This episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation through all CEUs registered at all
CEUs comm slash counselor toolbox I’d like to welcome everybody today to the
presentation love me doesn’t leave me addressing fears of abandonment the purpose of this
presentation is really to help us help clients increase their awareness of their story including
beliefs about behavioral reactions to situations that trigger their fear of abandonment so how
do we do that well the first thing we need to figure out is what fear of abandonment is and how
can we identify it in a clinical set setting then we’re going to explore the concept of schemas or
core beliefs and these are things that are formed in early childhood you know if you remember
prior classes we’ve talked about early childhood cognition is generally very dichotomous in children
Young children can’t look at that gray area so these schemas if they’ve gone
unchecked can lead to some very extreme belief patterns which lead us into common traps in
thinking reacting and relationships if your schemas are based on all-or-nothing you either
love me or you’re going to leave me hence the name of the book then your reactions are going to
tend to be more extreme and more all-or-nothing which increases anxiety because then anytime
a person who perceives any amount of disapproval is going to go to that extreme so we
want to talk about bringing it more toward the middle line and helping people learn to appreciate
and love themselves for themselves while they may not approve of the behaviors of other people they can
still love other people so just because somebody doesn’t approve of your behavior doesn’t mean
necessarily that they’re going to abandon you so we’re going to talk about that and then we’ll
learn skills necessary to help people accept their past as part of their story maybe they do
have a lot of abandonment issues and you know some people do and it is painful it cuts
to the core especially when those abandonment issues occur in early childhood when kids going
what that does so we’re going to talk about that and help people learn how to integrate it into
their present and we’ll learn the skills necessary to acknowledge that their past does not have to
continue to negatively impact them in the present so if they were abandoned when they were a child
you know we need to deal with that however if they continue to expect that every significant person
in their life will abandon them notice I use the word every because we’re still in those extremes
then they’re going to think that the past is negatively impacting them in the present so we’ll talk about
how to sort of moderate those belief systems how does this impact recovery whether you’re talking
about addiction or mental health issues connection is a basic human need we are not meant for the
most part to be Hermits in the middle of the woods there are introverts and in my husband’s an
introvert he has a couple of excellent friends he needs quiet time each day he doesn’t need to
be surrounded by people and he’s fine but I mean we’ve got human connection he’s not going to be
one that’s just going to you know move out to the middle of nowhere I’m an extrovert on the other
hand and I tend to have a lot of acquaintances and a lot of friends I draw energy from
being around other people so just because someone doesn’t have 150 acquaintances doesn’t
necessarily mean they don’t need connections so we want to recognize that connection is a basic
human need when infants are born they are put on their mother’s chest when we embrace each
other whether it’s mother and child or friends or whatever a chemical called oxytocin is released
and it’s our bonding chemical we are programmed we are hardwired for connection and oxytocin is a
very rewarding chemical so we want to recognize this that if people are so afraid of abandonment
that they push everybody away what are they losing as far as quality of life as infants and children
survival is dependent upon the relationship with the primary caregiver so if mom or dad wasn’t
happy if mom or dad was rejecting the young child was pretty much helpless to think about a child
who’s growing up in a family that’s just riddled with addiction and mental health issues and the
primary caregiver or caregivers are completely emotionally unavailable they may be physically
there but they may be so high or so depressed or so psychotic that they cannot attend to the
child’s needs what does that communicate to the child the child feels abandoned the child
feels a sense of neglect for people’s beliefs about other people and relationships were formed largely
based on their interactions with their caregivers so if this child was going Mom I’m hungry and
nothing happened or worse yet child was going Mom I’m terrified and nothing happened or they
were just given a pacifier and told to shut up then that is they were told they were communicated
to that, their beliefs their feelings their wants, and their needs were not important so they were
being rejected healthy relationships serve up as a buffer against stress so even if they had all
these negative experiences in early childhood teenage years you know maybe up until
they walked into your office it doesn’t mean it has to continue and how much can they gain from
having healthy relationships with a lot of clients that I work with who have pretty significant
abandonment issues can’t even fathom trusting someone enough to be in a healthy relationship so
we’re going to talk about how to sort of ease into that because you’re not going to say don’t let
your past influence your future and we’ll wave a magic wand and they’re ready to trust people
even once you point out that what happened in the past was largely not their fault or maybe not
even if their fault at they they’re still going to have difficulty not accepting responsibility
and going everybody leaves me so what talk about that addressing beliefs that formed as a result
of these relationships the past dysfunctional relationships we can help people create a
new understanding of events was mom or dad or caregiver being rejecting were you being
abandoned emotionally and physically because of you or because mom or dad just was able to do what
they needed to do to be a caregiver then they were doing the best they could with
the tools they had but it wasn’t enough to meet your needs so we want to talk about alternate
explanations for why parents and caregivers may have behaved in that way if you have a young child well
an adult now but who was put up for adoption or abandoned by their caregivers at a young age the
a young child was probably very confused because one moment their caregiver was there in the
next moment they were in the system so they were trying to figure out what did they do wrong and why
doesn’t that person love me anymore it must be me because children really can’t see well you
know mom is not able to function as a parent right now or dad is having difficulty coping we
want to help people better understand themselves in their reactions so that when they start getting
this urge to just cut all ties and be like you know what fine you know I’ll take my ball and go
home no problem what does that mean at there’s a certain point in all relationships in all healthy
relationships that you know sometimes people have to distance themselves from one another because
it’s becoming dysfunctional but for the most part, people will in relationships encounter
hiccups will encounter disagreements but in healthy relationships, they can work through
them in relationships with people who fear abandonment there are going to be two extremes
there’s going to be complete compliance and please don’t leave me or complete disengagement
and whatever I don’t care the final thing we want to do is help make people more conscious of
what they’re doing so they can make healthy decisions in their current relationships so when
they get that urge to either comply or disengage is that a healthy normative reaction right now
or are you reacting out of your past experiences the abandonment experience in childhood survival
depends on caregivers a four-year-old left alone for five days is not going to do so well you
know they may be able to scavenge food but once the food runs out where do they get it you
know there’s only so much that a child can do an infant can’t even get food
so survival depends on their caregivers and if their caregivers fail to meet those needs there are
high levels of anxiety and I will refer regularly to emotionally unavailable caregivers
and emotionally absent in addition to physically unavailable or absent because some parents and I
worked in the field of co-occurring disorders for over two decades and some parents just they are so
overwhelmed and so paralyzed by life itself they can’t even attend to anything else that’s going
on they’re doing good just to be breathing but if they have a child and that child’s needs are
getting neglected and fear of abandonment is a natural survival response when your food source goes away
what happens you start to freak the freak out so this is normal we look at this and say that that’s
that’s natural if a child thinks about the first time you take a child to kindergarten or pre-k
or daycare or whatever it is and you drop the child off even if they’re securely attached what
do they cry because they’re afraid that mom or dad won’t come back and they’re afraid of
this new situation that’s changed securely attached children will you know to adjust and then be happy to
see mom or dad when they come back but the point is there’s that initial oh crap reaction meeting
biological needs and safety are key triggers for anxiety at any age so we’re talking about housing
we’re talking about safety we’re thinking about Maslow’s hierarchy if somebody is not meeting the
child’s needs or if the person is not getting their needs met then they may have high levels
of anxiety and I add to the safety concept not only physical safety but also emotional safety
people need to feel safe in their heads and they need to be free from emotional abuse when
focused on survival people can’t focus elsewhere so if they’re not getting their physical needs
met guess what you know if you take somebody who is in pain who is sick who is hungry and who is
homeless are they going to work on self-esteem are they going to work on relationship skills
no, they’re focused on survival they need to have those basic needs met they need to have a certain
sense of security if they are in a situation that is dangerous physically obviously they’re not
going to be focusing on how I can better myself when they’re worried about somebody coming in
and hurting them physically likewise, it’s hard to focus on how can I better myself when everywhere
they turn they perceive someone telling us you’re not okay you’re stupid you’re lazy you’re bad
you were the worst decision I ever made in my life they can’t focus on personal growth when
all they’re getting is these verbal beatdowns all the time so people need to have acceptance if
they don’t have acceptance kind the opposite of acceptance is abandonment two kinds of extremes
again we’ll bring it back to the middle every stressful situation becomes a crisis the in
securely attached child now you can go back to and read Bowlby’s work on secure and all that kind
of stuff great reading but for the short version of this presentation remember that certs securely
attached children feel anxiety when their parents leave but then they can adjust and they’re happy
to see the parents return in securely attached children feel a great amount of anxiety when
their parents leave and are terrified that mom or dad won’t come back and then when mom or dad does
come back it’s your very very clingy or very very rejecting so with this child that’s in securely
attached it’s just like one to a hundred as soon as something happens that they think they may be
abandoned you see this pattern again in adults who are still struggling with these abandonment issues
that schema that they’ve formed and I’m getting a little ahead of myself that schema that they form
says if you let this person at your site or if this person disagrees with you or if this person
criticizes you they’re rejecting you and they’re going to abandon you so we want to you know check
in with those cognitions and look for trying to make those thoughts a little bit more helpful in
infancy or early childhood if caregivers were away for long periods because of work because
of the military if they were in jail if they just chose to be away or if they passed away children
may experience some abandonment issues now if the parents are away because a parent is a way
because of work or military or even jail and the other parent can help the child work through it
there’s much less drama if you will there’s much less issue with abandonment issues in totality
now if it’s whatever parent it is if the pay if the father happened to be the one went away
that person may have some residual issues with adult figures in their life that they need to deal
with but they may not know I’m not saying that every child of a soldier or a service person
is going to have abandonment issues that are so not true however if the experiences of the time
apart was not handled in a way where the child felt secure then it could have consequences that
are going into the present day if in early childhood caregivers were consistently or unpredictably
physically or emotionally present so think about a parent who has major recurrent major depressive
disorder addiction or is just ill-equipped to deal with a child when I was working at the treatment
center in Florida I had 14 15 16 year old young women coming in and having babies and you know
what does a 14-year-old know about giving birth and raising a child it’s not that they weren’t
necessarily trying you know they didn’t have great role models raising them in most cases and so they
don’t have anything to work with they don’t know how to be a parent they’ve never been taught so
it’s not always I don’t want to pathologize or make the parents look like bad people because
I believe that people do the best they can with the tools they have at any given time parents
don’t choose to be sucky parents sometimes it happens but I don’t believe they choose to
anyhow off my soapbox in later childhood as the child becomes elementary school middle school
age if they’re a poor family fit or they feel like they’re the black sheep they just don’t
have the same beliefs that the other people do they don’t seem to have the same interest that
their family does they may not feel accepted especially if the family’s going no that’s wrong
to believe and invalidate them so going back to that psychological safety if they’re constantly
being told their ideas are stupid they’re wrong they have the wrong point of view and they can
feel very isolated something can happen that ruptures the relationship with the primary care
giver whether it’s abuse or you know some other trauma and introduction of a new less
emotionally or physically safe caregiver can also lead to abandonment if the child feels like the
biological caregiver chose a new spouse over him or her say if you see where I’m going with that
because if this new person comes in and is less safe is abusive in some way emotionally physically
sexually it doesn’t matter the child is going to feel like they didn’t have a voice the child
is going to feel like the biological caregiver didn’t care and brought this other person in
any way which leads to feelings of rejection and abandonment so what are the reactions
fight-or-flight whenever there’s a threat we fall back to fight or flight or freeze but we’ll
talk about that when there’s a threat our anxiety goes up and we say in the past in these kinds of
situations, if I fought, did I succeed if so then we’ve got fights in the past did I succeed, and if
the answer’s no then the response is to flee pretty simply so anger towards someone unavailable
if they got angry and felt like it got them some sort of acceptance from somewhere that might
be the prevailing reaction sadness when someone goes away a sense of helplessness this person
just left me shame or self-anger about feeling needy or about pushing someone away with fears related
to rejection and isolation, nobody will ever love my loss of control or the unknown everybody
always leaves see how I’m using these extreme words again and fear of failure I can’t maintain
a relationship nobody wants to be with me because I’m not good enough so the questions for clients
in these situations what caused these fears as a child so when someone starts to have these fears
about a relationship, if the relationship starts to get rocking first question is what is it that
you’re afraid of in this situation if you stay together what is it that you’re afraid of if this
the person leaves what is it you’re afraid of and how likely is it that this person is going to leave
based on whatever is going on right now so let’s get some objective evidence here and another
the tool you can use is the challenging questions worksheet in cognitive processing therapy if
