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Relapse Prevention Group: Reducing Stress

Updated on March 31, 2019
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Kim is licensed in mental health and addiction counseling. Her education is in business, counseling, and health administration.

Confidentiality

Due to confidentiality in a therapy group, the names and situations identified in this story are fictitious. They are typical of situations that might be shared in a similar therapy group. Any resemblance to an actual situation is coincidental, yet not surprising.

Arriving

I am leaving the premises of my day job at a Fortune 500 corporate office location in an affluent suburb north of the city. Home is a scenic six mile drive east into a more rural area that was booming with suburban sprawl a few years ago. I am driving into the sunset en route to an urban, blue collar town that is further north and west of the city; a thirty five minute drive that I have been making three times a week for the past three years. The mill closed several years ago, and most of the men in town are unemployed. Many of the women with children are on assistance.

It’s cold. I’m tired. I have to stop for gas. It’s drizzling and has been overcast all day. It is getting dark especially early tonight because of the dense clouds. Traffic is not too heavy, but my car is making a funny noise.

I arrive at the counseling center and stop to fix a pot of coffee for the group and pick up my attendance book. It’s a court ordered relapse prevention group for indigent and habitual substance offenders.

Substance Use and Trauma

In a treatment group for substance use disorders, 60% of women and 40% of men have co-occurring trauma symptoms.

Co-Occurring Trauma

Sixty percent of women and forty percent of men in substance use treatment have co-occurring trauma symptoms. Sometimes the traumatic event occurred before substance use began, and sometimes it occurs as a result of substance use. In order to maintain sobriety from substance use, it is necessary to also seek treatment for trauma symptoms. In order to recover from trauma symptoms, it is necessary to maintain sobriety. The symptoms interact with each other and affect recovery from substance use and trauma.

Jenna

Jenna is early. Last week she was depressed and irritable. Tonight she is more hopeful. She shares her good news about the progress she is making toward reunifying with her children. She celebrates seven months clean from crack.

Getting Started

Group members trickle into the group room one at a time. The sign in sheet is passed around. The opening go-around begins. Social chatter stops and the group rules are in effect; one person talks at a time, what’s said in group stays in group, show respect to self, others and property, etc.

Usually there is a theme or issue identified during the opening go-around that the group works on. Sometimes there is not. On those occasions, we work more from the book. The topic tonight is, “Reducing Stress.” The objective is to identify sources of stress and work at reducing stress in order to prevent relapse.

I am concerned that if no one wants to work tonight, we will speed through the topic without really getting the full therapeutic benefit of the topic. My concerns are unfounded. Item two of ten on the worksheet relates to staying in the present by avoiding excessive guilt about the past and anxiety about the future.

Todd

Todd shares about the traumatic loss of his father, and the difficulty he has with intrusive thoughts and dreams about their motorcycle trip turned fatal.

Justin

Justin shares about his mother’s suicide four months ago; that this time was an apparent accidental overdose after several failed attempts at suicide in the past.

Steven

Steven is able to talk about his trauma for the first time without crying, and seems surprised to learn that other people have experienced traumatic events as well. He was involved in a motor vehicle accident ten years ago. No alcohol was involved, but he was driving a semi truck and an elderly woman failed to stop at an intersection. Images of her face flash in his memory as her body hits his windshield and is then thrown several feet into the air. He began to drink heavily and never drove a truck again. Alcohol was not involved in the accident, but he feels guilty and responsible. He believes he should have seen it coming; if only he had been more alert. Last year he was the driver in a drunk driving crash. He was injured and has problems with chronic pain. His heavy use of alcohol to cope with crash memories and now to manage chronic pain, has become a problem. He started group two months ago, has two months sober, and has a great deal of pain.

Megan

Megan is quiet and appears upset. She shares that she too has experienced a traumatic loss, but is not able or willing to share about it at this time.

Jenna

Jenna had shared in a previous group about her childhood trauma, and was able to identify and share with the group that the memories and nightmares are symptoms of Post Traumatic Stress Disorder (P.T.S,D), and even though their trauma is different from hers, their symptoms are the same.

Harry

Harry’s trauma events occurred in Iraq. He can’t afford medications and doesn’t want to go to VA. He just wants to complete his court and legal requirements. He seems comforted to know that others experience similar symptoms, and acknowledges that he too has trauma symptoms.

