not forget that rehabilitation is only one
aspect of this process; better and easier access to proper housing, good education
that supports the needs of the children and adults who require it, faster and more
supportive responses to domestic violence and equitable health care are just some
of the areas that accompany people to effective recovery. RecoverMe will help this
process but positive change is not possible without these social supports.
People in recovery are regularly blamed for creating their own situation. Of course
they must become aware of their own role in their situation and seek to change it,
and that is where RecoverMe can help; but to blame people in recovery without
reflection on the whole picture is in RecoverMe speak, limited thinking; thinking that
is narrow and unhelpful. RecoverMe encourages people to challenge their limited
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thinking, disputing their thought patterns and finding newer, more truthful
interpretations of their situations, and I encourage this for us all.
I have already mentioned the incredible help received from other projects in
completing this manual; I want now to thank the participants of SAOL for inspiring
this manual and also assisting in its compilation. Particular thanks must go to Barry
Costello for taking the original idea and creating a manual that makes the complexity
of recovery and the convolution of emotions simple to understand and make
effective. Thanks also to our inspiring Director, Gary Broderick, for guiding this work;
and to all the staff, board members, volunteers and student placements that have
had a significant part to play in this publication. My thanks also to the academics and
practitioners, from around the world, who read and guided the creation of
RecoverMe.
The SAOL Project aims to develop, responding to the changing needs of the women
who participate in our project with creativity and commitment and I am proud to
launch RecoverMe knowing that this undertaking continues in 2014.
Catriona Crowe
Chairperson
SAOL Project
June 2014
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Acknowledgments
SAOL Project would like to thank everyone who contributed to the development of
RecoverMe, particularly:
Gary Broderick, who came up with one exercise on his own and got it on the front cover.
To the participants who are the reason for this, who demanded this and who made this
manual possible by doing RecoverMe before everyone else.
To all the Board of Management, staff, volunteers and student placements who brought
their unique hope and kindness to RecoverMe. SAOL can only do what it does because
of you and is what it is because of you and the fact that the participants who come to
SAOL have a better chance of recovery by coming here is because of you and the
relationships you form with them. RecoverMe is an expression of that and you should be
almost as proud as Barry.
The team will support me in offering particular thanks to Bernie for the brillant edating
and spilling cheques as well as your amazingly positive outlook that brings happiness to
the project every day.
Joanne, who got the photocopier repaired; your timing was perfect.
To the projects who piloted RecoverMe ARAS, Ballyfermot STAR, Ballymun STAR and
Coolmine Drug Free Day Programme many thanks to the staff who worked on the pilot
and the participants who took part and gave such valuable feedback.
To Kevin Ducray, Melinda Hohman, Hilda Loughran and Josephine Lynch for your
support, encouragement and academic prowess.
To all the agencies who fund the work of the SAOL Project HSE, DSP, Probation,
NICDATF and CDETB we continue to be very grateful and hope you continue to
support what we do.
Special thanks to Unite Union, Hayworth and Hunt Office who have supported this
launch of RecoverMe; and to the Department of Health and the Office of Public Works
for sponsoring the launch at Dublin Castle conference Centre.
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Introduction
When Reduce the Use 2 (RTU2), was published in 2011, we had already noted that
some of the participants, who had found it useful in their recovery, were ready for
something more. RecoverMe was born out of the need to explore the deeper issues
relating to recovery and change. One of the participants who took part in RTU2 said,
I cant enjoy drugs anymore, I have Reduce the Use in my ear !, but as a result of
that initial learning, further questions arose: What next? Who am I without drugs?
What if the fear of change takes over? What are all these new feelings?
Taking up where RTU2 finishes, RecoverMe works with people who are changing
their use of substances and/or behaviours and want to learn more about what they
are going through. It builds on the changes initiated through RTU2 but now asks
group members to consider how the new emerging feelings are affecting their
thoughts and actions; and how awareness of such new feelings is acting both as a
trigger for relapse, and a motivator for change.
Following a similar structure to RTU2, RecoverMe takes insight from Cognitive
Behavioural Therapy, Motivational Interviewing and Mindfulness, it also draws on the
12 Step Programmes, Community Reinforcement Approach and Brief Interventions
to create a programme that nudges people who are often not yet drug free 1 into
exploring their feelings and how such explorations can lead to better, more lasting
recovery.
RecoverMe, like RTU2, does not expect participants to be drug free; instead it
encourages group members in the direction of positive change and highlights the
possibility of life without substances/addictive behaviours. However, SAOL and
RecoverMe believes that lasting stability with appropriate detoxification is a better
outcome than a rush for temporary, drug-free status that regularly results in relapse
which can often be dangerous.
This manual comes in two parts:
Part one: gives a background to the manual and a detailed overview of the
programme. It notes the reasons behind the exercises, the links to RTU2 and the
skills and materials required for each session. It also informs the facilitator of the
skills required to deliver the programme.
RecoverMe can be used effectively with people who are drug free. We highlight its usefulness with
people who are not drug free because we have found that people who are still using drugs or who are
on methadone or who are active in other addictions can and do address their feelings and work for
lasting change. RecoverMe suggests that those who have been able to fully take part in RTU2 are
likely to be sufficiently stable and motivated enough to engage in this programme.
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Part two: presents each of the twelve modules, including facilitator guidelines,
outlines of each module, all the worksheets and the handouts needed for each
module.
As with RTU2, the RecoverMe manual is for the facilitator and photocopies of
worksheets and handouts should be available for each group as needed.
Finally, it is our experience that people with addictions tend not to limit themselves to
one addiction, and therefore poly drug use along with behavioural addictions is the
norm. RecoverMe works best with people who have managed to remove the chaos
from their lives and now wish to keep these initial changes going. Whether they
have addictions to alcohol or heroin, gambling or the internet is ultimately immaterial
to the process of change. However, facilitators should keep in mind that such
matters may be of immense importance to group members, with drinkers less happy
to be in groups with drug users and gamblers not feeling understood when sharing
space with people with other addictions. To this end, group composition requires
your attention.
Feedback from the Projects who piloted the programme also note that people who
are drug free benefit from RecoverMe but that the language of exercises focusing on
maintaining a reduction in drug use is a little unhelpful.
Time and financial constraints for publication mean that we will not include versions
of exercises where drug/alcohol use is not the focus of change, however we will
make such versions available on our website at www.saolproject.ie. Keep an eye on
the website for any new exercises, updates to the current manual or details on
training in RecoverMe or any of our other manuals.
Please note, RecoverMe is free to use. SAOL Project asks that you acknowledge
our role in developing this programme and you might also consider letting us know
how the programme is going, so that we might incorporate your insights into future
editions of the programme (see section 2.13 for more details).
SAOL Project is also committed to supporting you in setting up a RecoverMe group,
so contact us at [email protected] if we can be of help.
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Section 1
Introduction to RecoverMe
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1.2
Ethos of RecoverMe
1.2.1 Worldview
1.2.2 Wheel of change/Transtheoretical Model of Change
1.2.3 Functional analysis
1.3
1.4
1.5
1.6
1.7
1.8
1.9
It Works!
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While this is different from person to person, we have found that the initial changes are made to new
behaviours and/or new substances and that longer term behaviours/substance-use will be addressed
during a second or third engagement with RTU2.
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RecoverMe is directive in its name also. Recover Me a play on the word Recovery,
names that through addiction I have been lost, however it offers a pathway for I (or
me) to be recovered.
It does not blame the substance use/behaviour for the loss but explores how this
use/behaviour hinders recovery; it wonders about why it might sometimes feel more
preferable to get drunk or high rather than get used to the I that has been absent
for a while.
RecoverMe is simply trying to highlight that the discrepancy between who I am, and
who I want to be, compared to who I am when I use substances or engage in certain
behaviours that are different. RecoverMe wants to explore those differences in order
to fully know and want the me that recovery can bring back to the fore.
For many people who engage in problematic substance use early in life, this journey
of self-knowing is hampered. Emotional knowledge is often limited. So that when
the friendly keyworker asks, And how are you today? the monosyllabic answer that
is offered is not because there is unwillingness to answer, but is often an unknowing
as to how to answer the question. After all, what are feelings? What are they for?
What do they do? Why are they important? My substance use/behaviour has
closed them down or exaggerated them for the past number of months/years and
now I do not know how I am feeling; and I do not have a way of measuring the
difference between happy, sad, angry, lonely, and scared.
Sometimes the keyworker can forget this and can be frustrated with the participant
for being too resistant. RecoverMe will help by offering a set of tools that will take
us all back a step or two; so that we can check that the people we work with have a
lexicon of feelings/emotions available to them.
NDRIC is the National Drug Rehabilitation Implementation Committee and was set up to implement
the Rehab Report (2007)
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facilitators are assessing individuals for a RecoverMe group they consider, along
with all other matters, two other issues:
1. How will the RecoverMe programme assist with the individual participants
care-plan and the work already being conducted with them? If there is any
indication that RecoverMe might interfere with such work then it is possible
that now may not be the time for the individual to take part in the programme.
The RecoverMe facilitator should consult with both the potential participant
and case-manager on this matter.
2. How can case managers and appropriate keyworkers be both informed and
utilised in the journey of learning that is RecoverMe? Participants may need
extra support in processing their learning; they may need help in completing
homework or keeping such documentation safe. Case managers and keyworkers (who will probably be working with the individual after RecoverMe is
completed) who are aware of the programme will add to its overall
effectiveness and make it a more integrated experience and set of learning for
the participant.
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Miller Williams
Evocation is the practice of drawing things out from the participant rather
than putting things in. People do not have to be fixed they need space,
room to think and a chance to work out what they want. They need the
opportunity relate to their emotions, choices and consequences. All the
facilitator has to do is add information when appropriate and assist the
participants in processing the new ideas, drawing out from them its
implication for their life.
RecoverMe intentionally promotes change to enable the participants lives to be
better, freer and filled with hope. This happens through the ethos as espoused by MI
but also in the knowledge that the participant is in a relationship with the RecoverMe
facilitator and the RecoverMe group members. Moreover, it is these relationships
wherein change and personal growth can occur.
This then is the other key element of its ethos that the participants and the
facilitator participate in the therapeutic process. This alliance is central to both MI
and Mindfulness-based practice and is enhanced by greater self-awareness.
Therefore, Mindfulness practices as well as self and group reflection are encouraged
throughout and beyond the RecoverMe programme. Facilitators are asked to
develop Mindfulness practice for themselves; each session begins with a Grounding
Exercise for the group to come together and build an awareness of where they are
at the start of that session.
1.2.1 Worldview
A key piece in Mindfulness is expressed with the term Worldview. Everyone has a
particular way in which they view or perceive the world. Such perceptions (ontology)
and how we know them (epistemology) result in how we determine change and how
our personality develops. Mindfulness tends to suggest that the activity in the world
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connected world, in the light of the context within which we find ourselves. In other
words, we shape our reality out of the experiences within which we find ourselves.
This is important for facilitators because the groups we work with have their own
realities and these have been formed out of their specific worldview or context.
Therefore, it is very important that facilitators get to know the worldview of the group
they are working with.
There is no absolute reality; there is no absolute interpretation of the world. There is
simply the worldview of the people we get to work with. It is our task to understand
that worldview as best as possible.
So, if your group have an aversion to tears, is there a shared interpretation given to
crying that is not the same as yours? If your group do not challenge each other, is
there a different take on what a traitor does? If people do not ask for help, is that
because to do so will be interpreted as being weak?
Worldview is not an objective take on reality; it is an interpretation of reality based on
the experiences of the participant group. Alertness to such interpretations is
essential for RecoverMe.
RecoverMe, then, can be summarised as:
A programme where new beliefs are presented, tried out and then used
to create new goals for continued recovery; this occurs in a reflective
environment of participation, acceptance, compassion and evocation where the
facilitator is as actively engaged with the learning as the participant.
RecoverMe is visualised as:
It is possible that RecoverMe would work without the ethos and approaches outlined
above. Even if it does, though, SAOL would not like to be associated with such
work. A respectful relationship for change is not too much to ask for people who
come to us for help; if you cannot provide that, then you are on your own!
1.2.2 Wheel of Change/Trans-theoretical Model of Change
RecoverMe, as with Reduce the Use2, uses the Wheel of Change as a cornerstone
for self-awareness in relation to the process of change. The Trans-theoretical Model
of Change describes the process of change in an effectively straightforward fashion
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that assists participants in identifying, without criticism, where they are in relation to
the change they want to make. As a model, its use goes beyond changing addiction
behaviour and offers a guide for change in relation to any aspect of the individuals
life. It is for this reason that we use this model as it can help people in early
recovery to identify the changes that they need to make that are not of necessity
directly linked to or arising from their recovery; it also shows them that the tools they
have learned from recovery can be adapted to everyday life
(Prochaska,Norcross,DiClemente, 2007).
In summary, the stages of the Wheel of Change are:
Pre-contemplation: Not Aware. This is the stage where the need for
change is not seen by the individual; but the need for change is often seen by
the people around them.
Contemplation: In two minds. This stage is where the individual is
particularly ambivalent about change the old activity/behaviour has not worn
out its usefulness and the new activity/behaviour does not look as enticing as
it might. Nonetheless, change is being considered.
Preparation: Getting ready. The stage where, even though there is still
ambivalence, the decision is made to change and a plan is designed to make
successful change as possible as it can be.
Action: The doing part, where the plans are activated; lots of change and
early coping strategies necessary.
Maintenance: Keep going. Once the change is made, the impact of such
change has to be adapted to, and other subtle adjustments made; this long
stage is acknowledged here.
Relapse: Sometimes the plan does not work out relapse occurs, this stage
acknowledges the return to old behaviours and encourages the individual to
reconsider contemplation.
Exit: Changed. This refers to the time when the problem is no longer a part
of the persons life; a time when the person is not going back to the behaviour
or even thinks about it very often. Technically, it is referred to as behavioural
extinction.
In diagram form, the Wheel of Change can be presented in many ways. This is one
that we find useful:
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This model can be used throughout RecoverMe; each time change is being
discussed, awareness can be improved by reminding people about it and asking
them about where they are on the Wheel of change in relation to that current issue.
1.2.3 Functional Analysis
Functional Analysis explores the antecedent, behaviour and consequence
eventuality in order to establish our understanding of our triggers for behaviour. This
work originally presented by B.F. Skinner (1938) is based on the ideas of operant
conditioning and positive and negative reinforcement. Fundamentally, it believes
that all behaviour serves a function and part of change and recovery is founded in
discovering and understanding such function(s).
Such function is summarised into four main types:
1. Attention: We need attention to survive, so our behaviour can be a way
of getting attention.
2. Escape or Avoidance: Wanting to get out of a negative experience that
makes one anxious or distressed is an easy to understand reason for
behaviour.
3. Self-Stimulation: Any behaviour designed to stimulate including relief of
boredom, creation of arousal or just physical incentive.
4. Reward: Something gained after a desirable behaviour has occurred;
such reward encourages the behaviour for the future.