you google it challenging questions worksheet CPT or cognitive processing therapy helps
people walk through the logic in some of their cognitions and identify some known as unhelpful
distortions so then after you figure out kind of what the fear is then we say what caused that as
a child in the past when you felt like this what caused that and how was this reasonable or helpful
you know in the past when you felt like this and you reacted in anger what was the outcome and
how was it helpful in some sort of way you know did it get somebody to pay attention to you did
it gets somebody to come to comfort you, okay so you were identifying the function of the current
behaviors and then we want to say what causes these fears now a lot of times it’s the same symp
or similar stuff but we could say how are these reactions now unhelpful because as independent you
know adult-type people we can fend for ourselves we can put food on the table we can go to work we
can do we can function independently whereas this is a child we couldn’t you know there were just
some barriers to that does that mean again that we should live in isolation and say well
I don’t need anybody no that’s not what I’m saying what I’m saying is is these fears that
are overwhelming about abandonment that causes people to push others away or cling on like you
know whatever clings on uh are these reactions helpful in the present day you know do you still
need to hold on to people like there’s no tomorrow temperament based on their temperament children
need different types and amounts of caregiver interaction um some children are wide open and
easily overstimulated you know my son was that way when he was born well to this very day um
when he’s awake he is like the Energizer Bunny on methamphetamine I’m he’s just going going
going and talking and talking to himself and he needed a lot of structure and he would get
overstimulated easily but we were able to help him figure out how to handle that instead of
getting mad at him for what seemed to be acting out we were able to help him channel and figure
out when he needed to take a break the introvert may not need as much one-on-one attention with
the caregiver may need a comforting word here and there but they may not need the amount of
the attention that an extrovert may need an extrovert tends to need more interaction with parents with
family with other people because they draw energy and they think while they talk and they think
while they talk with other people so they feel a lot more isolated if they are isolated so we
want to understand the person’s temperament and how they may or may not have gotten their needs
met how they may have been told they were wrong and invalidated when they were younger and you
can hear some of this is kind of going towards Linda hands DBT environment um but what we want to
look at what you need now how can we create an environment that’s accepting and welcoming
to you now based on their needs and caregivers’ reactions children form schemas or core beliefs
about the world and others so if they state their opinion and it’s squashed or it’s ridiculed then
they’re going to form this core belief that it is not safe ever to share my opinions because I am
always wrong now we’re talking about children here but a lot of times think back for yourself there I
think most of us have at least some all-or-nothing dichotomous thoughts that come in every once in
a while and you know we can catch them but if these dichotomies go unaddressed the person starts
feeling very lost and very abandoned because it’s all-or-nothing important points about children
under 7 from 8 to 12 children are developing alternative cognitive skills they’re
starting to be able to think abstractly they’re starting to be able to see the gray area and
alternate explanations but even you know during that period so zero to 12 children are having
difficulty envisioning all the possibilities so anything that happens before that we want to
encourage them to look at the schemas that were formed and challenge them to examine whether they
are currently accurate and helpful children think dichotomously when they’re that young it’s all
or nothing it’s good or bad it’s not kind of sort of something it is what it is I mean even think
about thinking back to grades that we would get it was satisfactory or unsatisfactory there was
no ABCD F when we were in elementary school and I don’t remember middle school then it was a
dichotomous grading scale you either did it or you didn’t children are egocentric so whatever happens
they say what was it about me that made this happen if mom’s in a bad mood what did I do if
you know Mom is rejecting stupid well I’m stupid children are very egocentric so you take
all or nothing combined with all about me and you can see we’re creating the perfect storm of children
can only focus on one aspect at a time when I work with adult clients you know they come in and they
tell me that they had an interaction with their boss he was walking down the hall and he was in a
bad mood and I just knew I did something and so we talked about that and I’m like how do you know
that because he had it he had an angry look on his face okay what are some other possibilities what
else might have been going on with him then and a lot of times we can brainstorm
ideas about a call he just got or where they just left a meeting that didn’t go so well or who
knows what else in this day and time when we’ve got our cell phones and PDAs and everything
there are a lot of things that can trigger a mood besides just whoever you pass in the hallway
children can’t think about those other things that might have triggered the mood they see somebody
unhappy and they’re like I’m sorry um so we want to encourage as adults we want to encourage them
to say all right what are the other possibilities even as children I try to work with my kids
to encourage them to look at alternate reasons why somebody may be acting a certain way children
can’t think abstractly and consider those possible options um even with kids you know knee-high
to a grasshopper if you’re in a situation and maybe in a store and somebody behaves not kindly
to you, you can talk about that later with the kids and say you know that was kind of unpleasant to go
through what you think might have caused that and brainstorm three ideas my favorite number is
three I don’t know why but brainstorm three ideas for alternate explanations for why that person
may have been in an unpleasant mood if children learn to do this when they’re younger it’s a
a lot easier to transition to as adults schemas are a broad way of perceiving things based on
memories feelings and thoughts it’s our go-to perception of what something’s going
to be like we have schemas about everything if you go to church you have a schema about what’s
going to happen when you go to your mother’s house you have a schema about how mom’s going to
behave and what’s going to happen we form these it’s our brain’s short shortcut instead of having
to analyze every situation it says oh I remember this been here before it’s probably going to be
like X Y Z unfortunately sometimes things change and one of the things we see in addictions
treatment as is as caregivers into recovery and get a hold on it and start working that
a new way of life and sobriety and all that stuff old family members or family members still expect
that old behavior they have that schema that when Jane comes in this is what’s going to happen
because they’re remembering how she behaved and acted in her addictive self so we want to help
people identify their schemas and check them sometimes they’re still accurate sometimes not so
much schemas that trigger abandonment fear center around the cell acceptability is this person going
to like me which is one of the reasons we do a lot of self-esteem work in reducing abandonment fears
because we want to reduce the need for people to solicit external validation we want them to say
I’m all that and a bag of chips and I would love to play with you but if you don’t want to play
I’m okay with that love ability if they were told they were unlovable if they perceived
they were unlovable then in the present, they may fear isolation they may fear that they’re not
lovable so they will try to do whatever they can or likewise they will build a lead wall that is 5
feet thick around them so nobody can hurt them they may have fears about their own
competence you know thinking back to Erikson you never thought some of these theorists from the
past would keep coming up even in current practice but they do if a child going through that period
of industry versus inferiority Erik Erikson’s stages of psychosocial development and they felt
like a failure all the time or they were never good enough the parents never recognized their
positive achievements then they may question their competence and feel like a failure if they
feel like a failure they may feel they may believe that nobody wants to be around them so they will
leave so if I fail they will leave and fears may center around adaptability some people are not
able to tolerate any loss of control they’re just like that they’re holding on with a death grip to
the relationship to anything that’s going on and it starts to go wonky they are going to freak out
so we want to look at what does it mean if you’re not in control of everything what does it mean
if you trust that this person is going to do the next right thing if you are doing the next right
thing as well schemas that trigger abandonment fears can also be sent around center around others
if someone is rejecting distant cold or is unable to handle the person’s needs then the person may not
feel acceptable so if they are in relationships with people like this then we need to look at is
Is it you who’s not acceptable or is something else going on with that person that may be making
them unable to deal with anybody else’s stuff right now the person may feel isolated if other
people are absent if people fail to keep promises they may feel like nobody’s ever there for them
competence if other people are always critical then the person will question their competence
and if others are unpredictable a lot of the time when people who have anxiety about abandonment
they come from situations where other people have not been predictable or if they were they were
unpredictably absent and relationship of self to others if they are afraid about their ability to
relate with others if they’re afraid of rejection if they’re afraid that if they start to love they
will be rejected and then they will be isolated forever if they are afraid of the unknown and they
I just want consistency more than anything and as soon as consistency starts to waver a little
bit because as we grow things change and people with abandonment issues don’t like things to
change because that’s not predictable and that’s not consistent so they may have difficulty if one
the person starts to change what they do I see this a lot not saying that it’s an abandonment issue
necessarily but when law enforcement officers retire you know because they can retire after
20 years so they may start a new career and that causes a lot of change schedule changes
they’re not law enforcement anymore and the spouse sometimes has culty adjusting to it as
does the retired officer but controllability if the person holds on to relationships and
everything in their life with white knuckles because they’re so afraid if they let go of
control that they are going to disappear or disintegrate then if something seems like it’s not
in their control, it’s going to be a catastrophe so attachment Styles secure if there’s an
emotionally available caregiver the child will seek the caregiver for comfort and guess
what the caregiver will be there and will more often than not meet the need for comfort with the
the correct type of comfort so hungry cold scared kind of following the child’s upset when the caregiver
leaves especially in new situations but the child gets over it it’s not a child that’s going to sit
there and cry for eight hours and then the child’s happy when the caregiver returns in this kind of
attachment the child learns to trust others will be responsive to their needs and validate their
needs a child learns to be self-reliant and try new things but if they fail they know they can
return to the home base they can go out and go well that didn’t go as planned and the caregiver will be
there to say alright let’s figure out what to do next not You are such a failure the child learns
to adapt to a variety of situations because when they’ve been faced with something that’s a little
scary caregivers have been there to kind of coach them on and go you got this it’s scary I got it but
you can do it the child learns to deal with stress because the caregivers are there to coach them
or to process it with them afterward because the caregiver is not always physically there but if
you’ve got children you know sometimes they’ll come home from school and they’ve had a really
bad day and you’d pull them aside and go you know what’s going on let’s talk about it so in this way
the child learns to deal with stress and the child learns to have accurate expectations of others
in the secure attachment, emotionally available situation remember children are egocentric so
if mom’s upset the child goes what did I do or Oh my gosh I hope mom’s not going to leave in
a secure situation sometimes the parent has to say something like Mommy had a really bad day at
work today has nothing to do with you I need to go take a timeout that helps a child understand
that you know what it’s not all about me and I can understand that sometimes moms upset for
something besides me and I can understand that if moms Up said it doesn’t mean she’s going to
leave so obviously, this is the ideal situation avoidant attachment styles the rejecting or harsh
caregiver the person depends less on the caregiver for security because every time they go saying mom
Mom I had a nightmare can I come into bed with you they’re met with going back to your bed and the
caregiver rolls over it’s not oh I’m sorry you had a nightmare let me walk you back to your room
when the child is separated from the caregiver there’s little response when the caregiver leaves
or returns because the kids like what uses that person to me the child learns not to depend on
a caregiver for comfort connection or security now imagine yourself a four-year-old child or a
six-year-old child thinking I can’t count on my caregivers for comfort connection or security
that must be a terrifying place to be and I can see why you would develop some pretty strong
defense mechanisms the ambivalent relationship between the cave caregiver is inconsistent or can bow can’t
talk caregiver is inconsistent or chaotic this is true in a lot of homes where there are
at least one parent who is battling some sort of addiction or mental health issue so the parent
may or may not be available you don’t know what the good days are going to be you don’t know what
the bad days are going to be so the child may be anxious and afraid to try new things or explore
because they’re like things are going good right now I don’t want to top will be an applecart just
going to sit here and ride it out a child may be clinging and demanding trying to elicit a response
remembering negative attention is better than no attention at all and the child is upset when the
caregiver leaves but also inconsolable when the caregiver returns because you know I was upset
I was scared you went away but you came back and that’s good but I don’t know when you’re going
to go away again and if you’re going to come back so it’s this constant anxiety of abandonment
core abandonment beliefs all people leave so we want to challenge that by identifying exceptions
mistrust people will hurt reject take advantage of me or just not be there when I need them you
know what that’s true sometimes because people have their stuff so when this happens let’s
look at whether it’s happening all the time and/or let’s also look at what else might be going on
with that person that caused them to hurt reject take advantage or not be there when you needed
the emotional deprivation I never get the love I need nobody understands me cares about me or even
ever tries to meet my needs here how dramatic and extreme that is so one of the things as clinicians
we can do is say if you are getting the love you needed what would it look like what
would be different what is it that you need that you’re not getting once we identify
then we can create a plan to get it but a lot of times other people don’t understand or may not
be able to interpret what you need so let’s help let’s try to figure out how to make this happen
nobody understands me alright let’s talk about why that might be and you know let’s look at some
people who’ve kind of gotten a grasp sometimes with clients with abandonment beliefs nobody
understands me translates to I don’t give a buddy a chance and I cut them off as soon as they become
