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Cognitive Behavioral Therapy and Alcoholism

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Section 17: Who Wants to Work?
When asked who is ready to do some work, James pre-maturely jumps the gun. He suddenly finds he is really not prepared and attempts to have SusAnne come to his rescue. Jerry immediately picks up on this attempt from James to shift attention onto another member and intervenes by asking SusAnne if she would mind being part of the work James is attempting. James’s hesitation lets us know he is really not ready and we move the focus away from him.
1. You are leading a group and ask, “Who wants to work?” There is a long silence and nobody gives any indication of wanting to work. What assumptions might you draw from this situation? What might you say?
I would assume that there is lack in the degree of trust and confidence within the group. I would ask each member if they could verbalize “How safe do you feel right now in this group”? And give reasons why or why not.
Section 19: Symbolic Exploration Through Role Playing
One of the first things I noticed about this segment is how Casey managed to muster enough courage to go through the role play. The issues of her not only feeling judged by SusAnne and other members in the group, as well as coming out to her mother are very important to her. Her willingness to take the necessary risk to the work on these issues is to be commended. However, skillfully guided her along by first asking a very important question, “Is this your agenda or Jerry’s?” The sheer emotion displayed in this role-play couldn’t help but to touch everyone in the room and therefore act as a catalyst for others to begin their work.

1. In a role play, Casey spoke to her symbolic mother in Vietnamese? As she did so, what did you observe?
The thing I observed the most was how the level of Casey’s comfortability increased drastically while speaking to her mother in her native tongue. This leads me to believe that Casey has been practicing on her own for some time exactly what she wants to say to her mother.
Section 20: Jyl’s Loss of Her Father
The key point in this section is that Jyl has lived with very low self-esteem for a long time which has led to her belief that she is socially inadequate. The acknowledgment from her father on his dying bed was enough for her to re-examine her worth and attempt to re-create herself in a more positive way.
2. How might you work with Jyl’s tendency to withdraw in social situations?
Jyl has already initiated the most important part of her work by sharing her issues and expressing her willingness to work through them. I would offer positive and commend her on her decision to make a contract and hold her to it. I would suggest that at some point during each session that Jyl verbalize at least one positive quality about herself and ask for feedback.
Section 21: Never Good Enough
While on a cognitive level, Jackie may know she is not responsible for her mother leaving, there still remains some unfinished business emotionally. Simply by sharing with the group she is able to get in touch with why she has always been such a people pleaser.
1. Jackie talks about trying to please others and to be perfect. To what degree can you identify with her issue? How might this help or hinder you in facilitating her work?
One thing as a leader I need to be careful of is the tendency to want everyone to like me. This can hinder my work with Jackie by me not being direct with her for fear of offending her. I need to be totally honest in my assessments even if its something she may not want to hear.
Section 22: Wanting Approval This section shows how valuable role-play can be in gaining insight into the dynamics shared between a group member and someone they have difficulty with.
2. Discuss what you consider to be the pros and cons of the leader being utilized by group members in role plays.
The positive things about leaders being utilized by group members in role plays is that it strengthens the amount of trust within the group, members receive the attention and help they need, leaders can make use of modeling so others can learn what to do, and leaders gain a better understanding of the members issues. The only negatives I can think of are the risks of transference and counter transference, as well as the member not taking what was worked on into real life.
Section 23: Working With Metaphors
It is important to pay close attention to words, phrases, and metaphors that members us to describe themselves. As members talk through their issues leaders can pick up on keys and offer them back to them to be used later. By the member examining what is actually being said, allows them to experience the full range of their emotions which can lead to better insight and maybe even closer towards their issues.
3. Assume that after Darren’s work he announces, “I’m feeling vulnerable and embarrassed. I can’t believe that I lost control like that.” How would you deal with this statement?
I would ask him how he felt about another member of the group who may have become emotional and if he saw that person vulnerable or weak?
Section 24: Working With Relationships
Role play can be very effective when working with relationships. In this section SusAnne has the opportunity to say out loud some things she’s been carrying around . She is also able to dump some things that she feels really don’t belong to her. In turn, James gets in touch with some things he’s been dealing with in his relationship. This is an example of maximizing transference reactions and getting two people engaged in therapeutic work.
3. In the video, SusAnne symbolically gives back to her boyfriend the hurt, shame, and lies she has been carrying around. What therapeutic purpose, if any, do you see in this technique?
Being emotionally burdened with her boyfriend’s baggage hinders SusAnne’s growth. By dumping it or placing it where it belongs frees her to move forward with her own issues.
Section 25: Andrew’s Struggle of Keeping Pain Inside
This section shows how leaders approach members who are struggling with expressing their feelings and are reluctant in either asking or receiving help when offered. A bit of humor was used to get Andrew to open even a crack. However, once he opened up just a little we saw the struggle of externalizing an internal debate. Role play is a useful technique in getting reluctant members to open up.
4. How accepting are you of what Andrew accomplished in the group? Explain.
I am very accepting of what Andrew accomplished in the group because despite his seeming unwillingness, as the session progressed he began to participate more and more. He was able to explore the polarities in his personality to help gain a better understanding of himself.

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