When one reflects on recovery and relapse, it is helpful to explore what the function
of each action might be for an individual; should the action stop being functional, it
will not be continued.
STAR also helps with understanding the function of behaviour:
S: Setting around which all of the action relating to the behaviour takes place.
T: Trigger, the events preceding the main behaviour. This may not be the
immediate cause to the behaviour but all that happened before. For
example, meeting a friend who invites you to a party may be the immediate
cause of the substance use but the trigger may have been a row with a family
member earlier in the day.
A: Action, this is the target behaviour, which in early recovery may be
substance use or avoidance of substance using.
R: Result what are the consequences of the behaviour? Was the function
achieved? Did the individual get the attention they needed? Did they avoid
pain or escape a stressful situation? Was stimulation or reward achieved?
Functional Analysis can therefore be an excellent way of assisting participants to:
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However, it can often be our own concerns about our ability to work with dual
diagnosis that holds us back. In such situations, you are encouraged to access
appropriate training.
Guidance
One to one mentoring and support
Group support
Feedback
Childcare supports
Removal of other practical blocks, such as travel and associated costs; group
start and end times; food (e.g. breakfast or lunch) and agreement from other
key-workers/agencies etc.
Knowledge about the current situation in the community (or communities) of group
members about current drug, alcohol and other addictions/practices is helpful. While
much of this will emerge during RecoverMe sessions, it is important that the
facilitator knows what is happening and is somewhat prepared for issues that may
emerge.
the facilitator will need to work together to explore how ready they are for a
programme like RecoverMe.
It is important to say that drug, alcohol or poly drug use is not in itself an impediment
to doing RecoverMe. The emphasis of this programme is away from reducing
substance use; rather the focus here is on how such changes impact on everyday
life. Drug diaries are still part of the programme, so facilitators need to remember
that reductions in alcohol or drug use may occur while a person is on this
programme. Facilitators should therefore remember to check that people are aware
of the dangers of medically unsupported changes in substance use whether
prescribed or illegal and, in keeping with their own policies and procedures,
encourage medical guidance for such changes.
RecoverMe will awaken thoughts and feelings. This can be expected as normal for
people who are drug free (as it is probably happening anyway), but it will also
happen for those still using substances or involved in addictive behaviours.
RecoverMe is not about exploring the background to those thoughts and feelings
and helping the person process such experiences; that is the work of counselling or
group therapy. RecoverMe is about accurately naming thoughts, emotions and
behaviours and examining them to see if participants have beliefs about them, have
a way of processing such emotions and checking to see if there are patterns in
feelings and emotions that are unhelpful or that might lead to relapse or other
harmful actions.
For the facilitator, there are two key areas that require attention:
1. The potential for relapse exists and therefore the need for relapse prevention
throughout the programme is necessary. This can be done weekly using the
safe plan at the end of the session.
2. There is a potential for a wide range of issues and memories to emerge or to
be revealed in new ways. As mentioned, RecoverMe is not about unearthing
these experiences; but the facilitator needs to be aware that they may
emerge nonetheless. Common negative thinking is often related to loss and
mourning, guilt and shame, and of course past traumas and painful
memories. It is important for the facilitator to know what supports are in place
for each participant and to check that they are utilising such supports while on
the programme. Even better practice is to have all other professionals
working with individual participants informed and aware of the group, so that
the work being done in RecoverMe fits in with any on-going care plan.
If an inter-agency care plan does not exist for participants, facilitators might
consider putting one in place.
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1.6
When SAOL published Reduce the Use2 in 2011, it was felt that there was an
important need to name the fact that women have different experiences of addiction
when compared to men. Women start, continue, relapse and recover differently from
their male counterparts. In 2014, the urgency to name this feels different. People
seem to be more aware that when they work with women that they need to be
sensitive to the gender differences. This awareness is necessary when facilitating
RecoverMe.
Still, it is an easy thing to forget when busily trying to get a group ready. Therefore,
we offer the following questions to help get your head gender aware:
ther than the usual group rules, are there any rules than might be helpful for
ight some participants be caring for children? Does this impact on the group or
motions are difficult for both sexes, but are there specific emotions that you
ot all men are violent, but will the women in your group have experienced
Ballymun Star
Coolmine (Day Programme)
Ballyfermot Star
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Aras (Kildare)
SAOL Project4
Addiction Response Crumlin (ARC) were also involved in this process but did not have enough of
the programme completed to feel ready to take part in the feedback. Nonetheless, we wanted to
acknowledge their participation.
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It is something that has been missing from the addiction recovery field.
This programme is not about the to do; rather it explores the how of
recovery. How to recognise emotions; how to integrate emotions; and
how to put words on thoughts and feelings instead of acting out on
them.
ii.
iii.
In one group that was only for men, it was recorded that it allowed
them a chance, for one of the first times, to openly discuss feelings and
how they impact their lives; and that they were then able to bring that
learning home.
iv.
v.
vi.
Module 3 had a lot to get through. Indeed, the recurring negative was
that there was so much to get through in the programme that the
schedule was too packed. As a result, we have adjusted the running
order and increased the number of Modules from 10 to 12. We are
also emphasising that a module may take more than one session to
complete and the speed of completion is left open to facilitator. See
2.3 below for more on this issue.
viii.
Layout issues and timing were two other main concerns; some detail
on explanation about some exercises. Hopefully these issues have
been addressed more effectively in this publication5.
Relevance to my life
Increasing confidence in relation to positive skills
Help with improving relationships
Given a sense of optimism
Influences how I will communicate with others
Identifying areas of change in my life
These are measured using a five point Lykert scale (strongly disagree (1) to strongly
agree (5) and the form is available in the Appendix 6 for use at the end of each
session.
Should this not be the case, we invite people to contact SAOL so we can up-grade the PDF version
that is available for download from www.saolproject.ie
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Modules
Total
Score
Percentage
Average
score
per session
Module 1
516/625
82.56%
4.13
Module 2
441/510
86.47%
4.32
Module 3
959/1135
84.49%
4.22
Module 4
527/570
92.45%
4.62
Module 5
493/560
88.04%
4.40
Module 6
531/595
89.24%
4.46
Module 7
422/510
82.75%
4.14
Module 8
230/265
86.79%
4.34
Module 9
166/180
92.22%
4.61
4285/4950
86.56%
4.32
In summary
Please note that in the pilot there were only 10 Modules and that Module 10 used a
different form for feedback that was for the participants own use. Module 3 was
divided into 2 sessions by some of the groups, therefore it records a particularly high
number of feedback reports.
The average score for each session is high with Modules 4 and 9 scoring particularly
highly. Sub-scoring within the 6 factors that participants were asked to score say
Relevance to my life and Identifying areas of change in my life being continually
rated highly; Increasing confidence in relation to positive skills scored slightly lower
than the others, but tended to increase as the programme continued.
Process measures can also be helpful, such as feedback regarding
curriculum content, instructional strategies, group leader skills, and client
satisfaction. In designing psycho-educational content for group work, it is
useful to know how clients respond to the group as a whole as well as to
individual sessions. This helps determine what is particularly meaningful to
them. Without this information, group workers can only make assumptions
based on what they observed during the group session as to the relevance
of the group content and process in that particular session (Corey & Corey,
2006 in DiStefano, Hohman and Barker (2013))
1.8
1.9 It works!
When we run training sessions about Reduce the Use 2, our colleague, Ger
ORourke, describes herself as being like a Catholic convert because she has so
much fervour in spreading the word about the programme. It works and she has
seen the evidence. More so, all the feedback we receive about that programme
confirms her vigour.
We know the same is true of RecoverMe. Already every agency that has tried it has
seen the impact on groups and is building it into their yearly plan. We have seen it
change the way participants view themselves and their situations; they begin to
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question their beliefs and they start using more emotion-words other than fine, grand
or angry.
Even more gratifying is how participants describe using the grounding exercises in
their everyday life, slowing down the movement from trigger to consequence as
healthy dispute can take place.
This programme assists people in their recovery journey. We began this process
thinking that people would have to be drug free before they could engage in this
work. We were wrong; people at any stage of the journey who show a willingness to
come to groups and participate will benefit. Some groups will take longer; but this is
an expedition, not a race. Take your time, enjoy the view; running RecoverMe will
help you in all your other work too.
Up on the watershed
Standing at the fork in the road
You can stand there and agonize
Till your agony's your heaviest load
You'll never fly as the crow flies
Get used to a country mile
When you're learning to face
The path at your pace
Every choice is worth your while.
Watershed, Indigo Girls, (1995)
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Notes:
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Section 2
Using the Manual
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There should be a clear finish date to the programme (it is not an ongoing
piece of work). If you need to extend the programme while it is running, it is
better practice to negotiate this with the group rather than letting it run without
a beginning, middle and end.
We encourage you to cover all of the Modules
As a way of respecting and emphasising the importance of homework given, it
is good practice to start sessions with a reflection on the Emotions Diaries
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and the effectiveness of any safety plans put in place during the previous
sessions. It also brings an awareness to participants about how last weeks
learning played out in everyday life.
2.4 Commitment Contract
This course requires the following level of commitment from each group member:
o Attending regular programme workshops
o Completing homework tasks
o Maintaining a drug diary
Programme participants need to be made aware of the commitment involved in the
course.
The use of a Commitment Contract is encouraged as this strengthens the level of
commitment from the individual. An example commitment contract is provided in
Module 1.
2.5 Confidentiality
Groups require a level of confidentiality but confidentiality is never absolute and
participants need to be clear about the limits to confidentiality in your groups and
agency. You should never presume that people know what confidentiality means
and time spent on clarifying both what it is and isnt will save potential distress and
later. NDRIC note that
Service providers are responsible for ensuring that their staff understand
and comply with their responsibilities under relevant legislation when report
writing, explaining confidentiality and working with service users,
storing/securing data, and sharing information with other agencies
individuals (Data Protection Act 1988 & 2003; Freedom of Information Act
1997 & 2003; Child Care Act 1991; Children First: National Guidelines for
the Protection and Welfare of Children 2011; Information Governance: a
Guide for health and social care staff, HIQA 2011).
(NDRIC, 2011 page 15)
Handouts and Worksheets that are used in more than one module
are gathered in the appendices at the end of the manual (e.g.
emotions diaries and safe plan sheets are found there).
Although we have structured each module to run for 2 hours (with an average group
of 8 people) we have decided not to include timings for each exercise. We know that
each group will work through the material at different speeds and therefore
encourage you to set a start and finish date for the programme but operate session
times to suit the needs of your own groups6.
2.10 On writing
Two key issues are important here:
2.10.1 Written work
Written work is an essential part of RecoverMe as it allows the participant to
reflect on the group learning at their own pace. Writing has proven to give
participants new insights into themselves and their relationships. It can embed
the learning from the previous session(s), and offer the opportunity for creating
new roadmaps for change.
RecoverMe asks that some written work is completed outside of the module
attendance. Some peoples living environment may not be conducive to writing at
home and in this case a place could be made available where this can be done
privately. In addition participants with literacy difficulties may need assistance
Saol Project is very willing to receive feedback on the timing of groups and will post common
findings on our website.
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Requests:
1. We are asking people who are using this manual to let us know that you
are using it and whether or not you would be willing to be contacted about
a future evaluation (an email to [email protected] will suffice).
It would be helpful to know:
a. How many are in your group (including age range
and gender mix)
b. What recovery issues are presenting
c. How its going/it went
2. We have included the Session Feedback Form and encourage you to use
it at the end of every session you run. The immediate feedback from
groups provides confirmation that something is working/not working for
your current group. Saol is always open to receiving feedback about this
process and we would be delighted if you sent us any summaries of this
work. We understand that this may not be possible but anonymous
constructive feedback is very welcome.
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Notes:
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Module 1
Introduction to RecoverMe
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1. Grounding Exercise
Note that this is usually a breathing exercise. However, as this will be taught
later in the session, an exercise that gives everyone in the group a chance to say
something is preferred at this point.
Ask participants how they feel about starting the course. Name any worries
they have about the programme and write up comments.
Send around the sign-in sheet (See Appendix 1).
Ask each person to introduce themselves, say why they are here and what
they hope to get from the programme.
2. Check-in: Introductions, Commitment Contracts and Group rules
2.1 Introduction to RecoverMe
Group members should already have a good understanding of what
RecoverMe is about. The specific modules are discussed with the
group using Handout 1.1 as we prepare for the Commitment Contract
(see 2.3 below). We have found that the following are important points
to emphasise about this programme and work within and outside of
the group:
The role of reflection: thinking about what we do in RecoverMe
outside of the group.
Written work and homework
Practicing the new techniques: Although participants will learn a lot
while in the group, this course is most powerful when it is
integrated into our daily lives, therefore, it is important to highlight
the importance of home practice.
Other relevant points:
It is helpful to let participants know that throughout the programme there will be a
number of exercises and that everybody will have ample time to give feedback.
At this stage it is important to give out Handout 1.1, Overview of RecoverMe and
the Commitment Contract (Handout 1.2).
Once the group has read and discussed the hand-out, ask each participant to
sign the contract. A copy will kept by the facilitator and a copy will be given back
to each participant at the beginning of the next session.
2.3 Establish Group Rules
Explain that all groups establish a set of ground rules. These are an agreed way
of working together and they will be displayed at all times during the course. We
have included below sample ground rules from previous courses, to help initiate
the discussion if needed.
Record the group rules on a flipchart and display these at all times. We have also
found it useful to type them up separately and give a copy to each participant for
their folder at the beginning of the next module.
Some sample ground rules:
Respect: treat other group members respectfully, for example let people
talk without interrupting.
Mobile phones: should be switched off and no one should take or make
calls during this time. If someone has to take an important call they can
inform the facilitator who can inform the group.
Good time keeping: the group should agree the time of their breaks and
should discuss why time keeping is important to the group as a whole. If
you are more than 10 minutes late without prior contact, you will not be
admitted into the group.
This can feel like and often is an automatic process. We do not have control over
the initial responses (thoughts, emotions and body sensations) but we can learn
new ways to deal with them.
When we feel an emotion it will register somewhere in our body. Learning to tune
into the body is a great guide to discovering how we are doing emotionally; the
body will let you know what is happening. If I feel stressed, the body may feel
tense (shoulders tense, chest tense, heart beating); if I feel happy, the body feels
lighter (smile on my face, chest feels lighter, stomach feels full).
We often spend most of our day in thoughts and not fully connected to the full
range of experiences that accompany emotions. The emotions diary will help us
to become aware of what emotions we are experiencing; immediate thoughts
after triggers; body sensations, our behaviours, emotions following our
behaviours and a reflection in the consequences of our behaviours. Bringing this
awareness to our moment by moment experience can offer us a range of
7
Copies of the Drug and Alcohol diaries can also be distributed for those participants who want to
keep this habit from Reduce the Use 2 going (Appendix 3)
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responses that may help us to be less reactive and more thoughtful and in
control of our responses to triggers.
Emotions Diary:
Day/Date: Record the day and time it helps when searching for patterns
to our behaviours.
Trigger: what was the event/situation that sparked things off?