confused and because they associate confusion with rejection so we might talk about communication
skills we might work on what it is that people don’t understand and how to better communicate
that and where to find people who have similar interests nobody ever even tries to meet my needs
you know where I would look for exceptions but I would also challenge the person and I would
say when do you meet your needs what do you do to take care of yourself a lot of times
clients with abandonment beliefs are so freaked out and afraid of being abandoned that they’re
not taking care of themselves either they’re just living and paralyzed going back to fight
flee or freeze they’re living a paralyzed state of I want to be loved but if I love I’m gonna get
hurt and I don’t know what to do they don’t even love themselves so we want to start talking about
if you had your best friend you know create this best friend persona what would he or she say to
you what would he or she do right now let’s try to help you understand yourself with mindfulness exercises
are good here because a lot of times these clients don’t understand themselves they’ve got
so much anxiety they’re so afraid and they don’t know where it’s coming from because a lot of
it has been going on for so long defectiveness if people knew me they would reject me you know
not everybody’s going to like you why do you need everybody to like you why is it important that
everybody likes you and failure I don’t measure up and I’m not able to succeed I usually put pull
out the obnoxious quote that if you haven’t failed you haven’t tried and we talked about what it
means to get outside your comfort zone and you’re not going to be perfect at everything you’re not
going to be Michael Phelps you’re not going to be the president of the United States that doesn’t
mean that you’re a failure that doesn’t mean you’re a failure so what things are you
good at what can you and have you succeeded at and go back and look over things like you graduated
high school not everybody does that you know raised a family, not everybody does that so we
want to challenge all nothing’ languages we want to look for exceptions and we want to look
for in what ways can you provide yourself the validation so you don’t fear abandonment you don’t
need other people to tell you you’re okay because guess what you’re telling yourself I’m okay and
before I go on to unhelpful reactions I do want to point out that if we tell people to tell
themselves you know I’m okay that sounds great but if they don’t believe it if it’s not supported
with evidence, it’s probably going to slow their growth because they’re sitting there going
telling themselves I’m okay and in the back of their head going you know you’re not so we need
to get that internal critical voice to kind of hush up by providing the person with the objective
evidence of why they’re okay why they’re good enough and that’s a slow process it’s not going
to happen overnight but encourage people to figure out why they believe what they believe and then
you can work from there okay unhelpful reactions fighting with someone you don’t want to leave
me because so the person may engage in a dominant sort of posturing behavior aggression hostility
blaming and criticizing trying to tear down the other person to say you know what I don’t care
and it would help if you were grateful that I’m in your life recognizing and seeking to get attention and validation
or approval so if they feel something’s going wrong in a relationship they may start trying to
do something to gain recognition to prove that they’re worthy of a relationship for what they do
versus who they are manipulation and exploitation said lying justifying I did this because you made
me so sometimes we all occasionally do things that aren’t the nicest people who fear abandonment
have difficulty saying you know what I screwed up and they’re more likely to go you made me do
I wouldn’t have done it if you would have X Y & Z people again who are worried about a relationship
is going to fall apart and may also make excuses for other people’s inappropriate behavior it’s like
you know I hate what this person does but if I don’t make excuses for it if I condemn it
then this person is going to leave in counseling we can talk about the difference between loving a
person and loving a person’s behavior you know I love my kids to death there is no question about
that but some of their behavior makes me want to climb a wall I’m very clear to separate from them
the difference between the behavior that I dislike and them because you know like I said I love them
to pieces and we want to help people start making this differentiation if they don’t do it already
and clinging and chasing is the other fight reaction stalking and messaging somebody 47 times on
Facebook in an hour all these kinds of behaviors and even online bullying those sorts of things can
be fight reactions in response to feeling like there’s a threat of abandonment flight is more
of the I don’t care if you leave so the person will withdraw physically and emotionally and
maybe even numb themselves with some sort of addictive behavior or distract themselves with
something completely different or find a new person just proof that you know what I didn’t
need you because I’ve got this new person now questions for clients about core beliefs
all people leave okay so what does it look like if somebody’s available to you if they
don’t abandon you who in your past left you or was unavailable emotionally now a lot of
I find it helpful for mental health and addiction clients to have them write an
autobiography because then we can go back and kind of review it and identify the core
people at certain stages in a person’s life what did the person who left you do to make you
feel rejected or abandoned in retrospect you know it was hard to see the difference what
was going on back then because you were a kid in retrospect what are the alternate explanations
for why this may have happened was it you or was it more about them who in your past
has been available to you emotionally most of the time people can point to one maybe two people
who have generally been there it’s unreasonable to expect someone always to be there who in your
present is available to you emotionally you know maybe they’ve only been in your life for six
months or a year but they are available and I say emotionally because you know not everybody can
be available physically all the time we’ve got jobs kids all that kind of stuff but can you pick
up the phone and call them or text them and say hey you know what I’m struggling right now
what do you do in your current relationships that cause people to leave do you push them away if so
how what are alternatives to pushing them away cutting all ties and just saying fine be that way
I wipe my hands off you if you cling how do you do this in what ways do you perceive yourself as
being clinging and what are some alternatives to holding on with all desperation and mistrust people
will hurt reject or take advantage of me or just not be there when I need them so again what does
it looks like when somebody’s or what does it feel like when someone is trustworthy and safe who in
your past was untrustworthy or unsafe what do they do they taught you this and what are alternate
explanations who in your past has been trustworthy and safe who in your present is available and
trustworthy What do you do to yourself that is unsafe or dishonest that’s one of those tricky
questions you’re there talking about other people other people then it’s like what
do you do to yourself how do you lie to your self or how are you mean and hateful to yourself
how does your distrust of other people or even yourself impact your current relationships some
people distrust their internal intuition so much that they don’t want to make friends with
other people, they’re like I can’t tell who’s going to hurt me and who won’t so just yeah I’m
going to wipe my hands of it all what could you do differently what do you think you could do
to start building trust and what does it look like to build trust because Trust doesn’t
just appear it builds gradually emotional deaths deprivation I don’t get the love I need nobody
understands me so again what does it look like when somebody understands you and meets your
needs who in the past failed to meet your needs emotionally and how can you deal with that now
you know it may have been mom it may have been ex-husband it may have been you know who knows
how can you deal with it now yourself so you can put it to rest who in your past is understood
you who in your present understands you how can you start again better understanding yourself
because it’s hard for other people to understand us when we don’t even understand ourselves and
what can you do to start getting your needs met one of the things was starting to get your own
needs met is to figure out what your needs are and this is one of the exercises I have people do as
a homework assignment they keep track of what is it they want daily keep a log and then
let’s talk about what common themes were seeing if people knew me they would reject me okay so how
do you know when you’re accepted or acceptable to someone who when you’re past may make you feel
defective are there alternate explanations and how can you silence those old tapes because
that person that statement stays as a heckler in the gallery we need to hush the heckler what
can you do part of it could be talking back and saying you know what I’m not going to listen
or I don’t have time for this right now who’s been accepting and supportive who is in your life
that’s accepting and supportive and how can you start accepting yourself and being compassionate
so some compassion focus training mindfulness work to help people understand themselves and start
being compassionate with themselves understanding their vulnerabilities and cutting themselves some
slack I don’t measure up I’m not able to succeed okay that’s a pretty big success you know what
is what success means success means different things to different people so what does it look
like to you to be successful let’s kind of hammer that out what is it if you are successful what
would be different what in your past has made you feel like a failure what are some alternate
ways of viewing it such as a learning experience or something I had to go through to grow or you
know brainstorming alternate explanations for why people fail they don’t have a response to
sometimes I ask them to kind of take on a flip role and say pretend you’re a parent and
your child comes home and they’ve tried out for the football team and they didn’t make the team
they failed what are you going to tell on what have you succeeded at doing in the past what are
you good at in the present and we want to pay attention to minimization here because a
a lot of our clients are not good at identifying their strengths what does being successful mean in
terms of your relationship with others do you have to be successful to be loved and be a
good relationship you know you’re going to be successful in a relationship if you’re
but do you have to be financially successful and powerful whatever you define success as in
order to be in healthy relationships who are three successful people you know and what makes
them successful in your eyes does success equal happiness you can do a whole group on that and
what do your kids need to do to be successful in life you know we want our kids to succeed we
want our kids to be happy so what is it that I envision my child’s life to be 10 to 15 years from
now triggering relationships the abandoner is unpredictable unstable and unavailable the
abusive relationship is untrustworthy and unsafe the deprived err depriving relationship the
a person is detached or withholding the Devastator is always judgmental rejecting and critical and
the critic is critical and narcissistic usually a lot of times people replay their past to try to
kind of get it right the second time so we want to look at do you have a habit of getting into
relationships with people who are not safe we can also ask them how do you exhibit these behaviors
in what ways are these behaviors present your current relationships and in what ways were these
present and your primary caregiver relationships behavioral triggers abandonment and mistrust
if somebody starts acting differently they change their behavior in some way a person who fears
abandonment goes oh that’s not good if they’re not getting constant reassurance that’s
that external validation can trigger abandonment fears so again we want to work
on internal validation and why is it that you feel you need constant reassurance from the other
person’s relationships feel threatening so work relationships those sorts of things the
a person who has abandonment issues won’t want their significant other around other people
and they become hyper-vigilant to rejection and disconnection even if it’s just somebody
going I had a really bad day I need 20 minutes and go into the room and shut the door
the person with abandonment issues will likely have a high level of anxiety so we want to ask
how these behaviors have threatened them in the past what are alternate explanations for why this
is happening with this person right now and what would be a helpful reaction to these behaviors
now so this is happening what would be a helpful reaction instead of assuming that the sky is
going to fall defectiveness and failure so if somebody is critical if they have unexplained time
apart there’s absent or inconsistent reassurance or if the person tells them they’re a failure
these or they fail at something these could all be behavioral triggers they could be like I
failed at something I’m not getting reassurance this relationship is fixin’ to end questions how
is this threatened you in the past alternate explanations and what would be a helpful
reaction to this particular situation right now envisioning activity what does a healthy
the relationship looks like presence versus abandonment acceptance versus rejection emotional support
versus emotional unavailability trustworthy versus untrustworthy and safe versus harmful
these are extremes what does it look like to be a middle ground there are going to be exceptions
you know things are going to happen so what does a healthy relationship look like and how do you
deal with exceptions if somebody’s not always present how can you create this relationship with
yourself that’s the big one and then how can you create this relationship with others’ mindfulness
questions what am I feeling what’s triggering it am I safe right now and if not what do I need to
is this bringing up something from the past if so how is this different how am I different
then I was when I was six or four and how can I silence my inner critic and finally what
would be a helpful reaction that would move me more toward my goals and a positive
emotional experience summary core beliefs about the self and others are formed in early
life due to children’s lack of knowledge of other experiences and primitive cognitive abilities
these core beliefs are often very dichotomous core beliefs can be formed around events or
experiences outside of the conscious memory identifying and being mindful of abandonment
triggers in the present can help people choose alternate more helpful ways of responding in
the present in Secure and Loved loved me don’t leave me are two excellent books
there are Google previews if you want to look at them to see if it’s something that you like
but they do take what we talked about in this presentation and expand upon it a whole bunch
more if you enjoy this podcast please like and subscribe either in your podcast player or on
YouTube you can attend and participate in our live webinars with Doctor Snipes by subscribing
at all CEUs comm slash counselor toolbox, this episode has been brought to you in part by all
CEUs com provides 24/7 multimedia continuing education and pre-certification training to
counselors therapists and nurses since 2006 used coupon code consular toolbox to get
a 20% discount off your order this month you As found on YouTubeSeanCooper🗯 The Shyness & Social Guy ⇝ The 3 WORST Mistakes You Must AVOID If You Want To Overcome Shyness (PLUS: 1 weird trick that targets the root biological cause of shyness so you can stop being nervous, awkward, and quiet around people…) http://flywait.darekw.hop.clickbank.net/ By Sean Cooper, The Shyness & Social Anxiety Guy. The fact that you’re reading this article tells me you may have already reached a point where you feel your shyness is NOT going away on its own… or you fear it’s getting worse and worse. And I don’t want you to waste one more day living a life where you feel left out, bored, or depressed because you don’t have the relationships which would make you happy. That’s why I’ve put together this page to help you avoid the worst mistakes that keep many people stuck with shyness for years… often giving up hope of ever improving as you watch other people have interesting “normal” lives without you. Yet this doesn’t have to happen.
this episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation through all CEUs registered at all
CEUs comm slash counselor toolbox I’d like to welcome everybody today to the
presentation love me doesn’t leave me addressing fears of abandonment the purpose of this
presentation is really to help us help clients increase their awareness of their story including
beliefs about behavioral reactions to situations that trigger their fear of abandonment so how
do we do that well the first thing we need to figure out is what fear of abandonment is and how
can we identify it in a clinical set setting then we’re going to explore the concept of schemas or
core beliefs and these are things that are formed in early childhood you know if you remember
prior classes we’ve talked about early childhood cognition is generally very dichotomous in children
young children don’t have the ability to look at that gray area so these schemas if they’ve gone
unchecked can lead to some very extreme belief patterns which lead us into common traps in
thinking reacting and relationships if your schemas are based on all-or-nothing you either
love me or you’re going to leave me hence the name of the book then your reactions are going to
tend to be more extreme and more all-or-nothing which increases anxiety because then anytime
a person who perceives any amount of disapproval obviously is going to go to that extreme so we
want to talk about bringing it more toward the middle line and helping people learn to appreciate
and love themselves for themselves while they may not approve of the behaviors of other people they can
still love other people so just because somebody doesn’t approve of your behavior doesn’t mean
necessarily that they’re going to abandon you so we’re going to talk about that and then we’ll
learn skills necessary to help people accept their past as part of their story maybe they do
have a lot of abandonment issues and you know some people do and it really is painful it cuts
to the core especially when those abandonment issues occur in early childhood when kids going
what that does so we’re going to talk about that and help people learn how to integrate it into
their present and we’ll learn the skills necessary to acknowledge that their past does not have to
continue to negatively impact them in the present so if they were abandoned when they were a child
you know we need to deal with that however if they continue to expect that every significant person
in their life will abandon them notice I use the word every because we’re still in those extremes
then they’re going that the past is negatively impacting them in the present so we’ll talk about
how to sort of moderate those belief systems how does this impact recovery whether you’re talking
about addiction or mental health issues connection is a basic human need we are not meant for the
most part to be Hermits in the middle of the woods there are introverts and in my husband’s an
introvert he has a couple of really good friends he needs quiet time each day he doesn’t need to
be surrounded by people and he’s fine but I mean we’ve got human connection he’s not going to be
one that’s just going to you know move out to the middle of nowhere I’m an extrovert on the other
hand and I tend to have a lot of acquaintances and a lot of friends I draw energy from
being around other people so just because someone doesn’t have 150 acquaintances doesn’t
necessarily mean they don’t need connections so we want to recognize that connection is a basic
human need when infants are born they are put on their mother’s chest when we embrace each
other whether it’s mother and child or friends or whatever a chemical called oxytocin is released
and it’s our bonding chemical we are programmed we are hardwired for connection and oxytocin is a
very rewarding chemical so we want to recognize this that if people are so afraid of abandonment
that they push everybody away what are they losing as far as quality of life as infants and children
survival is dependent upon the relationship with the primary caregiver so if mom or dad wasn’t
happy if mom or dad was rejecting the young child was pretty much helpless to think about a child
who’s growing up in a family that’s just riddled with addiction and mental health issues and the
primary caregiver or caregivers are completely emotionally unavailable they may be physically
there but they may be so high or so depressed or so psychotic that they cannot attend to the
children’s need what does that communicate to the child feels abandoned the child
feels a sense of neglect for people’s beliefs about other people and relationships were formed largely
based on their interactions with their caregivers so if this child was going mom I’m hungry and
nothing happened or worse yet child was going mom I’m terrified and nothing happened or they
were just given a pacifier and told to shut up then that is they were told they were communicated
to that their beliefs their feelings their wants and their needs were not important so they were
being rejected healthy relationships serve up as a buffer against stress so even if they had all
these negative experiences in early childhood teenage years you know maybe up until
they walked into your office it doesn’t mean it has to continue and how much can they gain from
having healthy relationships with a lot of clients that I work with who have pretty significant
abandonment issues can’t even fathom trusting someone enough to be in a healthy relationship so
we’re going to talk about how to sort of ease into that because you’re not going to say don’t let
your past influence your future and we’ll wave a magic wand and they’re ready to trust people
even once you point out that what happened in the past was largely not their fault or maybe not
even their fault at all they’re still going to have difficulty not accepting responsibility
and going everybody leaves me so what talk about that addressing beliefs that formed as a result
of these relationships the past dysfunctional relationships we can help people create a
new understanding of events was mom or dad or caregiver really being rejecting were you being
abandoned emotionally and physically because of you or because mom or dad just was able to do what
they needed to do to be a caregiver at that point in time they were doing the best they could with
the tools they had but it wasn’t enough to meet your needs so we want to talk about alternate
explanations for why parents and caregivers may have behaved in that way if you have a young child well
an adult now but who was put up for adoption or abandoned by their caregivers at a young age the
a young child was probably very confused because one moment their caregiver was there in the
next moment they were in the system so they were trying to figure out what did they do wrong and why
doesn’t that person love me anymore it must be me because children really can’t see well you
know mom is not able to function as a parent right now or dad is having difficulty coping we
want to help people better understand themselves in their reactions so that when they start getting
this urge to just cut all ties and be like you know what fine you know I’ll take my ball and go
home no problem what does that mean at there’s a certain point in all relationships in all healthy
relationships that you know sometimes people have to distance themselves from one another because
it’s becoming dysfunctional but for the most part, people will in relationships encounter
hiccups will encounter disagreements but in healthy relationships, they can work through
them in relationships with people who fear abandonment there are going to be two extremes
there’s going to be complete compliance and please don’t leave me or complete disengagement
and whatever I don’t care the final thing we want to do is help make people more conscious of
what they’re doing so they can make healthy decisions in their current relationships so when
they get that urge to either comply or disengage is that a healthy normative reaction right now
or are you reacting out of your past experiences the abandonment experience in childhood survival
depends on caregivers a four-year-old left alone for five days is not going to do so well you
know they may be able to scavenge food but once the food runs out where do they get it you
know there’s only so much that a child can do an infant can’t even get their own food
so survival depends on their caregivers and if their caregivers fail to meet those needs there are
high levels of anxiety and I will refer regularly to caregivers who are emotionally unavailable
and emotionally absent in addition to physically unavailable or absent because some parents and I
worked in the field of co-occurring disorders for over two decades and some parents just they are so
overwhelmed and so paralyzed by life itself they can’t even attend to anything else that’s going
on they’re doing good just to be breathing but if they have a child and that child’s needs are
getting neglected and fear of abandonment is a natural survival response when your food source goes away
what happens you start to freak the freak out so this is normal we look at this and say that that’s
that’s natural if a child thinks about the first time you take a child to kindergarten or pre-k
or daycare or whatever it is and you drop the child off even if they’re securely attached what
do they cry because they’re afraid that mom or dad won’t come back and they’re afraid of
this new situation that’s changed securely attached children will you know adjust and then be happy to
see mom or dad when they come back but the point is there’s that initial oh crap reaction meeting
biological needs and safety are key triggers for anxiety at any age so we’re talking about housing
we’re talking about safety we’re thinking about Maslow’s hierarchy if somebody is not meeting the
child’s needs or if the person is not getting their needs met then they may have high levels
of anxiety and I add to the safety concept not only physical safety but also emotional safety
people need to feel safe in their own heads and they need to be free from emotional abuse when
focused on survival people can’t focus elsewhere so if they’re not getting their physical needs
met guess what you know if you take somebody who is in pain who is sick who is hungry and who is
homeless are they going to work on self-esteem are they going to work on relationship skills
no, they’re focused on survival they need to have those basic needs met they need to have a certain
sense of security if they are in a situation that is dangerous physically obviously they’re not
going to be focusing on how can I better myself when they’re worried about somebody coming in
and hurting them physically likewise it’s hard to focus on how can I better myself when everywhere
they turn they perceive someone telling us you’re not okay you’re stupid you’re lazy you’re bad
you were the worst decision I ever made in my life they can’t focus on personal growth when
all they’re getting is these verbal beatdowns all the time so people need to have acceptance if
they don’t have acceptance kind of the opposite of acceptance is abandonment two kinds of extremes
again we’ll bring it back to the middle every stressful situation becomes a crisis the in
securely attached child now you can go back to and read Bowlby’s work on secure and all that kind
of stuff great reading but for the short version of this presentation remember that certs securely
attached children feel anxiety when their parents leave but then they can adjust and they’re happy
to see the parents return in securely attached children feel a great amount of anxiety when
their parents leave and are terrified that mom or dad won’t come back and then when mom or dad does
come back it’s your very very clingy or very very rejecting so with this child that’s in securely
attached it’s just like one to a hundred as soon as something happens that they think they may be
abandoned you see this pattern again in adults who are still struggling with these abandonment issues
that schema that they’ve formed and I’m getting a little ahead of myself that schema that they form
says if you let this person at your site or if this person disagrees with you or if this person
criticizes you they’re rejecting you and they’re going to abandon you so we want to you know check
in with those cognitions and look for trying to make those thoughts a little bit more helpful in
infancy or early childhood if caregivers were away for long periods of time because of work because
of military, if they were in jail if they just chose to be away or if they passed away children
may experience some abandonment issues now if the parents are away because a parent is a way
because of work or military or even jail and the other parent can help the child work through it
there’s much less drama if you will there’s much less issue with abandonment issues in totality
now if it’s whatever parent it is if the pay, if the father happened to be the one, went away
that person may have some residual issues with adult figures in their life that they need to deal
with but they may not know I’m not saying that every child of a soldier or a service person
is going to have abandonment issues that are so not true however if the experiences of the time
apart was not handled in a way where the child felt secure then it could have consequences that
are going into present-day if in early childhood caregivers were inconsistently or unpredictably
physically or emotionally present so think about a parent who has major recurrent major depressive
disorder addiction or is just ill-equipped to deal with a child when I was working at the treatment
center in Florida I had 14 15 16-year-old young women coming in and having babies and you know
what does a 14-year-old know about giving birth and raising a child so it’s not that they weren’t
necessarily trying you know they didn’t have great role models raising them in most cases and so they
don’t have anything to work with they don’t know how to be a parent they’ve never been taught so
it’s not always I don’t want to pathologize or make the parents look like bad people because
I believe that people do the best they can with the tools they have at any given time parents
don’t choose to be sucky parents sometimes it happens but I really don’t believe they choose to
anyhow off my soapbox in later childhood as the child becomes elementary school middle school
age if they’re a poor family fit or they feel like they’re the black sheep they just don’t
have the same beliefs that the other people do they don’t seem to have the same interest that
their family does they may not feel accepted especially if the family’s going no that’s wrong
to believe and invalidate them so going back to that psychological safety if they’re constantly
being told their ideas are stupid they’re wrong they have the wrong point of view and they can
feel very isolated something can happen that ruptures the relationship with the primary care
giver whether it’s abuse or you know some kind of other trauma and introduction of a new less
an emotionally or physically safe caregiver can also lead to abandonment if the child feels like the
biological caregiver chose a new spouse over him or her say if you see where I’m going with that
because if this new person comes in and is less safe is abusive in some way emotionally physically
sexually it doesn’t matter the child is going to feel like they didn’t have a voice the child
is going to feel like the biological caregiver didn’t care and brought this other person in
any way which leads to feelings of rejection and abandonment so what are the reactions
fight-or-flight whenever there’s a threat we fall back to fight or flight or freeze but we’ll
talk about that when there’s a threat our anxiety goes up and we say in the past in these kinds of
situations, if I fought, did I succeed if so then we’ve got fights in the past did I succeed and if
the answer’s no then the response is to flee pretty simply so anger towards someone who’s unavailable
if they got angry and felt like it got them some sort of acceptance from somewhere that might
be the prevailing reaction sadness when someone goes away a sense of helplessness this person
just left me shame or self-anger about feeling needy or about pushing someone away fears related
to rejection and isolation, nobody will ever love my loss of control or the unknown everybody
always leaves see how I’m using these extreme words again and fear of failure I can’t maintain
a relationship nobody wants to be with me because I’m not good enough so the questions for clients
in these situations what caused these fears as a child so when someone starts to have these fears
about a relationship if the relationship starts to get rocking first question is what is it that
you’re afraid of in this situation if you stay together what is it that you’re afraid of if this
the person leaves what is it you’re afraid of and how likely is it that this person is going to leave
based on whatever is going on right now so let’s get some objective evidence here and another
the tool you can use is the challenging questions worksheet in cognitive processing therapy if
you google it challenging questions worksheet CPT or cognitive processing therapy really helps
people walk through the logic in some of their cognitions and identify some know unhelpful
distortions so then after you figure out kind of what the fear is then we say what caused that as
a child in the past when you felt like this what caused that and how was this reasonable or helpful
you know in the past when you felt like this and you reacted in anger what was the outcome and
how was it helpful in some sort of way you know did it get somebody to pay attention to you did
it gets somebody to come comfort you, okay so you were identifying the function of the current
behaviors and then we want to say what causes these fears now a lot of times it’s the same symp
or similar stuff but we could say how are these reactions now unhelpful because as independent you