Shawn

Once again, Shawn is not able to relate to the topic. With the exception of his arresting event, his life is “normal” and he doesn’t have any “drama” like everyone else. He is a college student and his situation is different. He got a second DUI and accepts that attending group is part of the consequences he needs to pay for breaking the law.

Wrapping Up and Leaving

I share my reflection that current stress was not identified in the opening go-around, yet past stress was easily identified when asked what interferes with being able to stay in the here and now.

Group members share what they “got from group tonight” in the closing go-around, and recite the Serenity Prayer before leaving.

I finish my paperwork, lock up and set the alarm on my way out.

It is raining harder and the temperature is colder. The wipers and defroster work. The streets are slippery. I am driving slower as I leave the parking lot and head home. The moon is nearly full but barely visible. I am warm and calm.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2011 Kim Harris

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    • kimh039 profile imageAUTHOR

      Kim Harris 

      9 years ago

      :) It reminds me of The Little Engine That Could. I think I can, I think I can.....Have a great day, Vern. I'm going to see my body mechanic today to see what effects stress has had on my body this year!

    • vrbmft profile image

      Vernon Bradley 

      9 years ago from Yucaipa, California

      Think of it this way. If the car stopped running, you wouldn't hear the noise anymore!! I know, not funny!! I am driving a 1989 Celica GT which maybe someday will be a cool car, but now it is still a piece of lousy car!! Putting some money into it, but it does get to me where I need to go ALMOST! Sometimes I have to borrow a car and I have a good friend who lets me do that. Wow! Imagine that. Your group is lucky to have you.

      Take care

      Vern

    • kimh039 profile imageAUTHOR

      Kim Harris 

      9 years ago

      Thanks Vern. I don't like "nice" either! But "nice slice of my day" is ok! Thanks. Weather, car problems, economy, etc - acute and ongoing external stressors can take a toll over time. I wonder if checking out what that noise is would decrease or increase stress! It could be an "invitation" as you call it in your hub! I can't do much about rain or the economy, but I could get my car checked out! It would be really stressful if it stopped running!

    • vrbmft profile image

      Vernon Bradley 

      9 years ago from Yucaipa, California

      What a "nice" slice of your day. I hate the word "nice" but it seems to fit here. I know it really was raining and your car was really making a funny noise, but both the weather and your car are great metaphors for the stress we experience or can experience facilitating such a group. These groups can be very draining and even traumatizing. The truck driver and the woman's face on the windshield--My worst nightmare--but a skateboarder or a teen dressed in black crossing the street in front of my office as I leave especially if I leave at dusk when it is harder to see dark and shadowy objects.

      I appreciate you portraying the group members as people. Some times we are the only people in their lives who see them and treat them as fellow human beings and sometimes, therapists get so caught up in their boundaries and righteousness, they don't do it either.

      Anywho, a nice slice of Kim's day and wonder-filled work.

      Thanks for sharing it.

      Vern

    • kimh039 profile imageAUTHOR

      Kim Harris 

      9 years ago

      @Dim. Thanks for stopping by to read and comment. I really appreciate that. Yes, it's sad; especially when the addictive substance is prescribed, which is more and more common with pain and anxiety pills. People who have worked all their lives are no longer able to work because of their addiction. Some develop addictions for the first time in their retirement. very sad.

    • kimh039 profile imageAUTHOR

      Kim Harris 

      9 years ago

      @happyboomernurse. thanks so much for the positive comments; especially that you felt you were right there. the style is more of a story than my usual research based, non fiction style; so i wasn't sure how it would come across. It is easier to be compassionate when you're face to face with someone who is making an effort to do the right thing. It is easy to judge too when you see the damage addiction can do.

    • Dim Flaxenwick profile image

      Dim Flaxenwick 

      9 years ago from Great Britain

      Excellent hub. Thank you. Sad that so many people need this kind of help these days.

    • Happyboomernurse profile image

      Gail Sobotkin 

      9 years ago from South Carolina

      This was beautiful and compelling- as if the reader is right in there with the group. It was also very educational.

      You seem so well suited for the work you do and I always learn something from your hubs. This one reminded me to remain compassionate and remember that people struggling with these issues have a lot of emotional pain, often from past traumas. Sometimes the traumas are due to their substance abuse which ironically makes it even worse due to the level of guilt. God bless your attempts to lead them back to a place of healing and to give them skills to cope with stress.

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