Immediate Thoughts: What where the first thoughts that came to mind?
Emotion: What emotion was I feeling? Can I put a name on the emotion?
Note: As we learn more about emotions during RecoverMe this column
will become easier to fill in.
Body sensation: Where in the body did I feel the emotion and how did the
body respond?
Behaviour: How did I behave? Did I respond positively or did I react
negatively?
Emotion: What emotion was I feeling afterward my behaviour? Was I
feeling the same or had something changed?
Consequences: What was the outcome to my behaviour? It is important to
record both good and bad consequences.
A completed Emotions Diary (Handout 1.3)
Facilitate a short discussion about the handout and encourage each participant
to name one emotion from the page that they are feeling at the moment. Also
this handout is a very useful reference point for them during the week.
All about the Emotions Diary (Handout 1.4)
When discussing this handout, the following points may be helpful:
Highlight that this piece is not about right or wrong, it is about trying to
identify emotions during the day.
By recording emotions that come before/during triggers, we begin to
become more aware of emotional states that we may have difficulty
dealing with.
We also become aware of emotional states we are ok with.
Often times in the recovery process, emotions can seem overwhelming
and feel that the emotion will not change. By keeping a record, we can
begin to notice that these emotions actually do pass.
Being able to identify emotions helps build confidence and self-esteem. It
is very empowering to be able to describe your emotional state to
ourselves and others.
It helps us to identify skills already being utilised but we may be unaware
of.
Suggestions of a choosing a safe place, a good time, being comfortable
when completing the sheet etc. For those who lack these opportunities,
explore creative ways around the problem. For example, completing
diaries with key-workers; seeing if agencies can give you a space to do
the work, etc.
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Some of the group may find this piece difficult, it is important to facilitate this in a
light, conversational way to help relieve any fears.
This is to be displayed at all times in the group so that, when new emotions
emerge the facilitator or a group member can add the new emotion to the board.
This will be a reference point for all future exercises and will assist participants in
finding names for the emotions they want to discuss. Busy or larger groups may
require more than one board.
When the handout has been distributed, it is important to go through each of the
words to:
This
Once these sheets are completed the facilitator should collect them and keep
them safely in a folder for the next module.
A key point is to fill in the column recent changes made. This will help
participants identify any significant changes made in recent times or if they have
slipped back into old ways of behaving. No judgement should be passed by the
facilitator either way; eliciting comment from the participant is much more
important.
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You may ask participants to share if they are willing to share, especially any
recent changes that have been made. This can be a good starting point in
relation to what they are doing, where they are at and what the implications are
on their recovery plans.
challenge some of our thinking styles in order to better understand whether or not
they are helping or hindering our recovery.
These thoughts are made up of personal beliefs, automatic thoughts and
addiction-related beliefs; and they influence a persons interpretation of events
(events are also commonly known as Triggers). There are a lot of them! The
average human has 70,000 thoughts a day and this continues while you sleep,
this equates to a different thought every 1.2 seconds or 2 thoughts every
heartbeat (Johnston, 2012).
Our thoughts have a major effect on our emotions. By learning how to think in
certain situations, we can help to improve our emotional condition.
Some key points:
4.1.1 Our emotions are automatic; they are often influenced by our
thoughts and beliefs about situations that arise during the day.
When something happens to us we can often respond it made me feel like that
or that made me feel this way
When we can begin to look at alternative interpretations, we can view the same
event in many different ways; we can begin to recognise the connection between
thoughts, emotions and actions. However, when addiction is present there can
be a tendency:
Over the coming Modules we will be looking more closely at the connection
between the different thought processes and their impact on emotion and
behaviour. This will allow participants an opportunity to slow the process down
and improve the skills required to maintain recovery. We will also pay more
attention to the present moment, learning how awareness can make connecting
with our thought processes easier.
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Thought/Personal
Belief
Emotion
Why didnt
he/she say
hello, did I do
something
wrong?
Anger
Anxiety
Sadness
Body Sensation
Clinched fist
Heart beating
faster
Tightness
-Shoulders
-stomach
Urge
Reactive
behaviour:
Wanted to go
after them and
argue with
them
A range of different responses may arise from the group; there is no right or
wrong answer and it is important to encourage all feedback.
Ask participants:
Ask the group what they have learned; mostly, feedback centres on recognition,
that interpretation of an event affects thoughts and emotion.
They may also begin to realise how their interpretation may not reflect the truth,
may cause them (and others) undue distress or lead to reactive behaviour.
Note also that mood can play a big part in how we interpret situations; if
someone was in a positive mood, was their interpretation different?
4.3 The Link with Recovery
Explore the key question: how does this affect recovery?
If our perceptions of events in our life go unchecked then we can end up in a
cycle that will keep us where we are; for people in addiction, that can lead to
relapse or unhappiness and this can last for lengthy periods of time.
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When sufficient discussion has taken place, distribute Handout 1.9 to the group.
Let them know that this is just one possible pathway to a consequence based on
one interpretation of why a friend didnt say, hello. Invite each group member to
offer a word or sentence to describe the handout.
When the group have finished, it is important to remind them about their
homework for the week. In Module 1, this involves only the completion of the
emotions diary (and drug/alcohol diaries where appropriate).
As this is the first time they are being asked to complete an emotions diary you
should expect that some discomfort will be expressed by the group. Invite
expression of concerns, reminding them of supports that are in place and the fact
that, much like the drug/alcohol diaries, there are no right answers for such
diaries and that they will discover how they like to fill them out through practice.
Where possible, invite participants to share their first diaries with key workers or
group facilitators so that they do not feel that they are getting it wrong for a
week.
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending
and assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the
next session and
Offers people the chance to affirm themselves for the work that theyve
done during this session
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7. Safe Plan
Explain to group members that each module will end with the participants taking
a few moments to reflect on how they will commit to keeping themselves safe
until we next meet. This may focus on maintaining recovery for some groups or
have a more general focus on ways to live happier lives that help cope with the
challenges of recovery a little better.
Therefore, safety plans could range from harm reduction techniques and drug
avoidance techniques to managing leisure time and avoiding boredom.
Each person will have different aims. Give everyone a copy of the Safe Plan
(Appendix 5) and ask them to write at least one way in which they will work at
staying safe until the next RecoverMe session.
A brief sharing of their commitment is useful at this point, as it can help other
group members to come up with ideas for themselves. Note that it is not always
necessary to go around the whole group.
8. Feedback Sheet
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes.
They do not have to sign this sheet.
It can be helpful to explain to the group that this sheet is useful for you as the
facilitator in getting a sense of things that worked and didnt work during todays
session; and to invite them to be as honest as they can.
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Hand-out 1.1
Overview of sessions
Module 1: Introduction to the programme
Setting up structure and group rules; what is expected of you as a group
member; go over the modules and brief introduction into the basic ideas of
RecoverMe.
Module 2: The Role of Automatic Thoughts
The aim of module 2 is to identify automatic thoughts that are common in
recovery. The exercises will explore the effect that thoughts have on
addiction/recovery and look at ways to challenge them.
Module 3: As Simple as ABC
The aim of module 3, is help participants identify, how personal beliefs about
events in life can influence our emotions and behaviours. The exercises will
give participants awareness of the links between Thoughts, Emotions and
Behaviours
Module 4: I disagree
The aim of module 4 is to build on the learning from Module 3. The exercises
will help participants to understand how they can respond differently to their
immediate beliefs; and even if they do respond negatively to their beliefs
(resulting in negative behaviour), how such behaviour can be stopped and
more helpful behaviour can be initiated.
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Handout 1.2
Commitment Contract
I agree to attend this course and to complete work assigned to me.
I agree to inform all of the people from other agencies that I am currently working
with (especially my Case Manager) that I am doing this course, so that they can
support me, if such support is necessary.
I agree that if I do not want to complete the course I will let the Facilitator know and I
will be welcome to re-engage in any future course assessments.
Date:
_______________________
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Handout 1.3:
Emotional Diary Example
Day and
Time
Tue
04/04/20**
Trigger
Was there an
event/situation or
thought that made
me want to drink/use/
or behave
negatively?
10am
Wed
05/04/20**
5pm
Thurs
06/04/20**
7.30pm
Sitting at home
doing nothing
Bored
Immediate
Thought
What where the first
thoughts that
accompanied the
trigger?
Emotion
What was
the emotion
I felt?
Body
Sensation
Where do I feel
the emotion in
the body?
Behaviour
Emotion
What emotion
was I feeling
afterwards?
Consequences
What were the
consequences of your
actions both good and
bad?
Angry
Stomach tight,
chest heavy,
heart beating
faster
Irritated,
annoyed
Hurt
Knot in my
stomach,
wanted to cry
Felt calmer at
first then got
angry
Restless like
anxiety
Butterflies in
stomach, joints
felt tense
Tired and
happier in
myself
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Handout 1.4
All about the Emotions Diary
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Hand-out 1.6
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Handout 1.7
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Handout 1.8
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Handout 1.9
One Interpretation of Walking down the Street
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Example
TYPE OF DRUG
Alcohol
Tablets Sleepers
HOW OFTEN?
2 times a week
(Friday &
Saturday
Night)
Every day
HOW MANY/MUCH?
COST PER
WEEK
20
4 a day
How many/much
Cocaine
Alcohol
Methadone
Prescribed:
Un-prescribed:
Heroin
Tablets
Type:
Type:
Type:
Crack Cocaine
Hash
Head shop drugs
Other
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Reduced from
drinking
everyday
Reduced down
to 4 a day
from 10
Type of Drug
How Often?
RECENT
CHANGES
Recent
Changes
How often?
COST
Impact on self
7 hours per-day
Topping up by
10 every
second day
ACTIVITY
Internet Usage:
How often?
COST
Impact on self
On-line Gambling
Pornographic sites
Food
Increase in food:
Decrease in food:
Shopping
Sexual Activity
Gambling
Type:
Type:
Type:
Increased Alcohol
consumption
Substance misuse
Other
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Notes:
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Module 2
The Role of Automatic Thoughts
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Automatic thoughts are concerned current with situations, and are usually
short-term fleeting thoughts or images. The aim of this module is to identify
such thoughts, and explore the impact of that thinking on addiction/recovery
and to challenge them.
The aim is not to teach people to think as society would like them to, but for
people to identify patterns of automatic thoughts and to look at alternative
options to help them make decisions that they want.
MATERIALS NEEDED
Flip chart paper & marker
Participants folders and pens
Sufficient copies of Handouts 2.1 & 2.2
Ample copies of the emotions diary for participants (Appendix 2)
Sufficient copies of Worksheets 2.1 & 2.2
Sign in sheet (Appendix 1)
Copies of the Feedback sheet (Appendix 6)
Module 2: The Role of Automatic Thoughts
1. Grounding Exercise I
1.3 Guided grounding exercise
1.4 Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in Exercise (including review of last sessions safe plan)
2.3 Group Rules typed versions given back to group and reviewed
2.4 Commitment contract given back to each participant
3. Review of Emotions Diary (and drug/alcohol diaries)
3.1 Review Emotions Diary (and drug/alcohol diaries)
3.2 Any other homework
3.3 Emotions Board
4. Making the Link between Thoughts, Feelings and Actions
4.1 Opposite Emotions
4.2 Automatic Thoughts
4.3 Challenging Automatic Thoughts and Automatic Negative Thoughts
5. Review and preparation for next Session
5.1 Planning Homework: Emotions Diary
6. Grounding Exercise II
7. Safe Plan
8. Feedback Form
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2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the
group, so that individuals are not sitting through the entire session without
having spoken. Therefore a simple question that is asked to each group
member will work best at this time. Specific feedback should be asked for in
relation to the safe plan that was written at the end of the last session. Some
people will choose not to answer questions but as long as they are asked and
verbalise their desire not to answer, the purpose of the exercise has been
achieved. It also alerts facilitators to the mood of the group and individual
members.
For example:
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator as it may help others who are having difficulty
identifying emotions. Working even briefly with those who have completed the
work can reinforce their efforts and also reduce some of the blocks others
may be experiencing; it will also increase peoples motivation to complete the
work. Encourage each member to continue with their emotions diary
throughout the duration of the programme.
You should expect that people will have difficulty in completing emotions
diaries for the first few sessions. This will ease as participants begin to
understand and recognise emotions better as RecoverMe unfolds.
It is important to mention that while participants are encouraged to share
insights, such sharing must be fitting to the group. Therefore, facilitators are
encouraged to ensure that participants share appropriately and that if they
need to explore insights more deeply that they do so with the facilitator or their
key worker/counsellor in another space.
We have found that if group members are frightened by in-depth sharing too
early in the process, they are more likely to be anxious about the work. Good
pacing when unearthing emotions is essential.
3.2 Any Other Homework
There is no other homework to review from Module 1
3.3 Emotions Board
Ask the group members if there are new words they would like to put up onto
the emotions board. As any new emotions emerge within the group, they
should be added to the board.
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Affirm everyone for their effort and ask for feedback on what they have
learned from the exercise: Relieve fears or doubts!
4.2. Automatic Thoughts:
Distribute handout 2.1 to the group; the handout contains Automatic Negative
Thoughts and thoughts associated with addiction. You will need to explain
the following:
Automatic thoughts are brief thoughts or images that come to mind suddenly;
they are the first step to processing and understanding an event. Although
they are brief, they can have major influence on an individuals emotions and
behaviours.
They may be related to positive rewards (immediate results) in engaging in
addictive behaviour and ignore or discount potential negative consequences.
This belief has been reinforced through repeated addictive behaviours.
They often arise when a person comes across a high risk situation. The
persons automatic thought is that their addiction will help them cope better or
avoid what they perceive to be difficult emotional states or conflict.
They are a learnt belief, which in turn means they can be unlearnt.
They can be associated with the inner critic we all have in our minds. ANTS
multiply and get louder and if we let them. They can become a huge block to
confidence and recovery. If you can imagine having a picnic and one ant runs
across the table, that probably would not bother you too much; but if you have
forty ants running across your picnic then it is a major problem.
ANTS have the same impact on our minds and can have a huge impact on
our thinking. If left unchallenged they can become your reality and influence
your emotional development. They serve as a negative messenger, if I keep
telling myself I am worthless I will feel worthless
They normally come into the mind as a statement of fact and occur in the
here and now. They can happen so quickly we are not even aware of them.
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Ask the group to identify some more thoughts (from the handout) they
could associate with this situation which could lead to substance use or
unhelpful behaviour.
Ask them if they can identify any other thoughts (not on the sheet) that
could lead to difficulty. If any new thoughts emerge, ask the group to
record them on the sheet, as they can be used in the next exercise.
The facilitator might now suggest other situations where these thoughts
could also occur:
o Sitting at home alone
o A difficult day in work and/or recovery group
o Being late for an appointment
o An argument
o Things going well in Recovery
Distribute Worksheet 2.2. Ask them to read through the list of automatic
thoughts and to identify with any of the thoughts on the list. Explain and
discuss that these thoughts are normal and with a bit of work and awareness
they can be changed.