know adult-type people we can fend for ourselves we can put food on the table we can go to work we
can do we can function independently whereas this is a child we couldn’t you know there were just
some barriers to that does that mean again that we should live in isolation and say well
I don’t need anybody no that’s not what I’m saying what I’m saying is is these fears that
are overwhelming about abandonment that causes people to push others away or cling on like you
know whatever clings on uh are these reactions helpful in the present day you know do you still
need to hold on to people like there’s no tomorrow temperament based on their temperament children
need different types and amounts of caregiver interaction um some children are wide open and
easily overstimulated you know my son was that way when he was born well to this very day um
when he’s awake he is like the Energizer Bunny on methamphetamine I’m he’s just going going
going and talking and talking to himself and he needed a lot of structure and he would get
overstimulated easily but we were able to help him figure out how to handle that instead of
getting mad at him for what seemed to be acting out we were able to help him channel and figure
out when he needed to take a break the introvert may not need as much one-on-one attention with
the caregiver may need a comforting word here and there but they may not need the amount of
the attention that an extrovert may need an extrovert tends to need more interaction with parents with
family with other people because they draw energy and they think while they talk and they think
while they talk with other people so they feel a lot more isolated if they are isolated so we
want to understand the person’s temperament and how they may or may not have gotten their needs
met how they may have been told they were wrong and invalidated when they were younger and you
can hear some of this is kind of going towards Linda hands DBT environment um but what we want to
look at what do you need now how can we create an environment that’s accepting and welcoming
to you now based on their needs and caregivers’ reactions children form schemas or core beliefs
about the world and others so if they state their opinion and it’s squashed or it’s ridiculed then
they’re going to form this core belief that it is not safe ever to share my opinions because I am
always wrong now we’re talking about children here but a lot of times think back for yourself there I
think most of us have at least some all-or-nothing dichotomous thoughts that come in every once in
a while and you know we can catch them but if these dichotomies go unaddressed the person starts
feeling very lost and very abandoned because it’s all-or-nothing important points about children
under 7 from 8 to 12 children are developing alternative cognitive skills they’re
starting to be able to think abstractly they’re starting to be able to see the gray area and
alternate explanations but even you know during that period so zero to 12 children are having
difficulty envisioning all the possibilities so anything that happens before that we want to
encourage them to look at the schemas that were formed and challenge them to examine whether they
are currently accurate and helpful children think dichotomously when they’re that young it’s all
or nothing it’s good or bad it’s not kind of sort of something it is what it is I mean even think
about thinking back to grades that we would get it was satisfactory or unsatisfactory there was
no ABCD F when we were in elementary school and I don’t remember middle school then it was a
dichotomous grading scale you either did it or you didn’t children are egocentric so whatever happens
they say what was it about me that made this happen if mom’s in a bad mood what did I do if
you know Mom is rejecting well that was stupid I’m stupid children are very egocentric so you take
all or nothing combined with all about me and you can see we’re creating the perfect storm of children
can only focus on one aspect at a time when I work with adult clients you know they come in and they
tell me that they had an interaction with their boss he was walking down the hall and he was in a
bad mood and I just knew I did something and so we talked about that and I’m like how do you know
that because he had it he had angry look on his face okay what are some other possibilities what
else might have been going on with him at that point in time and a lot of times we can brainstorm
ideas about a call he just got or where they just left a meeting that didn’t go so well or who
knows what else in this day and time when we’ve got our cell phones and PDAs and everything
there are a lot of things that can trigger a mood besides just whoever you pass in the hallway
children can’t think about those other things that might have triggered the mood they see somebody
unhappy and they’re like I’m sorry um so we want to encourage as adults we want to encourage them
to say all right what are the other possibilities even as children I try to work with my kids
to encourage them to look at alternate reasons why somebody may be acting a certain way children
can’t think abstractly and consider those possible options um even with kids you know knee-high
to a grasshopper, if you’re in a situation and maybe in a store and somebody behaves not kindly
to you, you can talk about that later with the kids and say you know that was kind of unpleasant to go
through what you think might have caused that and brainstorm three ideas my favorite number is
three I don’t know why but brainstorm three ideas for alternate explanations for why that person
may have been in an unpleasant mood if children learn to do this when they’re younger it’s a
a lot easier to transition to as adults schemas are a broad way of perceiving things based on
memories feelings and thoughts basically it’s our go-to perception of what something’s going
to be like we have schemas about everything if you go to church you have a schema about what’s
going to happen when you go to your mother’s house you have a schema about how mom’s going to
behave and what’s going to happen we form these it’s our brain’s short shortcut instead of having
to analyze every situation it says oh I remember this been here before it’s probably going to be
like X Y Z unfortunately sometimes things change and one of the things we see in addictions
treatment as is as caregivers into recovery and really get a hold on it and start working that
a new way of life and sobriety and all that stuff old family members or family members still expect
that old behavior they have that schema that when Jane comes in this is what’s going to happen
because they’re remembering how she behaved and acted in her addictive self so we want to help
people identify their schemas and check them sometimes they’re still accurate sometimes not so
much schemas that trigger abandonment fear center around the cell acceptability is this person going
to like me which is one of the reasons we do a lot of self-esteem work in reducing abandonment fears
because we want to reduce the need for people to solicit external validation we want them to say
I’m all that and a bag of chips and I would love to play with you but if you don’t want to play
I’m okay with that love ability if they were told they were unlovable if they perceived
they were unlovable then in the present they may fear isolation they may fear that they’re not
lovable so they will try to do whatever they can or likewise they will build a lead wall that is 5
feet thick all the way around them so nobody can hurt them they may have fears about their own
the competence you know thinking back to Erikson you never thought some of these theorists from the
past would keep coming up even in current practice but they do if a child going through that period
of industry versus inferiority Erik Erikson’s stages of psychosocial development and they felt
like a failure, all the time or they were never good enough the parents never recognized their
positive achievements then they may question their own competence and feel like a failure if they
feel like a failure they may feel they may believe that nobody wants to be around them so they will
leave so if I fail they will leave and fears may center around adaptability some people are not
able to tolerate any loss of control they’re just like that they’re holding on with a death grip to
the relationship to anything that’s going on and it starts to go wonky they are going to freak out
so we want to look at what it means if you’re not in control of everything what does it mean
if you trust that this person is going to do the next right thing if you are doing the next right
thing as well schemas that trigger abandonment fears can also be sent around center around others
if someone is rejecting distant cold or is unable to handle the person’s needs then the person may not
feel acceptable so if they are in relationships with people like this then we need to look at is
Is it you who’s not acceptable or is something else going on with that person that may be making
them unable to deal with anybody else’s stuff right now the person may feel isolated if other
people are absent if people fail to keep promises they may feel like nobody’s ever there for them
competence if other people are always critical then the person will question their own competence
and if others are unpredictable a lot of the time when people who have anxiety about abandonment
they come from situations where other people have not been predictable or if they were they were
unpredictably absent and relationship of self to others if they are afraid about their ability to
relate with others if they’re afraid of rejection if they’re afraid that if they start to love they
will be rejected and then they will be isolated forever if they are afraid of the unknown and they
I just want consistency more than anything and as soon as consistency starts to waver a little
a bit because as we grow things change and people with abandonment issues don’t like things to
change because that’s not predictable and that’s not consistent so they may have difficulty if one
the person starts to change what they do I see this a lot not saying that it’s an abandonment issue
necessarily but when law enforcement officers retire you know because they can retire after
20 years so they may start a new career and that causes a lot of change schedule changes
they’re not law enforcement anymore and the spouse sometimes has culty adjusting to it as
does the retired officer but controllability if the person holds on to relationships and
everything in their life with white knuckles because they’re so afraid if they let go of
control that they are going to disappear or disintegrate then if something seems like it’s not
in their control, it’s going to be a catastrophe so attachment Styles secure if there’s an
emotionally available caregiver the child will seek the caregiver for comfort and guess
what the caregiver will be there and will more often than not meet the need for comfort with the
the correct type of comfort so hungry cold scared kind of following the child’s upset when the caregiver
leaves especially in new situations but the child gets over it it’s not a child that’s going to sit
there and cry for eight hours and then the child’s happy when the caregiver returns in this kind of
attachment the child learns to trust others will be responsive to their needs and validate their
needs a child learns to be self-reliant and try new things but if they fail they know they can
return to the home base they can go out and go well that didn’t go as planned and the caregiver will be
there to say alright let’s figure out what to do next not you are such a failure the child learns
to adapt to a variety of situations because when they’ve been faced with something that’s a little
scary caregivers been there to kind of coach them on and go you got this it’s scary I got it but
you can do it the child learns to deal with stress because the caregivers are there to coach them
or to process it with them afterward because the caregiver is not always physically there but if
you’ve got children you know sometimes they’ll come home from school and they’ve had a really
bad day and you’d pull them aside and go you know what’s going on let’s talk about it so in this way
the child learns to deal with stress and the child learns to have accurate expectations of others
in the secure attachment, emotionally available situation remember children are egocentric so
if mom’s upset the child goes what did I do or oh my gosh I hope mom’s not going to leave in
a secure situation sometimes the parent has to say something like mommy had a really bad day at
work today has nothing to do with you I need to go take a timeout that helps a child understand
that you know what it’s not all about me and I can understand that sometimes moms upset for
something besides me and I can understand that if moms up said it doesn’t mean she’s going to
leave so obviously this is the ideal situation avoidant attachment styles the rejecting or harsh
caregiver the person depends less on the caregiver for security because every time they go saying, mom
mom, I had a nightmare can I come into bed with you they’re met with going back to your own bed and the
caregiver rolls over it’s not oh I’m sorry you had a nightmare let me walk you back to your room
when the child is separated from the caregiver there’s little response when the caregiver leaves
or returns because the kids like what uses that person to me the child learns not to depend on
a caregiver for comfort connection or security now imagine yourself a four-year-old child or a
six-year-old child thinking I can’t count on my caregivers for comfort connection or security
that must be a terrifying place to be and I can see why you would develop some pretty strong
defense mechanisms the ambivalent relationship between the cave caregiver is inconsistent or can bow can’t
talk caregiver is inconsistent or chaotic this is really true in a lot of homes where there are
at least one parent who is battling some sort of addiction or mental health issue so the parent
may or may not be available you don’t know what the good days are going to be you don’t know what
the bad days are going to be so the child may be anxious and afraid to try new things or explore
because they’re like things are going good right now I don’t want to top will be an applecart just
going to sit here and ride it out a child may be clinging and demanding trying to elicit a response
remembering negative attention is better than no attention at all and the child is upset when the
caregiver leaves but also inconsolable when the caregiver returns because you know I was upset
I was scared you went away but you came back and that’s good but I don’t know when you’re going
to go away again and if you’re going to come back so it’s this constant anxiety of abandonment
core abandonment beliefs all people leave so we want to challenge that by identifying exceptions
mistrust people will hurt reject take advantage of me or just not be there when I need them you
know what that’s true sometimes because people have their own stuff so when this happens let’s
look at whether it’s happening all the time and/or let’s also look at what else might be going on
with that person that caused them to hurt reject take advantage or not be there when you needed
the emotional deprivation I never get the love I need nobody understands me cares about me or even
ever tries to meet my needs here how dramatic and extreme that is so one of the things as clinicians
we can do is say if you are getting the love you needed what would it look like what
would be different what is it that you need that you’re not getting once we identify
then we can create a plan to get it but a lot of times other people don’t understand or may not
be able to interpret what you need so let’s help let’s try to figure out how to make this happen
nobody understands me alright let’s talk about why that might be and you know let’s look at some
people who’ve kind of gotten a grasp sometimes with clients with abandonment beliefs nobody
understands me translates to I don’t give a buddy a chance and I cut them off as soon as they become
confused and because they associate confusion with the rejection so we might talk about communication
skills we might work on what it is that people don’t understand and how to better communicate
that and where to find people who have similar interests nobody ever even tries to meet my needs
you know here I would really look for exceptions but I would also challenge the person and I would
say when do you meet your needs what do you do to take care of yourself a lot of times
clients with abandonment beliefs are so freaked out and afraid of being abandoned that they’re
not taking care of themselves either they’re just living and are paralyzed going back to fight
flee or freeze they’re living a paralyzed state of I want to be loved but if I love I’m gonna get
hurt and I don’t know what to do they don’t even love themselves so we want to start talking about
if you had your best friend you know create this best friend persona what would he or she say to
you what would he or she do right now let’s try to help you understand yourself with mindfulness exercises
are really good here because a lot of times these clients don’t understand themselves they’ve got
so much anxiety they’re so afraid and they don’t know where it’s coming from because a lot of
it has been going on for so long defectiveness if people knew me they would reject me you know
not everybody’s going to like you why do you need everybody to like you why is it important that
everybody likes you and failure I don’t measure up and I’m not able to succeed I usually put pull
out the obnoxious quote that if you haven’t failed you haven’t tried and we talked about what it
means to get outside your comfort zone and you’re not going to be perfect at everything you’re not
going to be Michael Phelps you’re not going to be the president of the United States that doesn’t
mean that you’re a failure that definitely doesn’t mean you’re a failure so what things are you
