It you know anything about SunCloud, you’ve probably heard that one of the most common phrases we use with our patients is “bring it to group” (which is often followed by a patient eye roll). This is much more than a clever therapeutic catch phrase muttered to avoid a conversation in the hallway! It’s actually foundational to our treatment model at SCH. Unique among treatment centers, we explicitly focus on creating a recovery community attached to health that lives and breathes beyond the confines of our therapeutic day.
Why the insistence on “bring to group”? I’m so glad you asked.
Safety in numbers
Often the conversations that we are asking to be brought into group are happening already – they’re just happening in secret, among patients behind doors, in the milieu. We’re simply asking patients to have these conversations out in the open, face to face – something many of them (and us in supervision) reflexively avoid at all costs. Disease lives in shame, secrecy, isolation, fragmentation and splits (all rooted in trauma). Bringing these conversations to group, with therapist support, is the best way to support patients in having corrective experiences with a healthy family system (peers who are supportive and importantly a sober, emotionally present and competent authority figure who is equipped to help the patients—our group leaders). These are the experiences that help people attach to treatment, get excited about recovery, and start to value themselves. These are the corrective experiences that lead to deep and sustainable healing.
Another reason to BTG is to avoid misunderstanding, gossip, and triangulation. When patients are complaining about gossip in the milieu, it’s usually a good indication that there is a lot being avoided in group, and a lack of trust that their disclosures will be met with help by the authority figure in the group (subconscious or unconscious trauma belief being they will be punished, hurt, shamed, abandoned, misunderstood.) Many times, the disclosures that need to come to group involve active symptoms, relapse plans, or group based trauma responses such as fighting, flight (people leaving treatment AMA or not participating in group), freeze (the silent group), and the other F (use your imagination…romantic pairing). It’s also important for us as clinicians to use the group to diffuse or correct misunderstandings or miscommunications that may be happening and leading to subgrouping in the milieu and/or splitting in the staff team.
A key concept for all of us to remember is that patients‘ diseases cannot split staff if we are actively and directly communicating with one another. When we stay united as a cohesive and healthy “parent unit” for the patients to attach to, our patients heal at a deep level.
Examining special relationships
A central component of traumatic experiences is the presence of a power differential. In an effort to maintain power and control, and as part of the grooming process, survivors of trauma are often made to believe the relationship possesses an element of specialness. The need to recreate this specialness can be played out over and over again in relationships. It’s often seen in relationships with those in authority: teachers, coaches, bosses, therapists. Making everything speakable in group, avoiding side conversations in the hallway, “check-ins” between individual sessions is the best way to avoid stepping into a special relationship with a patient. There is always a “next group” they can bring it to – whatever “it” is! Often patients begin opening up in individual sessions, which feel less overwhelming. The power of bringing to group avails our patients the ability to tap into more support and bigger container for the toxic stressors they have absorbed throughout their lives.
As we well know, most of our patients show up to SunCloud with previous trauma experiences. The circumstances of the trauma are often recreated (trauma repetition) in the dynamics of various relationships – we call these re-enactments. This is often done in an effort to produce an alternate final result. Patients will undoubtedly present in group dynamics in the same way they show up in family systems, work systems, relationships, etc. Ideally, within the context of group therapy and appropriate attachment, patients can have alternate results – also known as corrective experiences.
There are few things as isolating as active addiction and mental illness. It has been said that the opposite of addiction, as well mental illness, is connection. The power of community and group treatment can effect change in a way individual therapy cannot. When patients work with others who struggle with similar issues, they can harness the power to effect change that is often unachievable with individual therapy alone. This both reduces isolation and gives patients the needed power to step away from behaviors of no-choice, just for today.
The group is a perfect place for patients to ask for support to be held accountable for areas of their life in which they are actively seeking help to change. In addition, we should always be asking about addictive behaviors and substances of no-choice in groups and encouraging sharing about any relapses. We can collude with the disease by being silence. We see this when we support focus on a trauma narrative without also discussing active ways the person is trying to metabolize the trauma in secret (think the patient who has a positive utox or weight loss or active self-injury).
Brené Brown says shame needs three things to grow: silence, secrecy, and judgment. And the antidote for shame is empathy. Unfortunately, we cannot give ourselves enough empathy to combat the shame; it has to come from others, through the sharing of our stories. Often our patients have been conditioned to not share their stories with others. Secret keeping is a core component to the addictive family system. We are actively breaking generational cycles by encouraging patients to make the shame speakable.
We believe the group is an agent of change and provides a space that promotes social support and sustainable, deep healing. It offers a unique opportunity for individuals to work on issues of intimacy and individuation. We are not an organization that feels the need to protect patient stories from others or avoids “triggering” some patients by silencing others. We actively participate in moderating triggering disclosures, helping patient to engaging in support and grounding, helping patients take a contrary action to trauma reflexes which hurt them. We believe in the power of patients sharing, and eventually owning, their stories. We believe in the power of group and the passion of our team to facilitate deep healing for the brave patients that come to us for help.