Then ask each individual to scale each statement from 0 to 10 where 0 =
completely untrue 10 = completely true for them.
After completing the sheet, ask participants to choose one of the statements
that they feel they might be able to let go of. We have found in our
experience that if you pick a statement in the middle, meaning marked 4-6, it
is easier for participants to do the exercise.
Participants may not believe that some of these statements can be
challenged. They may have believed them for a very long time. As a facilitator
it is important to support the individual and ask them to choose a statement
they are willing to challenge which is not too difficult for them.
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When they have chosen one statement, ask them to transfer it to Worksheet
2.3. You are now inviting them to explore the evidence for and evidence
against this statement.
Useful Prompt Questions:
When they have completed the worksheet, ask them to firstly read out the
initial statement and then the new statement.
Reflection on the exercise:
Ask the group how they felt after challenging the thought.
Is the new statement believable?
Do they feel like they could challenge another one of their thoughts?
Could this be applied to other areas of their life?
Thoughts are not facts: Handout 2.3
It is amazing to observe how much power we give unknowingly to uninvited
thoughts: Do this, say that, remember, plan, obsess, judge. They have the
potential to drive us quite crazy and they often do! Joseph Goldstein
The purpose of this handout is to help participants gain more insight into
thoughts and how they can have a major influence on our behaviour. We
often give too much attention to our thoughts; they often block or undermine
the efforts we are putting in.The problem with them is that we do not have that
much control over when they pop up in our minds. If we practice awareness,
we will learn that all thoughts are mental events of the mind, and we can
choose what we want to do with them. (Segal et al 2013)
This handout is to be read aloud with group
Guide Questions:
How are you as we come to the end of todays session?
What is staying with you that is important to you?
Is there anything that you didnt like? Are there any questions that you
didnt get to ask?
When the group have finished, it is important to remind them about their
homework for the week. In Module 2, this involves only the completion of the
emotions diary (and drug/alcohol diaries where appropriate).
Invite participants to use their supports in completing their diaries: key
workers, family members and friends or whomever else they may have
identified.
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the next
session
Offers people the chance to affirm themselves for the work that theyve done
during this session
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Handout 2.1
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Automatic Thought
Using is fun, not using is boring.
Craving to Use
Drug
Consequences
End up using for the day and
getting back into old behaviour.
Fail to give clean urine which in
turn leads to trouble with the
courts and probation services.
Drug Use
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Handout 2.3
Automatic Negative Thoughts and Addictive Related Thoughts can have a very
powerful effect on how we feel and what we do.
We cannot control what thoughts come into our mind, but we do have control
over whether we believe them.
We can begin to see thoughts as mental events not always based on facts
(EVEN THE ONE THAT IS NOW TELLING YOU THAT THIS IS NOT TRUE)
Thoughts are normal but we can tend to pay too much attention and give them
too much power.
Thoughts are often associated to events that are outside of us and that we have
no control over.
Adapted from:
Mindfulness Based Cognitive Therapy for Depression by Segal et al (2013)
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2. In the morning time when I leave my house I feel ____________ and not
_____________.
3. When I visit my friends during the day I feel _____________ and not
_______________.
4. When its night time I feel ____________ and not ____________________.
7. When
talking
about
my addiction
feel
_____________
and
not
_______________.
9. Talking to doctors about making the right decision about my recovery I feel
_________ and not ___________.
10. At night, when I am going to sleep I feel _________ and not ___________.
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Automatic Thought
I feel so helpless.
Im so weak
10
Automatic Thought
My addiction is my fault
10
Worksheet 2.3
The following exercise is designed to get you challenging your Automatic Thoughts rather than just letting it dictate how you feel
about yourself and/or your current situation. Start by writing down the automatic Thought you telling yourself:
Taking into account both the for and against, write down a more balanced message
Alternative message
Addictive Thinking
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Module 3
As Simple as ABC
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Grounding Exercise I
1.5 Grounding exercise
1.6 Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in and review of Safe Plan
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework
and emotions board
3.1 Ask participants to share emotions diaries
3.2 Any other homework
3.3 Emotions Board
3.4 Other New activities
4. As Simple as ABC
4.1 Understanding the influence of a Personal Belief
4.2 The ABC of Thinking
4.3 Applying Daves story to our own lives
5. Review and preparation for next Session
5.2 Planning Homework: Emotions Diary
6. Grounding Exercise II
7. Safety Plan
8. Feedback Form
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Note to Facilitator:
The work in this module is based on the ABC model (Beck, A, 1979) which helps
identify our limited thinking patterns; and takes its lead from Reduce the Use 2,
Module 3 The Role of Thoughts and Beliefs.
Unhelpful thinking is thought patterns that have the potential to cause negative
emotions and behaviours. They are learned, habitual styles of thinking that often
arise when faced with difficult/stressful situations.
The ABC Model:
Activating event: what is the activating event? What happened? What did I do? What
did others do?
Beliefs: what do I believe about the Activating event? What thoughts do I have about
the event?
(N.B. Personal beliefs are expressed through ANTS (the work explored in Session 2)
so it is helpful to explain to the group that changes to personal beliefs lead to
changes in ANTS)
Consequences: What emotions am I feeling? How did I behave as a result of A & B?
The ABC model also introduces two new ideas that will be introduced in Module 4
Disputing the belief: Identifying the Unhelpful Thinking style being used by the
individual and involves two deeper ideas:
1. Naming the thinking style: black & White Thinking, Minimising,
Catastrophizing (the distorted thinking associated with the response)
2. Rational Response (using everyday logic, what might a different response to
the activating event?)
Effect: which is a positive message or commitment that I can make to myself after
having been through the above process; it is also one which I am able to create a
different perspective on the original event.
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2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through the session without having spoken.
Key questions that you may find useful are:
For example:
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator.
You should expect that people will still have difficulty in completing emotions
diaries but that this is beginning to ease for some.
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The above example shows two different ways of viewing the same event.
Emotions and behaviours do not happen in isolation; both have other
influences. It is often the case that an outside event/trigger seems to cause
the emotion and resulting behaviour. This is not so.
It is the personal belief, arising from the event that will determine what the
subsequent behaviour or outcome:
EVENT + PERSONAL BELIEF = CONSEQUENCE
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Ask the group to identify any behaviour that Dave may end up engaging as
result of these thoughts and emotions.
Take two of the interpretations gained from examining Daves story, and
break them down into the component parts as shown in the table below: One
where his interpretation might lead to drug use and the last one where he is
confident of himself.
Work your way through the interpretation with the group, naming the event,
belief and consequences.
This should help to highlight that the interpretation of an events can lead to
many different (often negative) results and if left unchecked can lead to a
downward spiral.
The above exercise is important to help participants identify the power
thinking can have in their own lives and recovery.
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Table: Facilitators guide: this is to be laid out on the whiteboard/flipchart to help the group.
A
Activating
EVENT
Briefly describe the
event leading to the
unpleasant emotions
Friend using at a
party
Friend using at a
party
BELIEF
CONSEQUENCES
Emotional response
Anger-10
Fear-7
C
Consequences
Behaviours
Disappointment-8
Loneliness-7
Anger-6
Fear-4
Disappointment-8
Loneliness-3
Trust-6
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Ask each participant to identify what thoughts had about the activating
event.
These can include ANTs and addiction related beliefs that have been
identified in Module 2 and are similar style to the thoughts that caused
Dave difficulty.
In the event of someone in the group not identifying with one or more of
the events ask them, if they could think of any thoughts about the event
that could lead to difficulty.
The group are then asked to identify the different emotions attached to
their belief about the event, they can also put down other emotions that
they feel would describe how they felt more clearly.
Ask the group to scale the intensity of the emotion 0-10
(0= would not feel that emotion, 10= the intensity of emotion is very
strong).
Ask the group to identify any behaviour they may have engaged in as a result
of the thoughts and emotions.
Ask two or three group members to feedback to the group. One situation that
they feel comfortable talking about and outline the following.
o The activating event
o The thoughts/belief
o The consequences emotional/behavioural.
Discussion:
Can they see how these beliefs/interpretations can influence not only their
emotions but also their behaviour?
Acknowledge and affirm everyone for doing this piece of work and explain that
in session 4 we will be looking at exercise that will help to develop skills to
work with these beliefs when they arise.
It is very important that Worksheet 3.2 is kept for the next module; the
facilitator may collect and keep them for safety.
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6.Grounding exercise
This exercise is designed to help signal to the group that the session is ending
and assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the
next session and
Offers people the chance to affirm themselves for the work that theyve
done during this session
7. Safety Plan
Explain to group members that each module will end with the participants taking
a few moments to reflect on how they will commit to keeping themselves safe
until we next meet. This may focus on maintaining recovery for some groups or
have a more general focus on ways to live happier lives that help cope with the
challenges of recovery a little better.
Therefore, safety plans could range from harm reduction techniques and drug
avoidance techniques to managing leisure time and avoiding boredom.
Each person will have different aims. Give everyone a copy of the Safe Plan
(Appendix 5) and ask them to write at least one way in which they will work at
staying safe until the next RecoverMe session.
A brief sharing of their commitment is useful at this point, as it can help other
group members to come up with ideas for themselves. Note that it is not always
necessary to go around the whole group.
8.
Feedback Form
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Worksheet 3.1
The following table has three possible personal beliefs and you can guide the group
in identifying the emotions that might be associated with them. There should be lots
of answers (and all are correct) and positive associated feelings to negative
interpretations regularly occur:
Examples of Interpretations
Angry
Scared
Sad
Disappointed
Anxious
Trust
Optimistic
Bitter
Angry
Scared
Sad
Disappointed
Anxious
Trust
Optimistic
Bitter
Angry
Scared
Sad
Disappointed
Anxious
Trust
Optimistic
Bitter
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Behaviour
Worksheet 3.2
A
Activating EVENT
Joined a recovery
group and was
welcomed openly
BELIEF
CONSEQUENCES
Emotional response
Angry
Composed
Sad
Disappointed
Anxious
Optimistic
Trust
Bitter
Job Interview
a) Getting the
Job
Angry
Sad
Anxious
Trust
Composed
Disappointed
Optimistic
Bitter
b) Not Getting
the job
Angry
Sad
Anxious
Trust
Composed
Disappointed
Optimistic
Bitter
Angry
Sad
Anxious
Trust
Composed
Disappointed
Optimistic
Bitter
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Consequences
Behaviours
Activating EVENT
BELIEF
Bad marks in an
exam/test/essay
CONSEQUENCES
Emotional response
Consequences
Behaviours
Angry
Composed
Sad
Disappointed
Anxious
Optimistic
Trust
Bitter
Angry
Composed
Sad
Disappointed
Anxious
Optimistic
Trust
Bitter
Angry
Composed
Sad
Disappointed
Anxious
Optimistic
Trust
Bitter
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Dave has wanted to give up mixing coke and alcohol for a while and has
been trying to stop, on and off it for a few months now.
He had also started to take some sleeping tablets that a friend had
introduced him to because he hadnt been sleeping well.
However, its now been a week since he last used coke or tablets and he
is feeling really good about himself; he is even beginning to make some
plans for the future.
He hasnt had a drink in the past week either and if you ask him, he will
say there is no way he wants to go back using coke and alcohol together
again and that he feels proud of himself.
He even feels he has been sleeping a bit better these past few days.
Dave decides to go down to his local pub where there is a party on for a
friend of his. Dave is aware that there will be drink and drugs in the pub,
but has asked a friend to support him.
Dave has a few drinks and he starts to feel a bit tired. He then notices
that the friend he had asked to support him is taking coke.
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Module 4
I Disagree
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Module 4: I disagree
AIM
The aim of module 4 is to build on the learning from Module 3. The exercises will
help participants to understand how they can respond differently to their immediate
beliefs; and even if they do respond negatively to their beliefs (resulting in negative
behaviour), how such behaviour can be stopped and more helpful behaviour can be
initiated.
Materials Needed
Flip chart paper & marker
Participants folders and pens
Sufficient copies of Handouts 4.1 & 4.2
Ample copies of the emotions diary for participants (Appendix 2)
Sufficient copies of Worksheets 4.1 & 4.2
Sign in sheet (Appendix 1)
Copies of the Feedback sheet (Appendix 6)
1. Grounding Exercise I
1.1Grounding exercise
1.2 Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in and review of Safe Plan
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Ask participants to share emotions diaries
3.2 Any other homework
3.3 Emotions Board
4. I disagree
4.1 Daves story Continued
4.2 Unhelpful Thinking patterns
4.3 Applying Unhelpful Thinking Patterns to the ABCDE Diagram
4.4 Applying Daves story to our own lives
5. Review and preparation for next Session
5.1Planning Homework: Emotions Diary
6. Grounding Exercise II
7. Safety Plan
8. Feedback Form
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Note to facilitator:
This exercise introduces the next two parts of the ABC model D and E (see
Worksheet 4.2)
The A = Activating event or trigger leads to B = Beliefs which in turn results in C =
Consequences (which in recovery can be a slip or relapse). We now want to
introduce 2 new parts of the model, D and E:
D= Disputing. This is the point where we begin to question or dispute the thought
process that arose at B. The reaction to the trigger (A) resulted in a set of beliefs (B)
and we now want to dispute those beliefs. The intention is to either stop the beliefs
moving on to (C) or to move the person out of (C) quicker than would normally
happen.
(D) Is the point at which we ask, Is you thinking a little limited there? Are your
interpretations and/or beliefs a tad restricted? Are you missing some information or
are you reading the situation in a limited way, a way that is restricting you and
leading you to unhelpful behaviours?
By exploring our beliefs, we can uncover the limits to our thinking and see how these
restricted thoughts are unhelpful to us. The process of doing this and taking back
control of the activating event (A) will lead to E= Effect.
(E) Is the effect of bringing awareness to our thoughts and the resulting feelings.
Disputing our beliefs and uncovering new ways of interpreting events can lead to a
positive response; suddenly, we are not trapped in one way of thinking about an
event and new ways ahead become visible; self-efficacy can rise and new
possibilities give energy and hope.
In Session 3, Daves interpretations of events led to three different outcomes. In this
Session, we are going to look at Daves story again but this time examining his
Unhelpful thinking patterns and the possibilities (and positives) of new
interpretations.
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Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
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You should expect that people will still have difficulty in completing emotions
diaries but that this is beginning to ease for some.
3.1 Any other Homework
Module 3 did not have any other home work
3.2 Emotions Board
Ask group members are there any other words that they would like to put up
onto the emotions board. As new emotions emerge during the session they
are to be recorded on the board.
4. I disagree
4.1 Daves Story Continued:
Distribute Worksheet 4.1
This worksheet has an outline of one interpretation that Dave had about his
situation. In the light of this interpretation, invite the group to help Dave in
identifying patterns of thought that led to his unhelpful behaviour.
On the worksheet you will notice two broken arrows. The first arrow connects
(B) to (D). It is asking Dave to notice his immediate thoughts arising from the
activating event (A), but instead of going straight to (C) and resultant unhelpful
behaviour, to dispute these immediate thoughts (D) instead. At (D), Dave is
asked to consider other interpretations of what has happened and, hopefully,
identify a different interpretation than first emerged, and thereby, behave
differently and gain different consequences.