good at what can you and have you succeeded at and go back and look over things like you graduated
high school, not everybody does that you know raised a family not everybody does that so we
want to challenge all nothing’ languages we want to look for exceptions and we want to look
for in what ways can you provide yourself the validation so you don’t fear abandonment you don’t
need other people to tell you you’re okay because guess what you’re telling yourself I’m okay and
before I go on to unhelpful reactions I do want to point out that if we tell people to tell
themselves you know I’m okay that sounds great but if they don’t believe it if it’s not supported
with evidence, it’s actually probably going to slow their growth because they’re sitting there going
telling themselves I’m okay and in the back of their head going you know you’re not so we need
to get that internal critical voice to kind of hush up by providing the person with the objective
evidence of why they’re okay why they’re good enough and that’s a slow process it’s not going
to happen overnight but encourage people to figure out why they believe what they believe and then
you can work from there okay unhelpful reactions fighting with someone you don’t want to leave
me because so the person may engage in dominant sort of posturing behavior aggression hostility
blaming and criticizing trying to tear down the other person to say you know what I don’t care
and you should be grateful that I’m in your life recognition seeking to get attention validation
or approval so if they feel something’s going wrong in a relationship they may start trying to
do something to gain recognition to prove that they’re worthy of a relationship for what they do
versus who they are manipulation and exploitation said lying justifying I did this because you made
me so sometimes we all occasionally do things that aren’t the nicest people who fear abandonment
have difficulty saying you know what I screwed up and they’re more likely to go you made me do
I wouldn’t have done it if you would have X Y & Z people again who are worried about a relationship
is going to fall apart and may also make excuses for other people’s inappropriate behavior it’s like
you know I really hate what this person does but if I don’t make excuses for it if I condemn it
then this person is going to leave in counseling we can talk about the difference between loving a
person and loving a person’s behavior you know I love my kids to death there is no question about
that but some of their behavior makes me want to climb a wall I’m very clear to separate from them
the difference between the behavior that I dislike and them because you know like I said I love them
to pieces and we want to help people start making this differentiation if they don’t do it already
and clinging and chasing is the other fight reaction stalking and messaging somebody 47 times on
Facebook in an hour all these kinds of behaviors and even online bullying those sorts of things can
be fight reactions in response to feeling like there’s a threat of abandonment flight is more
of the I don’t care if you leave so the person will withdraw physically and emotionally and
maybe even numb themselves with some sort of addictive behavior or distract themselves with
something completely different or find a new person just proof that you know what I didn’t
need you because I’ve got this new person now questions for clients about core beliefs
all people leave okay so what does it look like if somebody’s available to you if they
don’t abandon you who in your past left you or was unavailable emotionally now a lot of
I find it helpful for mental health and addiction clients to have them write an
autobiography because then we can go back and kind of review it and identify the core
people at certain stages in a person’s life what did the person who left you do to make you
feel rejected or abandoned in retrospect you know it was hard to see the difference what
was going on back then because you were a kid in retrospect what are the alternate explanations
for why this may have happened was it really you or was it more about them who in your past
has been available to you emotionally most of the time people can point to one maybe two people
who have generally been there it’s unreasonable to expect someone to always be there who in your
present is available to you emotionally you know maybe they’ve only been in your life for six
months or a year but they are available and I say emotionally because you know not everybody can
be available physically all the time we’ve got jobs kids all that kind of stuff but can you pick
up the phone and call them or text them and say hey you know what I’m really struggling right now
what do you do in your current relationships that cause people to leave do you push them away if so
how what are alternatives to pushing them away cutting all ties and just saying fine be that way
I wipe my hands off you if you cling how do you do this in what ways do you perceive yourself as
being clinging and what are some alternatives to holding on with all desperation and mistrust people
will hurt reject or take advantage of me or just not be there when I need them so again what does
it looks like when somebody’s or what does it feel like when someone is trustworthy and safe who in
your past was untrustworthy or unsafe what do they do they taught you this and what are alternate
explanations who in your past has been trustworthy and safe who in your present is available and
trustworthy what do you do to yourself that is unsafe or dishonest that’s one of those tricky
questions you’re there talking about other people other people then it’s like what
do you do to yourself how do you lie to your self or how are you mean and hateful to yourself
how does your distrust of other people or even yourself impact your current relationships some
people distrust their own internal intuition so much that they don’t want to make friends with
other people they’re like I can’t tell who’s going to hurt me and who won’t so just yeah I’m
going to wipe my hands of it all what could you do differently what do you think you could do
in order to start building trust and what does it look like to build trust because Trust doesn’t
just appear it builds gradually emotional deaths deprivation I don’t get the love I need nobody
understands me so again what does it look like when somebody understands you and meets your
needs who in the past failed to meet your needs emotionally and how can you deal with that now
you know it may have been mom it may have been ex-husband it may have been you know who knows
how can you deal with it now yourself so you can put it to rest who in your past is understood
you who in your present understands you how can you start again better understanding yourself
because it’s hard for other people to understand us when we don’t even understand ourselves and
what can you do to start getting your needs met you one of the things was starting to get your own
needs met is to figure out what your needs are and this is one of the exercises I have people do as
a homework assignment they keep track of what is it they want on a daily basis keep a log and then
let’s talk about what common themes were seeing if people knew me they would reject me okay so how
do you know when you’re accepted or acceptable to someone who when you’re past may make you feel
defective are there alternate explanations and how can you silence those old tapes because
that person that statement stays as a heckler in the gallery we need to hush the heckler what
can you do part of it could be talking back and saying you know what I’m not going to listen
or I don’t have time for this right now who’s been accepting and supportive who is in your life
that’s accepting and supportive and how can you start accepting yourself and being compassionate
so some compassion focus training mindfulness work to help people understand themselves and start
being compassionate with themselves understanding their vulnerabilities and cutting themselves some
slack I don’t measure up I’m not able to succeed okay that’s a pretty big success you know what
is what success means success means different things to different people so what does it look
like to you to be successful let’s kind of hammer that out what is it if you are successful what
would be different what in your past has made you feel like a failure what are some alternate
ways of viewing it such as a learning experience or something I had to go through to grow or you
know brainstorming alternate explanations for why people fail they don’t have a response to
sometimes I ask them to kind of take on a flip role and say pretend you’re a parent and
your child comes home and they’ve tried out for the football team and they didn’t make the team
they failed what are you going to tell on what have you succeeded at doing in the past what are
you good at in the present and we really want to pay attention to minimization here because a
a lot of our clients are not good at identifying their strengths what does being successful mean in
terms of your relationship with others do you have to be successful in order to be loved and be a
the good relationship you know obviously you’re going to be successful in a relationship if you’re
but do you have to be financially successful and powerful all whatever you define success as in
order to be in healthy relationships who are three successful people you know and what makes
them successful in your eyes does success equal happiness you can do a whole group on that and
what do your kids need to do to be successful in life you know we want our kids to succeed in us
want our kids to be happy so what is it that I envision my child’s life to be 10 to 15 years from
now triggering relationships the abandoner is unpredictable unstable and unavailable the
an abusive relationship is untrustworthy and unsafe the deprived err depriving relationship the
a person is detached or withholding the Devastator is always judgmental rejecting and critical and
the critic is critical and narcissistic usually a lot of times people replay their past to try to
kind of get it right the second time so we want to look at do you have a habit of getting into
relationships with people who are not safe we can also ask them how do you exhibit these behaviors
in what ways are these behaviors present your current relationships and in what ways were these
present and your primary caregiver relationships behavioral triggers abandonment and mistrust
if somebody starts acting differently they change their behavior in some way a person who fears
abandonment goes oh that’s not good if they’re not getting constant reassurance that’s
that external validation can trigger abandonment fears so again we want to work
on internal validation and why is it that you feel you need constant reassurance from the other
person’s relationships feel threatening so work relationships those sorts of things the
a person who has abandonment issues won’t want their significant other around other people
and they become hyper-vigilant to rejection and disconnection even if it’s just somebody
going I had a really bad day I need 20 minutes and go into the room and shut the door
the person with abandonment issues will likely have a high level of anxiety so we want to ask
how these behaviors have threatened them in the past what are alternate explanations for why this
is happening with this person right now and what would be a helpful reaction to these behaviors
now so this is happening what would be a helpful reaction instead of assuming that the sky is
going to fall defectiveness and failure so if somebody is critical if they have unexplained time
apart there’s absent or inconsistent reassurance or if the person tells them they’re a failure
these or they fail at something these could all be behavioral triggers they could be like I
failed at something I’m not getting reassurance that this relationship fixing to end question how
is this threatened you in the past alternate explanations and what would be a helpful
reaction to this particular situation right now envisioning activity what does a healthy
the relationship looks like presence versus abandonment acceptance versus rejection emotional support
versus emotional unavailability trustworthy versus untrustworthy and safe versus harmful
these are extremes what does it look like to be a middle ground there are going to be exceptions
you know things are going to happen so what does a healthy relationship look like and how to do you
deal with exceptions if somebody’s not always present how can you create this relationship with
yourself that’s the big one and then how can you create this relationship with others’ mindfulness
questions what am I feeling what’s triggering it am I safe right now and if not what do I need to
is this bringing up something from the past if so how is this different how am I different
then I was when I was six or four and how can I silence my inner critic finally what
would be a helpful reaction that would move me more toward my goals and toward a positive
emotional experience summary core beliefs about the self and others are formed in early
life due to children’s lack of knowledge of other experiences and primitive cognitive abilities
these core beliefs are often very dichotomous core beliefs can be formed around events or
experiences outside of the conscious memory identifying and being mindful of abandonment
triggers in the present can help people choose alternate more helpful ways of responding in
the present in secure and loved me don’t leave me are two really excellent books
there are google previews if you want to look at them to see if it’s something that you like
but they do take what we talked about in this presentation and expand upon it a whole bunch
more if you enjoy this podcast please like and subscribe either in your podcast player or on
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at all CEUs comm slash counselor toolbox, this episode has been brought to you in part by all
CEUs com provides 24/7 multimedia continuing education and pre-certification training to
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This episode was pre-recorded as part of a live continuing education webinar on demand. Ceus are still available for this presentation through all CEUs registered at all, CEUs comm slash counselor toolbox. I’d like to welcome everybody to group therapy, which is a product of treatment improvement. Protocol 41. Today we’re going to be going over chapters 1 and 2 tips 41. They did make it into an in-service, which is what I loosely based. The next set of presentations on and we’re, going to talk about some of the different ways you can use group and make it beneficial and hopefully easier than some other ways of approaching treatment. So, in the first part of today’s presentation, the goal is to provide an overview of group therapy which is used in substance, abuse, and mental health treatment, and, as I said, I’m, loosely basing it on it, but a lot of times the groups That we’re doing in substance abuse are the same ones. We’re doing in mental health. We’re going to discuss the uses of group therapy in treatment, define five therapy models, explain the advantages of group therapy and modify group therapy to treat and address substance abuse issues. So group therapy is awesome because it supports members in times of pain and trouble. It’s something that we can make available to the community mental health center that I worked at before and if you’ve worked in community mental health or even private mental health. Maybe a lot of times. There are waiting lists to get into IOP to get into PHP to get into residential to get into detox. So one of the things that we started instituting was an intervention-level psycho-educational group, so we were able to sort of keep a tab on people who are on our waiting list. They got on the waiting list and they started coming to these groups that provided them with tools provided them skills. We weren’t treating any particular issue. We were focusing more on life skills, distress, tolerance, emotion, regulation, and all that other DPP kind of stuff. Helping them get through, was also enabling us to provide them with some hope and keep their motivation going. Group therapy can enrich members with insight and guidance. I found, and one of the reasons I love doing group so much is because you can ask a question to a group of 10 people and get 8 or 10 different answers to it, and the cool thing about that is that each person has their blind spots, so what they might not have thought about before might still be germane to them, and somebody else puts it out there. So when you start putting asking questions and putting the answers on the board or using the flip chart papers and having stations around the room that people go and contribute to the group process, you start getting a lot more feedback from individuals and they’re going To come up with ideas and suggestions and thoughts that not only each other had never had so they’re going to enrich each other’s lives, but they teach me something every single time. So I loved doing and still do love doing group and it’s. A natural ally with addiction, treatment or treatment in general group therapy enables us to provide a basic framework of information to people in a cost, effective manner. You know there are a lot of things like emotion, regulation, distress, tolerance, self, esteem, skills, effective interpersonal communication relationship skills, and self-esteem. I may have already said that we give to all of our clients whether it’s substance, abuse or mental health, and everybody who’s coming through the program. Has this curriculum? If you will go through now, it’s going to apply a little bit differently to each one and they’re going to take the stuff they get from those groups and they’re going to be able to take it back to their Therapists and say this is what I learned in group. If it is just a group process, then they’re going to be able to