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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: GROUP AS THERAPYBeing a part of a group can do some powerful therapeutic things. The active alcoholic is afraid of people “out there.” The phrase “tiger land” has been used by alcoholics to describe the world. That’s a fairly telling phrase! Through group treatment, the alcoholic will ideally reexperience the world differently. The whole thing need not be a jungle—other people can be a source of safety and strength. Another big bonus from a group experience is derived from the alcoholics’ opportunities to become reacquainted with themselves. A group provides a chance to learn who they are, their capabilities, their impact on and importance to others. Interacting honestly and openly provides opportunity to adjust and correct their mental pictures of themselves. They get feedback. Group treatment of those in a similar situation reduces the sense of isolation. Acoholics tend to view themselves very negatively and have an overwhelming sense of shame for their behavior. Coming together with others proves that one is not uniquely awful. Yet, mere confession is not therapeutic. Something else must happen for healing to occur. Just as absolution occurs in the context of a church, in a group that functions therapeutically, the members act as priests to one another. Members hear one another’s confession and say, in essence: “You are forgiven, go and sin no more.” (A short lesson in linguistics: the word sin is derived from the Greek word meaning “to miss the target.” It is what the person standing by the target called back to the archer, so that the archer could readjust his aim. It does not imply evil, or bad, as is so often assumed.) That is to say, group members can see one another apart from the alcoholic behavior. They can also often see a potential that is unknown to the individual. This is readily verified in our own lives. Solutions to other people’s problems are so obvious, but not so solutions to our own. Members of the group can see that people need not be destined to continue their old behaviors. Old “sins” need not be repeated. Thus, they instill hope in one another. Interestingly enough, one often finds that people are more gentle with others than with themselves. In this regard, the group experience has a beneficial boomerang effect. In the process of being kind and understanding of others, the members are in turn forced to accord themselves similar treatment.What has been discussed is the potential benefit that can be gleaned from a group exposure. How this group experience takes place can vary widely. Group therapy comes in many styles and can occur in many contexts. Being a resident in a halfway house puts the alcoholic in a group, just like the person who participates in outpatient group therapy. Group therapy means the use of any group experience to promote change in the members. Under the direction of a skilled leader, the power of the group processes is harnessed for therapeutic purposes.*126\331\2*

BDD BEHAVIOURS – DOCTOR SHOPPING: THE NEVER-ENDING QUESTI got a call one morning from a psychiatrist in Boston who needed some advice about a patient. “He’s seeing all the ophthalmologists in Boston,” he told me. “He thinks his eyes look cross-eyed, and he can’t be reassured that they’re not. He’s seeing doctor after doctor. They all tell him he looks fine, but he won’t stop doctor shopping. He wants to get his eyes fixed.”This story isn’t unusual. Many people with BDD seek nonpsychiatric treatment, often dermatologic or surgical. They see dermatologists for slight or nonexistent hair loss or skin problems, requesting various types of treatment. They see surgeons to have their lips thickened, jaws widened, ears pinned, or breasts enlarged. They see endocrinologists for supposedly excessive or insufficient body hair, dentists for braces, orthopedic surgeons for a supposedly crooked spine, podiatrists for “bent” toes, and urologists for penis enlargement. They may see doctor after doctor, trying to find one who will provide the desired treatment. Others visit nonprofessionals, seeking electrolysis, a hairpiece, or hair-growth tonics. There’s no limit to the types of treatment requested.”Seeing doctors is an obsession for me,” Victoria told me. “I’m looking for something from them. I want to keep some until I find out the answer. I’ve seen all types—general practitioners, orthopedists, and podiatrists. I’m trying to find someone who can tell me why my feet are so misshapen. They all tell me that nothing’s wrong with my feet. One doctor said my problem was that I had an obsession with body image. I agree that I have a body image problem because I’m so obsessed, but I also need to find out what’s wrong with my feet.”Doctors are seen for various reasons: to diagnose a perceived appearance problem, do testing to determine the cause of the perceived problem, obtain reassurance that it looks okay, or give treatment. They may be asked to providetreatment after treatment, or to redo a disappointing procedure done by themselves or another physician. ‘Jennifer had seen at least 15 different dermatologists. She visited each of them repeatedly, asking them over and over if her skin looked okay. “I saw some of them several times a week,” she said. “I couldn’t be reassured that my skin was fine. I wouldn’t go away. I asked and asked them about my skin, and I begged and begged them for treatment. A lot of them refused to see me anymore.”*107\204\8*

There is yet another psychological method of coping with pain, and I believe this is the best of all. It is not as complete as psychological dissociation, but it is completely free from the possible dangers which may result from the too facile use of dissociation. In this method we do not try to deny the pain, or make the part concerned numb, or stand apart from the pain. We accept it for what it is—a warning. But we accept it in its pure form without any overlay or embellishment at all. We allow ourselves to experience pure pain, simple and unadorned. When we do this we soon learn that pain—that is, pure pain—really does not hurt at all.