The second broken arrow goes from (C) to (D). This is to acknowledge that
even if someone responds negatively, they can still re-interpret their beliefs
(B) by moving to (D) which will hopefully lead to new, more positive behaviour
(E).
It is worth exploring with the group the consequences (C) on Dave of his
unhelpful behaviour. Referred to by Marlatt et al as Abstinence violation
effect, this is the disappointment you feel when you fail to stick with a plan
you had set in place for yourself.
Such an effect causes a lot negative beliefs and these can lead to further
unhelpful behaviours and, indeed, full blown relapse. Hence, it is important for
the group to recognise how serious such thinking can be to your recovery, but
also the power in learning skills related to broadening your interpretations.
even fortune-telling? Help the group to work out their interpretations. There
is no right answer here as all new interpretations will have value.
Record all feedback on Whiteboard/flipchart and keep displayed along with
feedback from the next exercise (Section 4.3)
While the group are exploring Daves story it is very important to highlight that
(B) may happen without Daves permission; that is, he does not have full
control of such immediate beliefs. But if he can begin to identify what thoughts
are arising and redirects his beliefs (B) to dispute and debate (D), he will
have more control over (C) and the ultimate outcome.
It is important that you help the group to acknowledge any negative feelings or
thoughts that Dave may have but also that you emphasise the relief and
energy gained as he takes back control from the original trigger.
4.4 Applying Daves story to our own lives:
Worksheet 3.2 (from Module 3) will help the group to apply this process to
their own lives.
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6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the
next session and
Offers people the chance to affirm themselves for the work that theyve
done during this session
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7. Safe Plan
Each person will have different aims for their safe plan. Nonetheless, do not be
reticent about checking for relapse prevention ideas form the group.
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session. A brief sharing
of their commitment is useful at this point, as it can help other group members to
come up with ideas for themselves. Note that it is not always necessary to go
around the whole group.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes.
They do not have to sign this sheet.
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Worksheet 4.1
A: Activating Event
B: Belief
What thoughts/beliefs
first came to mind?
E: Effect
C: Consequences
Emotional/Behavioural
What emotions did I notice, how did
I behave? Did I react?
Anger-8, Fear -7
Disappointment-6, Isolation-6
Dave believes his initial thoughts and ends up taking drugs
that night
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Worksheet 4.2
C: Consequences
Emotional/Behavioural
A: Activating Event
B: Belief
What thoughts/beliefs
first came to mind?
E: Effect
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Disqualifying
the Positives/
Filtering
Negative SelfLabelling
"I feel like a failure. I'm flawed. If people knew the real me,
they wouldn't like me."
You focus only on the negative details, ignoring all the positive aspects
of a situation.
Focus only on what is wrong and disqualifying our legitimate
achievements and good qualities.
Fortune telling
Mind Reading
Most of us find it hard to say what will happen tomorrow, let alone the
rest of our lives. Yet we have a great ability to predict the future in
negative terms and believe we know the outcome of everything that
happens in our own future.
"I can tell people don't like me because of the way they
behave."
Without their saying so, you know what people are feeling and
why they act the way they do. You believe you know how people
think and feel about you.
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Should
Statements
Excessive Need "I can only be happy if people like me. If someone is upset, it's
probably my fault."
for Approval
Disqualifying
the Present
Low frustration
tolerance
This is often missed. It is the thought and belief that I cant stand it;
I shouldnt feel this way, when in fact that, although it is unpleasant,
we are quite able to stand it.
Pessimism
Black and white thinking is the most common type of negative thinking,
and is the main cause of many problems including anxiety, depression,
and addiction.
Black and white thinking leads to anxiety because you think that any
mistake is a failure which may expose you to criticism or judgment.
Therefore you dont give yourself permission to relax and let your guard
down.
Black and white thinking can lead to depression because when you
think you have to be perfect; you feel trapped by your own unrealistic
standards.
Feeling trapped is one of the known causes of depression.
Black and white thinking can lead to addiction because anxiety or
depression
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When you become aware of negative thoughts and images in your mind, hold them
in awareness, with an attitude of gentleness and curiosity, perhaps expanding
awareness to include one or more of the following possibilities:
Perhaps this is confusing a thought with a fact?
Perhaps this is jumping to conclusion?
Perhaps this is black-and-white thinking?
Perhaps this is negative self-labelling and I am condemning myself over one
thing?
Perhaps this is concentrating on my weaknesses and forgetting my strengths,
filtering?
Perhaps this is self-blame, for something that isnt my fault?
Perhaps this is self-judgement?
Perhaps these are unrealistically high standards?
Perhaps this is mind-reading or fortune telling?
Perhaps this is expecting perfection?
Perhaps this is overestimating disaster?
The guidance for this section is to approach your thoughts with an attitude of gentle
interest and curiosity
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From thoughts come actions. From actions come all sorts of consequences. In
which thoughts will we invest? Our great task is to see them clearly, so that we can
choose which ones to act on and which simply to let be. Joseph Goldstein
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Notes:
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Module 5
Being More Than Fine
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MATERIALS NEEDED
Flip chart paper & marker
Participants folders and pens
Copies of Handout 5.1 & 4.2 for each participant
Ample copies of the emotions diary (Appendix 2)
Copies of Worksheets 5.1, 5.2, 5.3 & 1.4
Sign- in Sheet (Appendix 1)
Copies of the Feedback sheet (Appendix 6)
Module 5: Being more than fine
1. Grounding Exercise I
2.1 Guided grounding exercise
2.2 Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in Exercise (including review of last sessions safe plan)
2.3 Confidentiality
3. Review of Emotions Diary (and drug/alcohol diaries)
3.1 Review Emotions Diary (and drug/alcohol diaries)
3.2 Any other homework
3.3 Emotions Board
4. Being More than fine
4.1 Emotions Questionnaire
4.2 Defining Emotions
4.3 Connecting Emotions with everyday life
4.4 How do you know when youre..?
5. Review and preparation for next Session
5.1 Planning Homework: Emotions Diary
6. Grounding Exercise II
7. Safe Plan
8. Feedback Form
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Note to Facilitator:
Module 5 introduces a lot of material on emotions and may take some time to work
through. The quality of delivery is as important as the content within the module. It is
important to move at the pace of the group, if you sense that this may take longer,
this module can be delivered over 2 Sessions.
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
2.3 Confidentiality
It is timely to re-check that the group is clear about the limits of confidentiality
within this group. Give space to this discussion and note that conversation
about other rules may also arise.
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It is useful to link any feedback to the exercises completed thus far; and to
affirm examples where new thinking ins emerging.
3.2 Any Other Homework
There is no other homework to review from Module 4
3.3 Emotions Board
Ask the group members if there are new words they would like to put up onto
the emotions board. As any new emotions emerge within the group, they
should be added to the board.
4. More than Fine
Recovery from active addiction involves a number of different elements, such as
change in lifestyle, change in friendships, change in routine, change in thinking
and changing the relationship developed with emotions.
People moving from active addiction towards recovery will develop different
ways of dealing with emotions, some helpful and others not so helpful: selfmedicating, pushing emotions down or looking for escape to help avoid or fix
their current emotional state. Some of the ways participants will have learnt to
deal with emotions will have come through primary social settings i.e. family,
school, peer groups. Over the course of their life and their addiction they may
have developed some false beliefs about emotions.
Some of these beliefs have been around for a long time and they may not be
ready to explore or change immediately. Safety can be found in picking a
statement in the middle (meaning those marked 4-6). It can then be easier for
participants to do the exercise.
Allow for a group discussion by asking each group member to choose one of
the statements and share with the group how this may be helpful. Allow for
feedback.
We are not looking to blame or find the source of these statements, but to find
more about how they may use this learning moving forward.
they were in a very slow queue or they may have felt sad when they watched
a movie. They do not need to go into any great detail about the event, just a
general description of what brought on the emotion.
When each participant has filled each one, bring the group back together and
ask for feedback, again being supportive and keeping feedback brief. You
may ask them to choose one and explain it to the group. Participants may
want to share the same one, ask them to choose a different one as this helps
the group to acknowledge that everyone will have felt these at some stage.
4.4 How do you know when youre..?
This exercise is designed to help participants to develop their lexicon of
emotions.
Participants are asked to complete Worksheet 5.3 and we suggest that you
ask members to fill out one sheet for the six emotion: happy, sad, angry,
excited, scared and love. You will need at least 6 copies of this worksheet for
each participant.
Each feeling is to be accompanied by 2 physical, 2 behavioural and 2 external
reactions as proofs that you are feeling that emotion. This will assist the
participant to reflect on what happens when they are feeling a particular
emotion.
We are also asking the group to reflect on when they feel certain emotions,
and if their thought focus begins to narrow e.g. ANTs, addictive related
beliefs, Unhelpful thinking styles, fix or avoid, reactive thoughts or does their
focus stay opened e.g. acknowledging the emotion, not to wanting to fix or
avoid, not reactive, thinking of goals.
Again we are not looking for blame here or self-criticism, if it does arise it is
important to facilitate, that as we have learnt in the last 3 modules, these
thoughts are learnt responses to the emotion.
You should not be limited to these particular emotions if a participant has a
recurring/important emotion, then that can be included in the exercise.
An example of a completed worksheet is presented in Hand-out 5.2. this
is a good place to start before participants begin completing the sheets.
Discussion and Homework:
Leave space for the group to talk about what they wrote down in filling out
these sheets. It is unlikely that participants will complete all sheets. Invite
them to complete the worksheets as homework; even those who complete all
six worksheets can be invited to see if their initial answers remain the same
as they think about this between sessions.
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6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the next
session and
Offers people the chance to affirm themselves for the work that theyve done
during this session
7.
Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
A brief sharing of their commitment is useful at this point, as it can help other group
members to come up with ideas for themselves. Note that it is not always necessary
to go around the whole group.
8.
Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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9. Belief Statement: Letting myself feel bad would mean falling to pieces.
Truth: Being human, means there may be times that you feel down; it does not
mean that your life will fall apart, or that you are wallowing in it.
10. Belief Statement: Children get carried away with emotions; I should be in
control and know how to express each one of them, at all times.
Truth: Emotions come and go; it is a very high expectation to put on yourself to
believe that you can be in control of every situation and emotion. Trying to
control your emotions can lead to unhealthy or addictive behaviours.
11. Belief Statement: I should not feel nervous, this is a sign that I have low
self-esteem
Truth: Having good self-esteem does not remove feeling nervous, it may help
you manage the nerves slightly better, but nerves are a natural and normal part
of being human.
12. Belief Statement: People will think I only focus on drama if I express or
talk about my emotions.
Truth: Having emotions and expressing emotions in a healthy way means you
are human.
13. Belief Statement: If I feel these emotions, I will lose all self-control.
Truth: Self-control is important but we cannot be in control of everything. Trying
to control your emotions can lead to unhealthy or addictive behaviours. This type
of thinking can lead to more difficulty.
14. Belief Statement: I should not express emotions like hurt, fear and anger, if
I do they will only cause more harm.
Truth: Anger, hurt and fear are normal human emotions. No one is immune from
them, and it is important that when they are expressed appropriately they are
neither destructive nor dangerous.
15. Belief Statement: I am stupid for feeling this way. There must be something
wrong with me.
Truth: How you feel is how you feel, you do not need to criticise yourself for
feeling a certain way.
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Emotional
Social
Responses
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Notes:
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Module 6
More Than Words
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Module 6 introduces a lot of material around emotion and may take some time
to work through. The quality of delivery is as important as the content within
the module. It is important to move at the pace of the group, if you sense that
this may take longer, this module can be delivered over 2 sessions.
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries. We have found that the
following guiding questions are useful to prompt discussion.
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If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator.
You should expect that people will still have difficulty in completing emotions
diaries but that this is beginning to ease for some.
3.1 Any other Homework
Last week the group where asked to fill in Worksheet 5.3, ask the group if
they have completed them as these are important for this module.
If some people do not have it completed, for whatever reason, allow time for
them to fill it in.
Ask each pairing for feedback on the topics and put comments on a flip
chart/whiteboard. Look for any themes in the feedback and give time for a
group discussion to let participants process the information.
It can be helpful to ask the group if they recognised any elements of the
learning during the week in their everyday life. Specifically, ask if they
recognise any emotions they were feeling during the week? How did they
know they were there? And how did they manage them?
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If they did not recognise any emotions or learning or if they ignored them, did
they notice any behaviours they engaged during the week that helped them to
do this avoiding or fixing whatever was going on for them? Noticing our not
engaging is awareness that they may have never had before.
Scared
Sad
Happy
Loved
Angry
Excited
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If there is doubt about the meaning of any of the words, ask the group to refer
back to the definitions they made in last weeks session. While these
definitions only describe the main 6, they will act as a sounding board for
working out the type of emotion that is being decided upon.
As you are putting each word on the whiteboard/flipchart, ask the group to put
the word in the appropriate column on the worksheet. The facilitators guide
sheet can be useful if one of the columns needs more words. It can also help
you to recall words that may be important for the group to consider but they
havent named it as yet.
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As facilitator you might give some examples to help with the discussion,
showing the difference in expressing the emotions at different intensities. It is
also worth noting that some people will already have these words in their
lexicon but may not be feeling their differences. Some will both know and feel
their differences, so as facilitator, it is helpful to present this exercise as
something that is being explored rather than new material being presented.
High Intensity
Medium Intensity
Low Intensity
This exercise is very personal and although there maybe similarities, each
person will have different experiences; this is not a competition and no one
can tell another person what way to feel. There are not right answers here;
there are just right answers for each individual.
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When they have completed this piece of work, generate a discussion around
the lists.
Guide questions include:
Were they aware that each emotion has so many different linked
emotions?
Is it challenging/ confusing to look at this list?
Do they recognise the different emotions in themselves?
Do they recognise the different levels of intensity of emotions? Are
these levels easier to see with different emotions?
4.2.5 Exercise 5: Changing Last Weeks Descriptions of
the Same Event
Then using the example from Module 5 (Connecting
emotions with life situations), ask the group members to
choose one word from each intensity box to re-describe
that same event.
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Before moving on to the next exercise, leave room for a brief discussion on
any insights gained during this piece for work. Note that a more detailed
discussion will follow the completion of the next exercise.
4.3.2 Exercise: Levels of Intensity
Give each participant a copy of Handout 6.2
Example:
Sad
High
Medium
Low
Miserable, Heart-broken
Alone, Let down
Moody, Disappointed
The above example takes the words that describe SAD but would be
considered to have different levels of intensity; some people may not agree
with this and this is ok. Remember that each individual will feel each emotion
differently and there is no right or wrong emotional intensity level.
Discuss the handout with the group:
Note that:
The example used shows all words connected to sad. Emotions do not
always have this straight path; sometimes what starts off as disappointment
may end up as anger. Indeed, what starts off as content may end up as angry
or sad if I am uncomfortable with being ok. While acknowledging that
emotions are neither right nor wrong, indicate that some emotions might act
as early warning signs for triggers.