talk among each other and come up with their ideas, but IOP, PHP, and residential all have individual accounts. One component, if you’re doing an intervention level group 0 05 on the ACM. If you will, you may not have that individual therapy component. So you want to make sure that when you provide members with information – and you help them start gaining insight you tie it up in a nice little bow at the end and help them apply it. So what did you get out of today?’s group that could have been helpful last week and how could you have used it then go back around the room and say from whatever you got from today:’s group or what’s a morsel you got from today,’s, group that You’re going to use next week, and how do you expect to do that? So I encourage them to take one or two morsels and figure out how they can use that in their particular life. A little bit of a slide track here. In support groups, if somebody is going to celebrate recovery or 12 step group, or even a depression or anxiety management group, I encourage them when they walk out of the group to be able to answer the question. What was in that group for me? What can I take away from that now? It may be, I know what I don’t want to do, or it may be. That was a great idea that so and so had, but I want them to answer that question every time, not just walk out of a group and go well. That was a good group. Why? Why was it a good group? What did you get out of it? Group therapy, as opposed to self-help groups and support groups, if you will have trained leaders, so you do have a lot more ability to facilitate what’s going on and kind of point people in directions that you want them to go. Where support groups may have facilitators, but they don’t have the training that clinicians do and group therapy produces healing and recovery from substance abuse and mental health issues. You see a lot of people gain. Hope you see a lot of people gain optimism. You see a lot of people learn tools from one another and nobody can comic con. If you will – and I had to figure out a way to say that a little bit nicer than the way I usually do. But when people are in recovery and you can even think about it with your teenagers, if you’ve been around known more if you have them, teenagers hear what their parents say and they’re like yeah, okay, whatever old, fuddy-duddy, but when their Parents or when their peers say it, it carries a lot more weight, so sometimes the hope and faith and tools and stuff that they hear from their cohort has more impact than what we say. If we’ve created a good supportive, healthy, nurturing environment, group therapy has a lot of power to it because it’s basically like having a bunch of code therapists and the ability to control it a little bit more than in group therapy. You can address factors associated with addiction or these factors by themselves, such as depression, anxiety, anger, shame, temporary cognitive impairment, character, pathology, ie, personality disorders, medication management, and pain management. So let’s go through these a little bit. Depression groups are wonderful. Now we’re going to talk about different types of groups and there’s everything from the traditional therapy group where people are sitting in a circle and or however, usually in a circle and sharing what’s going on in their particular situation. To psycho-educational and skills groups, where we’re, providing them the tools to understand what’s going on and the tools to deal with what they’re experiencing, and you know with depression. One of the groups I’m, going to do is depression. Well, any of these is to talk about what is it. What causes it? Where did it come from? How is it impacting you to have people start figuring out what that means to them, then we’re going to start talking, probably in the next group, about what are some ways we can start addressing this and what has worked for you. What what has worked in the past and what things might you want to do? Try? Temporary cognitive impairment can be addressed in the group in the sense that we can provide some life skills coaching. We can provide for early recovery and substance abuse. For example, a lot of people come to our groups, or at least where I used to work. They would get out of detox and they weren’t fully detoxed. Yet they had two days under them and the drug was out of their system. For the most part, you know, except for like marijuana or benzos, but they were still not on their game so getting them to just get there on time, be prepared, pay attention, and process what’s going on was huge. We didn’t expect to make huge therapeutic gains, but what I wanted was somebody to be able to dress up and show up. If you will character, pathology can be addressed in groups, one of the basic reasons that Marsha Linehan created dialectically. Behavior therapy was to address borderline personality disorder and DBT is very strong in skills groups. Now it has individual components and coaching components as well, but she uses the skills groups to help people with character, pathologies, and borderline personality disorder, among other things, start learning about what are these symptoms. What do they mean? What does it look like and how can I deal with them and then they personalize it in their sessions? Medication management is huge for me, whether it’s, somebody who’s on antidepressants or somebody who’s on methadone. I don’t care, but I think it’s really important for people when they start taking medication, especially psychotropic medication, whether it’s, addiction or mental depression, or anxiety to be able to go into a group and talk with others who’ve Been on similar medications understand the side effects understand that gets better understand what they’ve done, that helped them deal with the side effects. For example, a lot of my clients used to be on Seroquel and Seroquel is extremely sedating, so a lot of them found that they needed to take it at night. But I had a small group of people who, when they took it at night, you know they would go to sleep at like 11, 00 get up at 6 30 and they were still groggy. As I’ll get out from the Seroquel and among themselves, they started talking about okay, so I need to take it at 7, 00 every night for it to be out of my system. So I can function the next morning they worked it out by talking about how long before it starts sedating you and how long the sedating effects last, but it helped clients stay more compliant with their medication because a lot of times and not knock Psychiatrists or doctors, but the ones that I’ve had experience with. For the most part, I’ve had a couple of awesome: attendings they don’t have the patients they don’t have time in their schedule to hear all of the issues and help the client brainstorm, and a lot of times they don’t think to share with the patient. These are the most common side effects that people tell me they experience. Yes, they get the handout from the pharmacist. There are like six pages, long and in eight-point font of all the potential side effects. But what do people feel like when they start taking it? This Zoloft is another one. You know that’s, what one is commonly prescribed and a lot of patients feel kind of like they’ve got the flu. They feel dizzy for the first two-to-three days and then that wears off, if they understand that, if they have a place where they can go and talk about the side effects and talk about how to deal with some of the side effects, it helps. And this is also a place where they can talk about things like weight, gain and fatigue, and lethargy. And how do you deal with this when you’re on this Giller medication, it doesn’t have to be facilitated by a nurse or a doctor. That’s more helpful if it’s facilitated by a clinician. What we want to do is encourage patients to become aware of what their potential obstacles are to be maintained to remain med, compliant, and identify some ways to address them. Some intervention that might be effective and then go talk to their doctor, so they are armed with knowledge when they go see their psychiatrist and say I’m having these problems, it also gives them a chance to talk to other people and understand what it looks like if the medication is working for them and gives them hope if they have to change two three four times to find the right medication, so medication management obviously, is a group that I think is important. If you’ve got clients that are medicated on pain, management,’s, pain can cause depression and anxiety. Your body perceives pain as a stressor, so anybody who has pain may experience negative affect, especially if it goes on for a while, so helping them figure out ways to deal with the pain and ways to deal with breakthrough pain. If you’re dealing with somebody who’s in recovery, then you’re also dealing with the issue of pain management without narcotics, so pain management groups can help teach stress management skills, progressive muscular relaxation, and sharing nonpharmacological interventions that they can discuss with their doctor, such as massage physical therapy, acupuncture yay, it also is a place that people get hope again. This is going to keep coming up with group therapy hope because they hear other people’s stories and yeah. I hear that after John’s accident, he was in agony for six months and he was able to get through it, so they can share and support one another. Another group provides positive peer support for abstinence from substances or addictive behaviors. Remember we want to check our clients, and assess our clients to make sure they’re, not engaging in addictive behaviors like internet gaming, pornography, gambling, food-ish food, and eating addiction. Anything like that, but it also provides positive peer support for positive action in any direction. So if it’s growth goals, if it’s depression goals, the group is there to cheer you on. They’re also there to notice when you’re starting to lose your motivation and point it out and help you increase that motivation groups reduce isolation. So if you’re dealing with someone who’s got empty nest syndrome, someone who’s got depression, someone who’s got it up an addiction. It helps them understand that they’re, not the only one dealing with that and they can share and support, enabling the members to witness the recovery or transformation of their fellow group members and see how other people deal with similar problems, because we all I mean There’s what twelve people in class today. So if I throw out any problem, I’m probably going to get at least eight or nine different suggestions for how to deal with it and that’s cool, but that’s. The awesome part about group two because they can share. What do you do when you can’t get to sleep at night? What do you do when the anxiety is so oppressive that you feel like you can’t breathe, rich, and provide information to clients who are new to the recovery process? So they know what to expect they’re not going to be giddy as all get out. Twenty-four hours, seven days a week, 365 days a year, probably ever that’s not reality, but it helps them learn what the recovery trajectory looks like helps. They accept the fact that they’re going to be bad days and it helps them see how they can be empowered in the process. It provides feedback on group members, values, and abilities. They’re going to hone in on their values, and you know I encourage them in my groups and obviously from a multicultural perspective. I think it’s vital that we encourage members to explore their values and accept or reject them as they are and do not meet them. For me to say whether your values are right or wrong, I want you to know what your values are and make sure that they’re. Yours, not something that came from the media or something that just kind of popped into your head. You don’t know where it came from that you, don’t agree with, and sometimes that will come up, especially as it pertains to medication, use or controlled drinking, or anything like that. But it also provides feedback on their abilities, and this is where I focus more than values. What is it that you have done already? What are your strengths if you went three hours yesterday without being depressed and crying that is awesome? What did you do? How did you do it? How are you able to do that, I want to highlight that ability, so we can build on it. We want to highlight the exceptions to the problems and offer the sort of family-like experience where people get a sense of belonging and support when groups are run well, even if their skills are psycho-educational groups when a group member leaves drops out relapses, whatever happens, They just if they suddenly leave. It affects the entire group. When you’ve got a well-run group and a group member graduates or completes treatment, there’s still a whole process and sort of a grieving process, as that person leaves the family and launches out of the nest. Whatever you want to say, we the way I’ve always run groups and what the way I was taught was. We always celebrate that at the end of somebody,’s treatment, or experience after the last group that that person attends we have a little bit of a little pizza party or something to celebrate. Let people say their goodbyes and have a good sense of closure. A lot of our clients did not have good family experiences, so we want them to have the experience of being supported, being able to have different opinions and disagree with others, but being respected and being able to care about groups encouraged coach support and reinforce What they’re doing? Well, we don’t have to focus on what they’re doing wrong. You know, we can talk about that. An individual – or you know it may become germane to the group, but what we want to do is reinforce what they’re doing. Right from a management perspective groups allows a single treatment professional to help several clients. At the same time, as I said, there are a core set of groups – educational modules, if you will that, I think all clients need to be exposed to so group is a great way to do it instead of saying the same thing six times a day to Each one of your clients having a group available with the advent of media and Internet, just like we’re doing right now. Web chat web groups. You can do some skills-based groups, you know if they’re, not treatment. You don’t have as many issues with confidentiality, but you can also have videos online that you have them watch, learn from complete a worksheet and then come and participate in a one-hour group, instead of maybe having to sit through the whole lesson, which is An hour or so and then participate in the group, so there are a lot of different things that you can do using group techniques to reach a bunch of people in with one treatment provider. In the same hour. Groups add needed structure and discipline because, generally the group leader has a certain goal for the group or has a certain style of managing the group, so it can help sort of add a rhythm. If you will to the group process. Now we’re talking about traditional therapy groups. You’re going to be sort of like the parent that controls the rhythm of the family. If you’re talking skills or psycho, read groups, you’re going to be setting more of a tone like a teacher and creating a learning experience, but it adds structure, so people feel safe. They know what they can share, what they’re. What’s too much sharing or what’s inappropriate sharing and it helps people also learn to bite their tongue, wait their turn all those other things that can be helpful in life. They instill hope in a sense that, if that person can make it so can I so they see people doing a little bit better yeah. They also see some people doing a little bit worse, sometimes, but that’s an opportunity for them to be able to reach out and provide support, and that helps the person providing support as much as it helps the person receiving it. I truly believe that most people get a sense of contentment if you will, by being able and being able to reach out and help someone that they are concerned about, it provides support and encouragement to one another outside the group setting now this gets a little dicey Depending on your groups and your agency philosophy in reality, in substance abuse groups, the people that are in your group are probably going to be going to the same support group meetings so telling them not to ever contact each other outside of the group is unrealistic. They’re going to see each other in the community, so it’s important to help them understand how to set boundaries and what’s? Okay, behavior, and what’s? Not okay, behavior between group members, other groups, other facilities are less stringent on that and encourage the clients to reach out to one another outside of the group setting. So, depending on the group, the issue, your agency, all that kind of stuff there’s going to be more or less sharing. What I want to see, especially, is, if you have, for example, in IOPS three hours here and have three groups with breaks. I want to see people talking outside a group. I want to see people sharing, not just all sitting in there going when do we get out of here? I want them to develop relationships and learn how to effectively communicate so group therapy is not individual therapy done with an audience. It is not a mutual support group. It’s designed to help people develop and practice knowledge and skills in a microcosm. You’re, creating a mini family or a mini-community. It aids patients in learning how to develop healthy, supportive relationships and also how to terminate relationships, because sometimes when people graduate they move on it, which doesn’t necessarily mean that they’re going to continue to interact with the clients in the group. Alright. So the second half of this class, we’re, going to look at the group therapy models used in treatment, explain the stages of change, and discuss three specialized group therapy modules that may be used for the stages of change. I’ve gone over this before for new people. I’ll go over it again, real quick think about getting into a pool in the summer. It’s hot it’s like 90 