I have warned you several times that your success or failure with this method depends very much on your willingness to go along with me. The idea of pain in pure form not hurting is probably quite new to you. It seems strange. More than that, most likely it seems downright silly. But do not just reject the idea because of this. You have the evidence of my own personal experience and that of many patients. So let yourself go along with me.

The wise use of autosuggestion is very valuable, but the relief of pain by this method is often difficult. For it to be effective we may have to set out deliberately to increase our suggestibility. It is possible that this could have side-effects in the direction of increasing our suggestibility in other areas. These are the problems of the use of autosuggestion in the self-management of pain. Then if we consider dissociation, we see that it is essentially a disintegrating process of the mind, whereas our ultimate goal is complete integration and maturity, which of course is a manifestation of integration. A very significant point about the self-management of pain by feeling pain in its pure form is that it is essentially an integrative process. Therefore the

side-effects of learning the self-management of pain in this fashion are all to the good, and work for greater integration and maturity of the personality.

*131\57\2*

Everything we do, we do on a background. All that we do in life is done on our personal background and on our cultural background. All that a nation does, in both peace and war, is done on its historical background. The small things we do in life, our relationships of man and woman, are all done on the background of what we are. There are specific things that we can do in the management of stress, but their effectiveness is greatly modified by the background of our way of life.

Every one of us, there is no escape, each of us, is a conglomerate of living material. Over countless generations, by the process of evolution, this living material which is us has developed certain needs and reactions. This is the biological background for what we do in the management of stress. If we keep within this background, the specific things we do will be so much the more effective.

The most important thing that we can do in helping our brain integrate the excess of impulses which it is receiving is to let our mind run quietly for a while. This not only temporarily reduces the overload on our brain, but actually helps our brain to work more effectively. So the evolutionary process has provided us with a need to conduct our life in a way that provides a background which makes it easy for our mind to run quietly for short periods, and so avoid the effects of stress. One problem is that, as we develop an increasingly sophisticated way of life, we tend to ignore our simple biological needs.

*62/98/5*

Idealism

“They call me a greenie. That’s OK by me because that’s how I feel about things. They laugh. They say we would hinder progress. If that’s how they see it, that’s their way of looking at things. Different from my way. Seems to separate us, one from the other. Makes us different. Not the same. Not one of them. And tension comes between us. Feel it in all kinds of situations.”

This is life. The idealistic among us become separated from the main stream of humanity. Become an identified minority group within the community. And, as with other minority groups, suffer from the prejudice and alienation of the main mass of society.

If we ourselves have leanings in this direction, what should we do? Modify our idealism to suit the prevailing trends of society? No. Never. Rather we must seek an inner security in ourselves, and so save our idealism from forming a background of stress.

Contraception

“I’m a good Catholic. No, I shouldn’t say that. Put it this way. My friends would say I am a good Catholic. I attend Mass. I go to confession. But I shop about. I try to go to a priest who is modern in his views. Is that cheating? Some times I think it is. Wake at night thinking about it. Should I go to one of the old school, and face the music? Be reminded of Hell and damnation. It’s all about contraception, of course.”

Just another background problem which makes her more likely to become stressed if a major problem should arise.

Church-going

“My wife likes to go to church. That’s OK. I am quite pleased for her to go. But must I go too? If I go, I get irritated by the waste of time. Then my irritation shows up between the two of us. If I don’t go, there comes a distance. It’s as if we were on different planets. People with different interests. The one not understanding the other. And that wonderful feeling of Sundays together just disappears.”

Life is a sequence of giving and taking. And nowhere is it so paramount as in our relationship of man and woman. Such giving has no price attached to it. If there be a price, it is not giving. It is then simply a transaction of the market place. The spin-off, the side effect, comes in our reduction of tension, and its effect on the whole stress situation.

*25/98/5*