4.3.3 Exercise: Getting to know a Trigger Emotion
We are now going to create a level of intensity for the trigger emotion. Give
each participant a copy of Worksheet 6.1
Ask each individual to create their own high, medium and low intensity chart
for the emotion that they have chosen as a trigger for them. Put the trigger
emotion at the top of the worksheet, and then start with emotions they
experience as having low levels of intensity and working up to their trigger
emotion.
They can pick emotions from the different lists created during the session; the
starting emotions do not have to be obviously related to the trigger emotion
e.g. if anger is a trigger, the first sign may be nervousness or if sad is a
trigger, the first sign may be insecure.
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When the group have finished, it is important to remind them about their
homework for the week. In Module 6, this involves only the completion of the
emotions diary (and drug/alcohol diaries where appropriate).
Invite participants to use their supports in completing their diaries: key-workers,
family members and friends or whomever else they may have identified.
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the next
session and
Offers people the chance to affirm themselves for the work that theyve done
during this session
7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
A brief sharing of their commitment is useful at this point, as it can help other group
members to come up with ideas for themselves. Note that it is not always necessary
to go around the whole group.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Emotional trigger:
SAD
Heart-Broken (H)
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Scared
Angry
Sad
Happy
Excited
Loved
Nervous
Annoyed
Upset
Mellow
Over Joyed
Needed
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Emotional trigger:
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High
Scared
Angry
Sad
Happy
Excited
Loved
Afraid
lonely
Furious
Depressed
Elated
Valued
Elated
Connected
Terrified
Guilty
Enraged
Agonised
Over joyed
Glad
Over joyed
Wanted
Horrified
Anxious
Outraged
Alone
Thrilled
Hopeful
Thrilled
Valued
Petrified
Boiling
Hurt
Ecstatic
Fired up
Ecstatic
Appreciated
Fearful
Irate
Dejected
Passionate
Fired up
Cherished
Panic
Seething
Hopeless
Passionate
Confident
Shocked
Betrayed
Miserable
Hopeful
Understood
Pissed off
Anxious
Glad
Valued
Medium
Apprehensive
Upset
Heart-Broken
Cheerful
Cheerful
Beloved
Frightened
Mad
Sombre
Gratified
Gratified
Valuable
Threatened
Defended
Lost
Good
Good
Acknowledged
Insecure
Frustrated
Distressed
Relieved
Relieved
Grateful
Uneasy
Agitated
Let down
Satisfied
Satisfied
Respected
Intimidated
Disgusted
Melancholy
Glowing
Glowing
Confused
Resentful
Helpless
Cautious
Worried
Annoyed
Unhappy
Glad
Glad
Regarded
Nervous
Timid
Uptight
Moody
Contented
Contented
Needed
Resistant
Blue
Pleasant
Pleasant
Admired
Irritated
Upset
Tender
Tender
Touchy
Disappointed
Pleased
Pleased
Mellow
Mellow
Unsure
Low
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Notes:
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Module 7
Keeping the Wheels in Motion
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1. Grounding Exercise I
1.1 Grounding exercise
1.2 Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in and review of Safe Plan
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Ask participants to share emotions diaries
3.2 Any other homework
3.3 Emotions Board
4. Keeping the Wheels in Motion
4.1Programme review
4.1.1Continue discussion
4.2 Creating a plan
4.2.1Group Exercise: Creating a plan
4.2.2 Individual Exercise: Creating a plan
4.3 How can I incorporate this plan into everyday living?
4.3.1 Group Feedback
4.3.2 Role Play
5 Review and preparation for next Session
5.1 Planning Homework: Emotions Diary
6 Grounding Exercise II
7 Safety Plan
8 Feedback Form
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Note to Facilitator:
During this module we will be making plans. This is a doing module, that invites
participants to create plans around their emotions.
It is likely to be strange for them to be thinking about making plans for coping with
trigger emotions; therefore, you can expect that there will be ambivalence and
sustain talk throughout the module.
It is therefore useful to be mindful of motivational interviewing techniques and the
wheel of change during this and Modules 8 and 9. For your assistance, we include
our version of the wheel of change (adapted from Prochaska and diClemente, 1984)
which might prove useful when you are drawing attention to such ambivalence and
sustain talk with your group:
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1. Grounding Exercise 1
1.1 Grounding exercise
Grounding and meditation exercises can be found in Appendix 4. It is
important that if you are going to lead a meditation to read over them first and
feel comfortable leading meditations. The purpose of meditation is to bring
peoples focus into the room and to let go (as best they can) of what is going
on outside of the group.
These exercises are by no means exclusive to the programme; if you have
other ones that you prefer to use, feel free to use them. The purpose is that
the group members are given time and space to ground themselves.
1.2 Sign-in sheet
Send around the sign-in sheet (See Appendix 1).
2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through the session without having spoken.
Key questions that you may find useful are:
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator.
You should expect that people will be more comfortable with completing
emotions diaries but some may still be finding it hard. They may require some
extra support.
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Automatic thoughts
Unhelpful Thinking Patterns
Beliefs about emotions
How do I know what I am feeling?
Trigger emotions
This is an opportunity to discuss with the group the work they have been
engaging with over the last number of weeks. It is important to highlight that
this is not a test but a conversation to help each other to understand some of
the themes a little more or fix any misunderstandings.
Allow time for this discussion. Some guide questions:
As individuals and as a group, what has been like to engage in this
work?
What are we learning through this process?
Do the exercises reflect everyday life? Where are we seeing the
signs? What if anything has changed? How do we know if things
have changed?
Is there anything that you feel could be explained a little more?
What does any of the group need that would help them engage a
little more in the process?
4.1.1 Continue discussion
Having awareness is very important but it is not always enough. Having a
plan in place will help each participant to be aware of early warning signs. It
will also give them options that will help them respond to each emotion as it
comes up.
The group have had a week to allow this work to settle and become
somewhat familiar to them. We are now going to open up a discussion on the
learning:
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Record all feedback on the flipchart/whiteboard and keep for later in the
session.
4.2 Creating a plan
Create a plan to help you cope when trigger
emotions arise.
Give each participant a copy of Handouts 5.2
and 7.1. The purpose of these handouts is to
help participants think about doing something
differently when they begin to notice certain
emotions; this something might be this pre-prepared plan.
Maintaining old behaviours is not necessary and even when the feel
overwhelmed, they have options.
4.2.1 Group Exercise: Creating a Plan
Before asking individuals to try this exercise, work through an example with
the whole group. Ask the group for one common emotion that they would all
like to work on.
On the flipchart/whiteboard lay out the same design as
Worksheet 7.1
The bottom part, Intensity of Emotion and ability to
cope should be filled in first.
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Someone may put in remove myself from the situation but it may not be
appropriate to their living circumstances. If that is the case, what other coping
strategies can they use?
Once they have completed a full plan, ask them to come back together and
discuss their work. Invite the group to generate ideas for strategies for
anyone who couldnt come up with ideas for new coping strategies.
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Following the discussion, ask participants to revisit the level of intensity and
ability to cope for a second time. Now that the plan is in place:
Has either number shifted up or down the scale?
If it did what has changed, what has been helpful?
Some people may feel that nothing has changed. When this arises, explore
some of the following points/questions with the group:
What parts of the plan may change that could help you to move up half
a point or one point on the ability to cope scale?
Acknowledging the difficulty of completing this work, could some of the
wording change in the plan to make the plan more achievable?
The intensity of emotion may stay the same, does this mean ability to
cope stays the same? Remember, we are not trying to remove the
emotion but make plans that will help us to deal with it.
Reminding individuals that we do not always have control over the
initial reaction and thoughts (as these are often learnt responses), we
can however change the next piece and in doing so it gives us more
choices.
Ask if is ok for the group to give some feedback to help with the plan?
If an individual feels that they cannot put a plan in place that would
increase their ability to cope with a certain emotion, would they be
willing to work on a different emotion?
Helpful
Thoughts
Physical
Behavioural
Social Coping
Strategies
Ask group members if they are willing to share their plan? If they do, record
each emotion, coping strategy and helpful thoughts, and place it into its
appropriate category. Display all feedback and retain for later.
Try to generate as many coping strategies as possible from the group.
Type these up later as they are to be used as a handout for the next module.
4.3.2 Role Play
Ask if anybody in the group is willing to do a role play for the emotion they
have created a plan for?
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If no one volunteers to do one of their own, you will have to take the lead and
start the exercise, using the example from Handout 5.2. Create a scenario
where this emotion may emerge and ask two members of the group to
volunteer to help you with this.
There will be some planning in the beginning but each role play should take
no longer than two or three minutes, so that, depending on the willingness of
the group, it is possible to do quite a few role plays.
The role play is to include three people; the person who has volunteered
should be the director and will watch their plan being played out by two other
people. This should only occur if they feel comfortable; at any point, anyone
involved in the role play can call a halt and, as facilitator, you lead the group
on to the next role play or to the review of the session.
Those not playing characters will act as observers and give feedback.
Steps are as follows:
1. The director decides the emotion; they choose the scenario where this
emotion may emerge and who would be there and what might be said.
2. One person is playing the part of the person who wrote the plan and is
trying to implement it.
3. The other person plays the part of someone who would be there when
this emotion emerges e.g. partner, friend, dealer, police, doctor, boss
or parent.
4. The director directs the characters by telling them what to do and say.
(The Facilitator should prompt the director by asking questions such as
is this how the character sounds and acts? The more realistic it is, the
more they will learn from the experience).
5. The role play begins once the director is happy with how the characters
are playing the roles.
6. The role play should play out as naturally as possible with the safety
plan being implemented as realistically as they can.
When finished, the facilitator asks the actors to come out of character and
back into the room. The actors are given an opportunity to give feedback on
how the role play was for them. Then the director is asked about how it was to
observe their own plan being played out.
Then if the director is comfortable, would they now re-play the scene but this
time, the director plays their own role? If they would like to do the exercise
themselves, allow a minute to run through it.
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7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
A brief sharing of their commitment is useful at this point, as it can help other group
members to come up with ideas for themselves. Note that it is not always necessary
to go around the whole group.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Helpful Thoughts:
Physical
Social
Behavioural
10
Very Intense
5
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10
Able to cope
10
Very Intense
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10
Able to cope
PHYSICAL
BEHAVIOURAL
Go for a walk.
Respond instead of reacting.
Stretch.
Try to look at it from the other
persons point of view.
Go to gym.
Dont judge the emotion.
Engage in exercise.
How much of the emotion do I
Massage.
need to express now?
Deep breaths.
Do some writing.
Remove yourself from the
Do something you enjoy doing.
situation, if you can.
Acknowledge the emotion;
Be aware of the emotion in
where
it
is
on
the
your body.
thermometer?
Dance.
Pull back from people who are
not healthy for you right now.
Sing.
Play, have fun.
SOCIAL
THOUGHTS
Phone a safe friend.
Positive self-talk.
Meet a safe friend.
Do you need to sort this
situation out right now?
Speak to a friend.
Can I come back to it?
Attend a support group.
I can deal with this?
No matter what is going on,
attend your support services.
I have a plan in place, I know
what to do.
Be around people that are
healthy for you.
I have the ability to cope.
Do something positive for
As difficult as this feels, it will
someone else.
pass.
If possible remove yourself
from the situation.
Engage in a positive activity.
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Module 8
Embracing Success
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1. Grounding Exercise I
1.1 Grounding exercise
Grounding and meditation exercises can be found in Appendix 4. It is
important that if you are going to lead a meditation to read over these first and
ensure you feel comfortable leading meditations. The purpose of meditation is
to bring peoples focus into the room and to let go (as best they can) of what
is going on outside of the group.
These exercises are by no means exclusive to the programme; if you have
other ones that you prefer to use, feel free to use them. The purpose is that
the group members are given time and space to ground themselves.
1.2 Sign-in sheet
Send around the sign-in sheet (See Appendix 1).
2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and Review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through the session without having spoken.
Key questions that you may find useful are:
For example:
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries. We have found that the
following guiding questions are useful to prompt discussion.
If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator.
You should expect that people will still have difficulty in completing emotions
diaries but that this is beginning to ease for some.
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4. Embracing Success
4.1 Creating a Plan (Homework piece):
At the end of last weeks session, participants were asked to create a plan for
one of their emotional triggers. This is an opportunity to open up discussion
about the work and explore what it is like to approach this work at home.
This can be opened up to the group with two questions, remembering that this
is exploration.
What went well?
What was it like to engage in the work?
This is a real opportunity to explore how participants are feeling about
engaging in the work. During the last number of sessions we have been
creating lists and plans; now we are asking them to discuss what goes on in
their own lives. We are trying to elicit themes from the group here. As they are
talking, notice if any of the following themes arise:
Ask the participants if it is ok to stop for a moment and record the themes in
the group. Ask if it is ok to enquire of the group if anybody identifies with what
is being written on the board. If the group do not identify the themes, it is
important for the facilitator to explain what they have written on the board in
more detail. Then re-ask the group if they identify with the themes and
discuss why it is that we might be finding it difficult to embrace change.
This discussion will help with the rest of the session on embracing success.
4.2 Daves story continued:
Distribute a copy of Handout 8.1 to each participant. Ask the group to take a
couple of minutes to read over it and then ask someone to read the story
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It is
Daves story is not untypical of how someone in recovery can be doing really
well in many areas of their life, setting goals, achieving positive outcomes and
then, seemingly out of the blue, they seem to self-sabotage and return to old
behaviours.
4.2.1 Exploring Daves Story
The facilitator re-reads Daves story out loud. As they do this, the group
highlight as many of the following as they can identify:
All of the above are to be discussed with the group but it is more effective to
allow the group to find these issues within the story rather than the facilitator
identifying them.
Questions that will help create this exploration:
What happened for Dave?
When did things begin to change for Dave in relation to the visit?
How was Dave handling success?
Is Daves story realistic? If so, why?
Had Dave set a goal that was unachievable?
Could it be that Dave really didnt want the responsibility of his
child?
Can anybody identify with Dave?
What changes could Dave have made?
What can we learn from Dave?
What happened on that night?
As a way of completing this discussion, allow the group to create an ending
for Daves story. It is important to nudge them towards creating a positive
ending, one wherein Dave does not have a drink. This is important as it gives
a sense of hope, that even at the point of a slip, we still have options and
things can go well.
4.3 Moving Towards Success
Our deepest fear is not that we are inadequate. Our deepest fear is
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As stimulus for a group discussion, write the above quote on the board
or you can print off a copy for each participant. Ask the group if they
identify with the quote. It is important to ask the group what it means
to them.
Action
Engaging with a service
Stable on prescribed medications
Did you get off the train? NO
Getting takeaways from the clinic.
Did you get off the train? YES
Get back on track; engage with support.
Did you get off the train? NO
Work on building relationships
Did you get off the train? NO
Receiving awards for courses completed
Did you get off the train? NO
These stations continue along the journey from active addiction into recovery.
Ask the group:
What has been your experience at each station on the journey?
Do you ever notice the successful stations?
If we sit back and reflect, what is the next station you are aiming for?
What will the station look like? Who will be there?
Does anything hold you back from achieving your dreams?
Are you ever afraid?
At the end of this reflection, return to Williamsons quote and ask the group:
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Now distribute Worksheet 8.1. Ask each participant to reflect on a time when
they achieved success during their journey of recovery.
When they have filled in their individual sheets, ask the group if there is any
part of success that may be a trigger for them and if they need to put a plan in
place around that trigger? This may seem like a strange question for some
participants, so be prepared to discuss how success is a trigger and what a
plan for coping with success will look like.
Once everybody has completed their letter, we are going to ask each
participant to read it out to the group if they feel comfortable doing so.
At the end affirm each participant for their effort.
4.6 Home Work
Distribute Worksheet 8.3
As part of their work at home, ask each participant to think about and write
down goals they would like to achieve within the next year. This is to include
These can be in relation to anything but are often linked to: health, education,
social life, children, addiction, legal issues, relationships and their emotional
life.
When the group have finished, it is important to remind them about their
homework for the week. In Module 8, this involves the completion of the
emotions diary (and drug/alcohol diaries where appropriate) and completion
of worksheet 8.3
Invite participants to use their supports in completing their diaries: keyworkers, family members and friends or whomever else they may have
identified.
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the next
session and
Offers people the chance to affirm themselves for the work that theyve done
during this session
7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
A brief sharing of their commitment is useful at this point, as it can help other group
members to come up with ideas for themselves. Note that it is not always necessary
to go around the whole group.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Open Focus
Awareness of what
is happening both
positive and
negative
Belief in your ability
Physical
Emotional
Narrow Focus
Thinking only
about the
negative aspects
Focusing on what
is wrong e.g.
other peoples
opinions
Social
Responses
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Worksheet 8.3: What do I want to change? Short-term (3 months), mediumterm (6 months) and long-term (12 months)
Write down goals that you would like to achieve over the next year, in the following
areas:
HEALTH:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
EDUCATION:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
SOCIAL LIFE:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
ADDICTION/RECOVERY:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
LEGAL ISSUES:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
CHILDREN/RELATIONSHIPS:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
EMOTIONAL LIFE:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Module 9
Facing Fear
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1. Grounding Exercise I
1.1 Grounding exercise
Grounding and meditation exercises can be found in Appendix 4. It is
important that if you are going to lead a meditation to read over them first and
feel comfortable leading meditations. The purpose of meditation is to bring
peoples focus into the room and to let go (as best they can) of what is going
on outside of the group.
These exercises are by no means exclusive to the programme; if you have
other ones that you prefer to use, feel free to use them. The purpose is that
the group members are given time and space to ground themselves.
1.2 Sign-in sheet
Send around the sign-in sheet (See Appendix 1).
2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through the session without having spoken.
Key questions that you may find useful are:
For example:
Can you tell us one positive thing that has happened for you this week?
How did your safe plan turn out? Tell us one thing that worked well in
keeping you safe.
Was there one thing that you planned on doing since we last met and
succeeded in completing?
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries. We have found that the
following guiding questions are useful to prompt discussion.
If any group member is comfortable enough to share their insight, this should
be encouraged by the facilitator. You should expect that people will still have
difficulty in completing emotions diaries but that this is beginning to ease for
some.
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4. Facing Fear
4.1 What do I want to change? Short-term, medium-term and long-term
goals
Distribute Handout 9.1: The handout shows how each area of our lives is
intertwined and suggests that how we behave in one area of our lives can
have a direct impact on other areas of our lives.
Ask the group to choose three areas of their lives, from Handout 9.1, that they
want to make changes in. It can be useful here to ask participants why they
have chosen these as more important than the other areas. This is not to
question the decisions or to criticize; it is to draw out from the participants
statement of values important to them.
Then distribute 3 copies of Worksheet 9.1 and a copy of Handout 9.2 to
each participant.
Ask participants to fill in Worksheet 9.1 for each of the three areas that have
been chosen. Hand-out 9.2 offers an example of what a completed sheet
might look like.
This exercise asks participants to name the changes they are going to make.
Some things they are going to name are already being enacted so they are
asked to name what else they are changing with regard to these actions.
Recognitions concerning the speed of change need to be explored and what
can realistically be expected to happen in a given time frame.
In Discussion:
After participants have completed the worksheets, the facilitator should ask
each participant to outline what they have decided to do. They should be
encouraged by the group in undertaking these important endeavours.
The facilitator might ask:
Why did you choose those specific areas of life to work on and how are
they inter-linked?
What does each action mean to the participant? Specifically, actions will
have an impact on the persons life how life-changing is this choice?
Why is it important? Who else will notice the change?
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As facilitator, manage these discussions carefully and read the comfort of the
group carefully throughout.
When discussions regarding change are
happening, even among very motivated groups, sustain talk is likely to
emerge.
4.3 Setting realistic Goals
When you are in addiction recovery, you make goals all the time. But they are
not always carefully thought through. They dont always take into account the
number of things that you will have to adjust to make way for change.
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Taking one of the action plans briefly outlined in Worksheet 9.1, ask each
participant to create a MAPP (My Action Plan Predictions) outlining all of the
points along the journey in relation to achieving that goal.
Facilitators handout shows a very simplified way of laying out a MAPP. It is
an example of what someones goal plan may look like in terms of recovery. It
is important to note that it is very rarely a straight process; there are many
different turns, bumps with some straight sections along the journey. As
facilitator it is helpful to draw this up on the board, along with the different
stations, asking the group the following:
Coloured pencils/pens/markers
A3 sheets for those who want to create a larger image.
Rivers, roads and train tracks are useful pathways for participants to explore
for their presentations. But any pathway/journey will do.
Facilitators should encourage participants to be as detailed as possible when
drawing their MAPP; and their work in the group may require further reflection
and work at home.
Attention should be paid to what the person has experienced before, when
attempting similar changes and building these experiences into their MAPP.
Emotions and feeling should also be included. What changes will happen to
each participant as they journey through this change? Will their confidence
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increase? Will they become shy and reserved because of changes to drug
use? Will family and friends be supportive or annoyed by their changes?
When will this happen and what will be their impact? When slips and lapses
are likely and how are they to be handled when they arise?
Each participant will be asked to show their MAPP to the group and they
should be asked to talk about:
Distribute Worksheet 9.3 and ask the group to complete this work at home.
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6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the next session
and
Offers people the chance to affirm themselves for the work that theyve done during
this session
Examples of grounding exercises with full instructions can be found in Appendix 4.
Recordings of grounding exercises are available from the SAOL website should you
prefer to play the exercise rather than lead it yourself.
7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
A brief sharing of their commitment is useful at this point, as it can help other group
members to come up with ideas for themselves. Note that it is not always necessary
to go around the whole group.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Handout 9.1:
Every part of our lives is intertwined but which parts are you going to commit to
doing something about. Choose three areas of your life for which you will make new
changes (three of the following or any area you wish to name for yourself):
After deciding, move your attention to Worksheet 9.1
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Handout 9.2
cigarettes
cigarettes
roll-your-own
months)
Note: you choose your own time frame so short term might be a week or a
month or 2 months; medium term might be 6 months; long term might be 1
year to 18 months.
But if you find yourself pushing the date as far away as possible, then that
might be telling you that the goal/action you are choosing is a bit too difficult
for you at this time.
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Worksheet 9.1
Fill out one of these for each of the areas you are committing to work on.
Handout 9.2 gives an example of one that is filled out.
Goal:
________________________
Action:
________________________
Date for Review:
_______________
Goal:
________________________
Goal:
________________________
Action:
_______________________
Action:
_______________________
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Worksheet 9.2:
This is your Pie Chart (or your 24 Hour Clock)
How do you fill it in? How many hours do you spend on the following?
Family:
Work:
Exercise:
Watching Television:
On the computer:
Playing/Having fun:
Hobbies:
Reading:
Addiction related activity (Good or bad!):
Prayer/Religious activities:
Other:
Other:
Other:
Sleeping:
________
________
________
________
________
________
________
________
________
________
________
________
________
________
Now fill in your 24 hour clock each division line represents one hour. You might
wish to use different colours/patterns to represent each area listed above.
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___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Module 10
Becoming my own Lighthouse
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3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries.
3.2 Any other Homework
Last week the group where asked to fill in worksheet 9.3, NCT Nifty Care
Tactics for action plan and some will complete their MAPP
3.2 Emotions Board
Ask group members are there any other words that they would like to put up
onto the emotions board.
Each participant can read out their own NCT to the group if they feel
comfortable. As a facilitator it is important to encourage and support every
effort that is being made along with making sure that it is realistic. Also
making sure that the NCT should include Fun, Support, Power (Selfdetermination and self-autonomy) and Awareness. It is very unlikely that no
one will read out their work, if they do as facilitator you can lead an example
on the board highlighting Fun, Support, Power and Awareness.
It is also important to highlight that this NCT can be brought by participants to
their sessions with case managers and key-workers. This can be added to
care plans and these sources of support can be brought fully on board with
goals being targeted.
Ask them to identify the belief associated with the trigger event
To begin, invite the group to start at the bottom part of the worksheet at
the trigger that could lead towards a reacting/lapse
Generate group discussion about the process, especially directing the
discussion towards the decisions being made along this relapse cycle.
Notice any believing of the thoughts
Ask about where focus narrows towards addiction (as the only way of
dealing with the trigger)
Highlight any negative behaviour changes
How they may intervene at different stages?
Discuss what they do and do not have control over?
Also, that after a lapse or relapse remind the group that we still have a
decision to make. As Handout 10.1 shows, we dont have to stay in the cycle
of lapse/relapse. We can dispute what is happening and make a decision to
stay with these behaviours or look for alternatives.
Ask the group then to fill in the top part of the worksheet, identify skills already
learned from previous experience and from the learning on this programme,
which may help them respond differently to the situation.
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stop in our tracks. We are stuck in recovery and dont know what to do.
Distribute Handout 10.2 and ask the group if they identify potential sticking
points in recovery?
Some pointers for facilitators:
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connects them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until
the next session and
Offers people the chance to affirm themselves for the work that theyve
done during this session
7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Handout 10.1
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Handout 10.2
My own potential sticking points
in Recovery:
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
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COGNITIVE/MENTAL relapsing
warning signs:
Anxiety
Intolerance
Anger
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Cognitive/Mental
Behavioural
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First is to identify that you are in emotional difficulty and identify the emotion
Use your Creating a Plan for the emotion
Remember that you can ask for help and that isolating is not helping.
Practice relaxation
Recognize that your behaviour may be changing
Practice self-care
Worksheet 10.1
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Worksheet 10.2
Emotional
Cognitive/Mental
Behavioural
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_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
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Module 11
The Middle way
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Materials Needed
Flip chart paper & marker
Participants folders and pens
Sufficient copies of Handouts 11.1 & 11.2
Ample copies of the emotions diary for participants (Appendix 2)
Sufficient copies of Worksheets 11.1 & 11.2
Sign in sheet (Appendix 1)
Copies of the Feedback sheet (Appendix 6)
1. Grounding Exercise I
Grounding exercise
Sign-in sheet
2. Check-in
2.1 Introduction to todays session
2.2 Check-in and review of Safe Plan
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework
and emotions board
3.1 Ask participants to share emotions diaries
3.2 Any other homework
3.3 Emotions Board
4. The Middle Way
4.1 Finding my Middle Way
4.2 Acceptance
5. Review and preparation for next Session
5.1 Planning Homework: Emotions Diary
6. Grounding Exercise II
7. Safety Plan
8. Feedback Form
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1. Grounding Exercise I
1.1 Grounding exercise
Grounding and meditation exercises can be found in Appendix 4. It is
important that if you are going to lead a meditation to read over these first and
ensure that you feel comfortable leading meditations. The purpose of
meditation is to bring peoples focus into the room and to let go (as best they
can) of what is going on outside of the group.
These exercises are by no means exclusive to the programme; if you have
other ones that you prefer to use, feel free to use them. The purpose is that
the group members are given time and space to ground themselves.
1.2 Sign-in sheet
Send around the sign-in sheet (See Appendix 1).
2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through the session without having spoken.
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries. We have found that the
following guiding questions are useful to prompt discussion.
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Where the wavy line moves furthest away from the straight centre line, indicates the
points where there is most flexibility within a recovery plan. Where the wavy line is
closest to the straight centre line indicates the points where there is little flexibility
within the plan.
The middle way acknowledges the need for flexibility in recovery. It also
understands there are areas in an individuals recovery where being flexible is not an
option.
This idea invites group members to examine a middle way for their recovery; to see
if there is wiggle room that can be built into their plans particularly in the areas of
emotions, thoughts, behaviours, family and expectations.
The middle way is different for everyone. Some people will be able to give
themselves a lot of leeway; others will have to keep things tighter. But the purpose
of this exercise is to open members minds to the fact that a plan without any middle
way is more likely to fail. We all need room to manoeuvre from time to time.
Group members need to be encouraged to be honest; but group members also need
to be encouraged and be open to the fact that what is right for them may not be right
for the person sitting beside them and vice versa. For example, one person may be
able to miss some Fellowship meetings whereas another may not; one person may
be able to accept their angry feelings whereas another may find such feelings to be
too much of a trigger for them at this point.
However, it is important that the facilitator emphasises that while we are encouraging
finding the flexibility within all plans, it is important that the group understand that we
are not encouraging reckless behaviour!
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Ask group members to read through each sheet and mark which examples
are relevant to their recovery and life. The example given may prove to be
exactly what they need and in such cases they can simply use this for their
list.
Distribute Worksheet 11.1 and Handout 11.2
Each person is asked to create a list of middle ways for each of the five
areas listed and they are asked to find three middle ways under each
heading. To assist in this, they can use Handout 11.2 as a reference as to
what their middle way might look like. You might like to read through this
handout with the group, discussing it with the group before participants try to
fill out Worksheet 11.1
When filling in Worksheet 11.1 the following questions need to be highlighted
with the group; it may be helpful to write these up on the whiteboard/flipchart:
Is there room for the possibility that my goals may not always turn out the way
I want them to? Do I have enough flexibility in my plan that, if my goals dont
always turn out the way I want them to this does not result in me giving up?
The goal never needs to change but maybe the plan needs to be altered a
little.
4.2 Acceptance
God grant me the serenity to accept the things I cannot change;
The courage to change the things I can
And the wisdom to know the difference
[Above is the Serenity Prayer that is well known in the fellowships. You can
choose whether or not to put in God at the beginning, as you will know your
group best].
Write the Serenity prayer on the whiteboard/flipchart and also on the board
draw a circle and a star similar to Worksheet 11.2.
Group discussion:
The discussion of acceptance in relation to change is extremely important;
facilitators are encouraged to elicit themes from the group rather than
teaching a concept.
For many, acceptance can feel like a passive stance; that if I accept things,
then I am doing nothing. This stance ignores the wisdom that the prayer
requests. There is a difference between what I must accept and what can be
changed; and therein lies the energy and excitement of personally driven
change. The intention of this exercise is to help participants recognise what
they cannot change but also to embrace what can be changed; and to
challenge them to know the difference so that they do not waste lots of energy
chasing after the wrong changes.
Distribute Worksheet 11.2
Ask the group to fill in the things they can change and then the things they
cannot change. It is useful to ask the group if there anything they would or
could move from outside star to inside and vice-versa.
When this work is done, invite further discussion on this matter.
A lot of what goes on in a persons life and on the journey of recovery is
outside of the individuals control. Over the last 10 sessions we have been
working on changing the parts of us that we do have control over.
As part of the journey of recovery it is important to acknowledge that there
are things that go on in our life that we have no control over. When we see
things really as they are, we give ourselves a genuine choice as to how we
respond. We do not sit back and permit the world to go by, or allow people or
circumstances to walk over us. We are actually learning to respond, to know
our world and to be at peace with our own limitations.
By gaining acceptance we are actually gaining back our power.
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When the group have finished, it is important to remind them about their
homework for the week. In Module 1, this involves the completion of the
emotions diary (and drug/alcohol diaries where appropriate)only.
6. Grounding Exercise II
This exercise is designed to help signal to the group that the session is ending and
assists them in making the transition back into their everyday life. It also:
Helps to connect them with the here and now before leaving
Gives space for them to reflect on their safety plan for the time until the
next session and
Offers people the chance to affirm themselves for the work that theyve
done during this session
7. Safe Plan
Give everyone a copy of the Safe Plan (Appendix 5) and ask them to write at least
one way in which they will work at staying safe until the next session.
8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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Hand-out 11.1
Emotional: can I allow myself to feel the good emotions in recovery, while
understanding that I will also feel difficult emotions?
Feeling angry on occasions is not the I feel lonely some of the time and I have
end of the world and I have plans to plans to make sure that such feelings
make sure that such feelings dont take dont take over.
over.
Feeling anxious is sometimes good and I I often feel like a failure and so when I
have plans to make sure that such feel this, it is not the end of the world
feelings dont take over.
but it is also not fact!
I dont have to feel happy all of the time
My current good emotions will change, Being sad is ok some of the time and I
but I invite them to come back
have plans to make sure that such
feelings dont take over.
My current difficult emotions will change Feeling awkward is usual for someone in
and I will cope when they come back
recovery; I know I will not feel awkward
all of the time.
It is ok to express my negativity every so I am ok with being bored some of the
often
time.
It is ok to not like my current feeling but Feeling nervous at times is natural and
its also good to stay with it.
important and although I might prefer to
not have to feel it, Im ok with being
nervous some of the time.
I can remind myself that emotions are not Being furious or full of rage or pissed off
facts.
or highly stressed is ok, some of the time
and I have plans to make sure that such
feelings dont take over.
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I must do
I should not
I have to
If I dontthen
I cant go there
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Emotions
Family
about it.
Cognitive
Expectation
that
such
natural
Behavioural
If I have an argument, I will
try
to
keep
my
head
but
ok I can adjust.
more
planned
than
three
215good either! I
all the time is not
will trySAOL
to find aProject
middle Ltd.
way.
Emotions
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
Family
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
Cognitive
______________________
______________________
______________________
______________________
______________________
______________________
______________________
Expectation
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
_______________________
_____________________
______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
Behavioural
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
________________________
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________________________
________________________
________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
___________________
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Module 12
Im On My Way
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1. Grounding Exercise I
1.1 Grounding exercise
Grounding and meditation exercises can be found in Appendix 4.
These exercises are by no means exclusive to the programme; if you have
other ones that you prefer to use, feel free to use them. The purpose is that
the group members are given time and space to ground themselves.
1.2 Sign-in sheet
Send around the sign-in sheet (See Appendix 1).
2. Check-in
2.1 Introduction to todays session
Give a brief overview of what the focus of todays session will be about
2.2 Check-in Exercise and review of Safe Plan
It is important to get everybody to say something at the beginning of the group
so that individuals are not sitting through without having spoken.
3. Review of Emotions Diary (and drug/alcohol diaries), any other homework and
emotions board
3.1 Review of Emotions Diary (and drug/alcohol diaries)
Ask participants to reflect on their emotional diaries. We have found that the
following guiding questions are useful to prompt discussion.
I am courageous because I
know I cant change my past or the things I have done but I want to
change to make my future better.
I am courageous because I am
sheet. Better still is to create your own boars on a big sheet of card. Depending on
the size of your group, you may need more than one board.
The only changes to the rules of a usual game of snakes and ladders are:
-
Do not go up a ladder without first taking a ladder card. If the card permits you
to go up the ladder, go up. If not, stay where you are or do as the card
instructs.
Do not go down a snake without first taking a snake card. If the card permits
you to go down the snake, go down. If not, stay where you are or do as the
card instructs.
Players can use a skills card whenever they want. Players are given 4 skills
cards at the beginning of the game. These cards counteract the instruction given
on the ladder or snake card so you can use the card to avoid going down a
snake or use another card that permits you to go up the ladder.
[The skills cards are so called as a way of highlighting that each individual can
have their own personal skills that push past a current difficulty and makes
recovery more possible].
We have found it more useful to play this game by dividing the group into two teams;
however, if there is a large group, it might be useful to have two games going at
once.
All the hand-outs are attached.
4.3 Review and Evaluation of Programme
Facilitator asks each group member to gather their folders together for a reflection on
the programme.
Using Worksheet 10.3 Review and Evaluation, ask each participant to complete
the worksheet. When all have finished, ask them to come back together and
encourage them to share their findings with the rest of the group, e.g. what part of
the course they found least beneficial, what part they found most beneficial etc.
Write the key points up on the whiteboard/flipchart for evaluation purposes.
Reinforce the learning by encouraging group discussion.
If there are any participants who feel they would benefit from another opportunity to
re-do the course, take their details and arrange a follow up appointment with them.
Retain the worksheets for your own review and evaluations.
5. Grounding Exercise II
Just before the final checkout it is helpful to get everybody to ground themselves, so
that they can have a few moments to reflect on the programme.
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8. Feedback Form
Each participant is asked to complete a Feedback Sheet, an evaluation of the
session, before leaving the group (See Appendix 6). It will take no more than 2
minutes. They do not have to sign this sheet.
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True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
True
False
Neither true
nor false
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Go Up
You call on the support of a friend
climb the ladder
You are eating a good, balanced diet and You have started missing breakfast and
you are eating at regular times. Climb
eating a lot of fast food in the evening
the ladder.
dont go up this ladder
Snakes
Go down
Dont go down
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Bibliography
Beck, A., Wright, F.D., Newman, Cory, F., Liese, (1993) B.S. Cognitive Therapy of
Substance Abuse. The Guilford Press New York London
Bor, R. & McCann, D. (1999). The Practice of Counselling in Primary Care. London:
SAGE Publications ltd.
Bowen, S., Chawla, N., & Marlatt, G. A. (2011). Mindfulness-Based Relapse
Prevention for Addictive Behaviours-A Clinicians Guide. New York: The Guildford
Press.
Bryant-Jeffers, R. (2003). Counseling a recovering Drug User-A person Centred
Dialogue. Oxford: Radcliff Medical Press.
Carroll, K.M. (1998)Therapy Manuals for Drug Addiction A Cognitive Behavioural
Approach: Treating Cocaine Addiction. Yale University (1998).
Citywide Drugs Crisis Campaign (2004) Cocaine in Local Communities, Survey of
Community Drug Projects
Citywide Drugs Crisis Campaign (2006) Cocaine in Local Communities, Citywide
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Cormier, R. A., Dell, C. A. and Poole, N. (2004). Women and substance abuse
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Corrigan, E. M. and Butler, S. (1991) Irish alcoholic women in treatment: Early
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Corey, G. (2012) Theory and Practice of Counseling and Psychotherapy, Ninth
Edition. Belmont: Brooks/Cole
Cox, G. and Lawless, M. (2000) Making contact: An evaluation of a syringe
exchange programme. Dublin: Merchants Quay Project
Cox, G., Kelly, P. and Comiskey, C. (2008) ROSIE findings 5: Gender similarities
and differences in outcomes at 1-year. Dublin: National Advisory Committee on
Drugs
Crane, R. (2009). Mindfulness-Based Cognitive Therapy. New York: Routledge .
Daley, D.C & Howard, M.B (2002) Dual Disorders, Counseling Clients with Chemical
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Miller, W.R, & Munoz R. (2005) Control Your Drinking, Tools to Make Moderation for
You. New York: The Guildford Press
Miller, W.R, & Rollnick, S. (1992) Motivational Interviewing: Preparing People for
Change, New York: Guilford Press
Miller, W.R, & Rollnick, S. (2002) Motivational Interviewing, Preparing people for
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Miller, W.R, & Rollnick, S. (2013), Motivational Interviewing, Preparing people for
Change, 3rd Edition. New York: The Guildford Press
Monti, P.M: Abrams, D.B, Kadden, R,M, Cooney, N.L. (1989) Treating Alcohol
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Monti, P.M, Kadden, M.R, Rohsenow, J.D, Cooney, L.N, & Abrams, B.D,. (2002)
Treating Alcohol Dependence: A Coping Skills Training Guide. New York: The
Guilford Press
Morgan, M. and Brand, K. (2009). ESPAD 2007: Results for Ireland. Dublin:
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NACD & PHIRB (2008). Drug use in Ireland and Northern Ireland 2006/2007; Drug
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Poole, N. and Dell, C. A. (2005) Girls, women and substance use Canadian Centre
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The Guilford Press
The SAOL Project (2011) Reduce the Use 2. A cognitive behavioural type manual for
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The SAOL Project (2014) SOLAS sa SAOL (light in Life) Domestic Violence
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Turner, N., Welches, P., & Conti, S. (2013). Mindfulness-Based Sobriety- A
Clinicians Treatment Guide for Addiction Recovery Using Relapse Prevention
Therapy, Acceptance & Commitment Therapy & Motivational Interviewing. Oakland:
New Harbinger, Inc.
US Dept. of Health & Human Services (2005) Substance Abuse Treatment Group
Therapy A Treatment Improvement Protocol TIP41
Waldrop, A.E. et al. (2010) Community-dwelling cocaine-dependent men and women
respond differently to social stressors versus cocaine cues
Waller, T. & Rumall, D. (2004) Treating Drinkers & Drug Users in the Community.
Malden: Blackwell Publishing Inc.
Weiss, R.D, and Mirin, S.M. (1995) Cocaine: The Human Danger, The Social Costs,
The Treatment Alternative. New York: Ballantine Books
Wilsnack, S. C. and Wilsnack, R. W. (2002). Women and alcohol: An update.
International gender and alcohol research: Recent findings and future directions.
Alcohol, Research and Health
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On-line supports
CBT
http://www.youtube.com/watch?v=IbQkUJaE4d0
http://www.youtube.com/watch?v=Rpvgy-lS_zM (Beck, model, cue exposure and response
inhibition)
http://www.youtube.com/watch?v=LaiwKasS8bI (Beck, multiple problems related to case
conceptualizations)
http://www.youtube.com/watch?v=aWyg_bhSxOc (Beck, negative core beliefs)
http://www.youtube.com/watch?v=Nk59lutY_E4 (Beck, case formulation, belief/ behaviour/
focus)
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http://motivationalinterview.net/
Some MI Videos
http://vimeo.com/20901845 (Prof William Miller, +/- 8 minute overview)
OR
http://motivationalinterview.org/quick_links/about_mi.html (Prof William Miller, +/8 minute overview)
http://vimeo.com/56949751 (A short overview by a number of experts)
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Appendices
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Appendix 1
_______
Facilitator(s) ________________
Name
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Emotions Diary-By filling out this diary sheet you will begin to see patterns in how your feelings/emotions connect with your drug
use and what triggered them. It also reminds us how we coped, what we did, what we felt after our actions (e.g. when we make
good decisions we dont always feel good afterwards). This information will help in your self-awareness and prompts us in taking
control of our actions
By filling out this diary sheet you will begin to see patterns to your drug or alcohol use, what triggered it, the
feelings associated with those triggers, the actions you took and the consequences of those actions. You should record every trigger regardless of whether
you ended up using drugs or not. This information will help you to become more self- aware around your drug or alcohol use. Record as many situations as
possible in between each module of the course and bring your Journal with you to each module.
Day & Time
Trigger
Behaviour
Good Consequences
Did anything good
happen?
Bad Consequences
Did anything bad happen?
Here are some risky situations. Mark them from 1 to 3 as you see fit (1 = no temptation to use; 2 = slight temptation to use; 3 = strong temptation to use):
Risky situation
When I am angry
When I feel sad
When Im around others who
are using
When I have money worries
Risky situation
Risky situation
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Appendix 4
Start of session
Grounding Meditation: 10 mindful breaths
If there is a table in the room ask the group to move their chairs back a little
1. Coming now to sit, feet flat on the floor; back is straight but not stiff, head and
neck balanced on the shoulders. Allowing the shoulders to relax a little,
resting your hands comfortably on your lap. Closing your eyes if that feels
comfortable, if not allowing a soft gaze onto the ground a few feet in front of
you, as best you can allowing the mind to settle
(Allow 3 in and out breaths, before next instruction)
2. Become aware of physical sensations throughout body, especially sensations
of touch: Feet on the floor, body making contact with the chair. Allowing the
body to become comfortable on the chair, finding your own balance.
(Allow 3 in and out breaths, before next instruction)
3. Letting the sensations of touch fade into the background of awareness and
bring your attention to the breath, breathing in-breathing out, bringing
awareness to wherever you notice the breath most, this maybe at the tip of
the nose, or the rise and fall of the stomach. Nowhere to go, nothing to do
(Allow 3 in and out breaths, before next instruction)
4. Following the full cycle of each in breath and each out breath, nowhere to go
nothing to do
(Allow 2 in and out breaths, before next instruction)
5. Now bringing your awareness to the breath right down in the abdomen,
stomach area. It may be helpful to put your hand on your stomach to help
notice the rise and fall with each in breath and each out breath.
6. Now staying with the full cycle of each in breath and each out breath, counting
10 in breaths and 10 out breaths.
After 5 breaths give following instruction
(If you notice your mind wandering off into thoughts, acknowledging where the
mind has gone and gently bringing yourself back to the next in-breath or next
out-breath)
Continue to 10 breaths
7. Now expanding your awareness around the breath to the whole body sitting
here, becoming aware of the feet on the floor, the chair supporting you
(Allow 3 in and out breaths)
8. And now opening your eyes whenever you are ready and as you begin to
open your eyes, becoming aware of your space in the room and the other
people in the room.
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Appendix 5
My Safe Plan
Between now and the next session of RecoverMe, I will keep
myself safe from harm by:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Name at least one way in which you will reduce the harm to
yourself from drug/alcohol use or avoid high risk
situations. You dont have to stick with one you can
name as many as you want.
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Date: ________
Agree Strongly
Agree
Total:
Appendix 7
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