degrees. You are sweating bullets, pre-contemplation, and you’re still laying on the lawn chair going. I ain’t hot. Yet no, I’m not anywhere near hot enough to go near that pool contemplation you’re starting to get hot and sweaty, and you’re looking at the pool going. You know that might be a nice change in preparation. You move to the side of the pool and you’re dangling your feet in the water trying to figure out. If you’re ready to take the plunge because it’s cold, I mean compared to the 90 92 5 degrees C is outside and you know your 98 6 body temperature water is cold, so you’re preparing action is when you jump in you. ‘re, like I, can’t take it anymore. I’m too hot to jump in the pool. Now, if that pool is too cold, if it’s too painful to stay in there because you’re just like a ho ho, you may jump back out again and back into preparation or further back. If you get in there and get moving – and you know, get your body temperature back up that’s – sort of basically like treatment – and you’re getting the swing of things, then you just want to maintain. So you don’t get cold again and recurrence is when you get out you get hot again and go through this process again so pre-contemplation, I ain’t got a problem. Contemplation yeah, I’m a little uncomfortable, but I’m not ready to do anything yet preparation. I’m starting to get ready to make a change because this is uncomfortable, but I’m not very it action I’m on it, and maintenance is keeping your gains and maintaining a steady state, so variable factors for groups, the group leader group or Leader of focus, so if you’re focusing on a part of it, is your training. You know if you are more Rogerian client-centered in your training versus cognitive, behavioral versus DBT versus AC T, whatever your theoretical underpinnings are and what you choose to focus on. In that particular group, there’s a lot of stuff. We can focus on whether it’s cognitive, physical, or emotional. We want to another thing that affects it is the specificity of the group agenda. If you’re going to have a group and it’s on self-esteem, well that’s not specific, so we could go sixteen different ways till Sunday if you’re looking at self-esteem and disarming the internal critic. Now that’s much more specific for that group, so that’s going to affect what that group looks like for that session or that says sessions how similar or different your group members are. If they have a lot of different experiences, you’re going to have a different experience as a group leader. Then, if you have a lot of people who have the same experiences, open, ended or determinant duration of treatment, if you’ve got a group that somebody can join and if they want to stay for 104 weeks, they can stay for 104 weeks. That’s up to them versus a group that is 16 weeks long that’s also going to affect how your group goes. What do you cover, how connected do group members become? I use 104 weeks just to sort of overemphasize. I hope nobody stays in the group for 104 weeks, but the level of leader activity is. I have seen groups where its leaders will throw out a discussion and are like okay topic for today is what do you think about it, and let the group facilitator with a little bit of nudging here and there versus other groups where the leader is very involved In goes around goes okay, Sam.What do you think about this sally? What do you think about it and that affect how people react and what they expect it? Doesn’t necessarily affect what they get out of it, but these are variables that could affect how someone meshes with the group. Not everybody is going to like a real open, ended, a loosey-goosey group I don’t. You know I’m structured. So I prefer to be in groups where I know what the agenda is, and what we’re going to do. In my groups, start with a review from the last group that’s the first five minutes, and check in with everybody. Next, in five minutes we do a 15 to 20-minute psycho, ed piece, and then the last. You know 30 minutes of group. I spend going around the room and having people tell me, what is it that you got out of this? What do you think you could use this next week etc and apply it to what they know that’s how my groups go, so they’re, really very structured. You’ve got to be able to drop back and punt. If a client is in crisis or something strikes a nerve with them, you know you might have to change up a little bit. But overall you’re sort of setting the tone for what’s going to happen in the group, the duration of treatment, and the length of each session. You’re going to cover a lot more in a 3 hour of IOP session. That and treatment is five days. A week for 12 weeks, then you’re going to cover in a treatment program that’s one hour a week for eight weeks, just knowing what you’re going to try to cover will affect the depth or the breadth of what you go through. The arrangement of the room also affects how the people interact. If you have them set up in theatre, style, or classroom style. People interact differently than if they’re all sitting around in a circle, and if you ever want to experiment with that, it is interesting to notice how much differently people interact and how much more they seem to participate when they’re sitting sort of in A circle versus when they’re in theater style and I feel like they can hide and the characteristics of the individuals. Sometimes you’re, going to have people who are enthusiastic and chatting. Sometimes you’re going to have people who are not, and it could be for a whole host of reasons. It could be a bad fit, it could be their involuntary, or it could be they just got out of detox. It could be that they’re. All are just at that level of clinical depression that they’re having a hard time staying with the group and it’s up to us to adjust to try to meet the needs of as many people in a group as possible. Now, while I’m saying this, they didn’t say to size of the group. Here, the recommended size of the group is 8 to 12 people. If you’re dealing with adolescents or people with severe and assistant Mental Illness, it’s more along the lines of 812. For your average group 15 for psycho-educational and skills groups any more than 15. You’re doing a class and not a group. Psycho-egg groups assist individuals in every stage of change, pre-contemplation contemplation, yay. It helps clients, learn about their disorders, their treatment or intervention options, and other resources that might be available to them, such as assistance with prescriptions or physical therapy, or whatever other wraparound services. We often call it might be available. They can also be used to provide family members with an understanding of the person in recovery, so family egg groups can be awesome because then you get to understand and hear what the family thinks is going on and expects is going to happen in treatment and What they’re seeing and hearing, and you can normalize for them what’s going on with the client, so somebody recovering from clinical depression or somebody with bipolar disorder. You know this is what recovery looks like this is what living with the disorder looks like. This is what being on this medication looks like, I, ‘ve had a lot of patients because I deal with mainly co-occurring. I’ve had a lot of patients who have bipolar disorder, and you know some sort of substance abuse issue. They start taking. Seroquel, because that seemed to be the drug of choice for our prescribing at that particular time and they would start acting all groggy and family would freak out going you’re using again, and so Family Education groups were a great time for us to educate. Not only about the disorder but also about treatment, medication, side effects, and how to interact with the loved one to be as most supportive as possible. So ad groups educate about a disorder or teach a skill or tool and work to engage the clients in the discussion. I don’t want to stand up there in the lecture. I want them to be able to throw out ideas. So if I say you know what is it that you do when you’re struggling with somebody, because they just great on your every last nerve, what are some things you do to solve that problem or to deal with it? I don’t want to just tell them everything I want to do something more Socratic and encourage them to tell me how they work with it, and if they come up with something that’s, not quite on point. As far as being the most effective or healthiest approach, then we’ll talk about it and we’ll say well. I’m sure that’s worked for you. I’m wondering you know if there’s a kinder gentler way to do it, or you know you kind of massage it a little bit to morph it into something useful. We want to prompt clients to relate what they learn to their issues, including their disorders. You know how you, how this relates to your depression, but also your goals, your challenges, and your successes? Psycho-ed groups are highly structured and follow a manual or curriculum, and it doesn’t have to be a manualized curriculum that you buy from somewhere. You can create your curriculum, but you teach the same thing and it’s sequential and it follows a teach, apply practice method. So you teach a skill, you have them talk about how they would apply it, how that might apply to them, and then you have them practice it in role plays or imagine how they might use it. Next week, basic teaching skills are required for psycho-ed groups, though, which requires that you understand the basic components of learning, and I call these the three C’s capture, which is how you get the knowledge I mean you got to get it into your brain. Somehow I am a visual kinesthetic learner. I learned virtually nothing from sitting in lecture classes. I’m off in la la land in about 30 seconds. I know this about myself, so I need to have material that I and see, which is why I do powerpoints here some of y’all may not might not even be looking at the screen. You may be often doing something else and listening to me more power to you. However, you get the information in your brain is great. Global and sequential. Some people are global. They need the big picture when they’re doing a puzzle. They want to see the box first to do the frame and then fit all the pieces in sequential people. Don’t want the box that’s cheating they look for pieces and put them together and then try to figure out how all the pieces go together to make a hole and then their wall out as a whole. To appeal to both of those at the beginning of the group give an overview of what you’re going to cover in the group, and if you can sort of a written agenda it’s, not always practical. I always tried to put it up on the whiteboard. We always had issues with how many copies we were allowed to make and stuff. So in the interest of saving trees, try to give them some sort of an agenda, so they know what the progress is or what they can expect from group talk about it, so people can hear it and apply it through role plays having them apply it to themselves. Make them manipulate that information in their mind and provide visual representations like bullet points of what you’re going over. If you can’t, if copies again are an issue, have them bring a notebook and write on a whiteboard, so they can see it. So you’re presenting information in as many ways as possible. Conceptualization is relating the information to building blocks. So if you’re teaching a unit on cognitive distortions, then you’re going to talk about maybe using extreme words or nothing talk. So I might say tell me about a time that you’ve said something like you always do this and then what we’re going to talk about, how to change that and how you know. Thinking about things that way might be contributing to some of their distress and then caring. This is the biggest one which is again why I have clients when they leave a group, ask themselves: what could I get out of that? Why was that important to me if they’re not motivated to remember it, they’re not going to think back to high school biology or college humanities archaeology? 101. For me, I learned what I needed to learn for as long as I need to learn. It’s to pass the test, and then I forgot it all because I didn’t care about it, so we want them to care or they’re not going to remember so get it in their heads and help them relate it to something they know and make Them care about it, make them figure out why it’s important to them, foster an environment, to support participation, encourage participants to take responsibility for their learning, use a variety of learning methods that require sensory experiences, which means talking about it. You know talking about it listening to it and maybe drawing art therapy try to incorporate as many senses as possible. I always find that role plays are a big hit. You can also break up concepts and have to break up your group into smaller groups and have each of the smaller groups reteach a concept to make sure that they understand it and be mindful of cognitive impairments. So if you’ve got someone who is impaired in some way, make sure that you have some sort of method to ensure that that person is keeping up with the rest of the group. If it’s a diverse group skills development cultivates the necessary skills to prevent a relapse, depression, anxiety, and addiction and achieve an acceptable quality of life. Part of the skills groups assumes that the clients lack needed skills such as coping skills, interpersonal skills, and communication skills, hence the term skills group. So we want to allow clients to practice skills in groups. Psycho-ed groups provide the knowledge and, if you remember basic treatment, planning, and knowledge skills and abilities, so you know it, you learn how to use the skill and then the ability is a put those skills into practice. So we want them to be able to practice. These skills in a safe microcosm, you want to focus on skills, directly related to recovery and those to thrive in general. Think about Maslow’s hierarchy. They need to get those biological needs met, they need food, shelter, medication, pain management, health, safety and safety from themselves and love and belonging. So we want to help them make sure they’re getting those not just focusing specifically on depression or anxiety skills development groups have a limited number of sessions and a limited number of participants. So everybody can practice. We don’t want a big auditorium. We want that 8 to 15 number ideally, and there used to strengthen behavioral and cognitive resources. Skills groups focus on developing an information base on which decisions can be made and actions can be taken. So when they’re thinking when they practice the pause and they’re trying to decide okay, what is the best reaction to this current situation that’s when skills kick in and they’ve got a menu of skills to choose from cognitive, behavioral Groups, conceptualize dependence on substances as a learned, behavior that subjects to modifications through various interventions, which is a bunch of garbage garbled a for CBT groups, really look at using as a triggered behavior in response to pain. You want the pain to go away and your drug of choice does that. The same is true for self-injury or a variety of other symptoms that we see in our patients. So we want to look at what’s triggering those and how can we. What are they trying to meet? What need are they trying to meet with that behavior and how can we help them meet that? Otherwise, sorry, my nose is itchy today, work to change, my learned, behavior by changing my thinking, patterns, beliefs, and perceptions and include psychological elements like thoughts, beliefs, decisions, opinions, and assumptions. Cbt groups develop social networks that support abstinence, so the person with dependence becomes aware of behaviors that may lead to relapse and develop strategies to continue in recovery. Now that’s for addictions, groups for anxiety and depression, the same is true. We want them to have social networks with other people who experience the same diagnosis. If you will so, they can become aware of relapse. Warning signs when are starting to become impatient. They’re not sleeping as much, whatever their relapse warning signs are for their condition, disorder, whatever you want to call it, so they can develop. Strategies to stay, happy and healthy educational devices are used in CBT groups including worksheets role plays, and videos that encompass a variety of proof, and approaches that focus on changing the way we think and the behavior that flows from it. I cannot stand feeling this way can be changed too. I don’t like feeling this way, but I know it will change. In the next moment. Cbt techniques teach group members about self-destructive, behavior and thinking that lead to maladaptive behavior. We look at those unhelpful, cognitions and their effects of them. How does that impact you in your relationships? The way you perceive the world and your general sense of empowerment and happiness? They focus on problem-solving and short and long-term goal-setting which a lot of people don’t know how to do. Imagine how much better people and more empowered people feel when they figure out hey. I know how to do that. I know how to see a problem, develop a plan and solve the problem and they help clients, monitor feelings and behavior, particularly those associated with their diagnosis. Support groups are useful for apprehensive clients who are looking for a safe environment and they boast remembers efforts to develop and strengthen their ability to manage thinking and emotions and interpersonal skills support groups. Don’t have a trained facilitator necessarily, so they’re. Not necessarily. How do I want to say this? They’re only as effective as the effectiveness of the group leader and the health of the group leader, support groups, address pragmatic concerns, and generally improve members, self-esteem and self-confidence they’re. Often open-ended with changing members, encourage discussion about members, current situations, and recent problems. So we’re less focused on education and skill building and more focused on what’s going on with you today, and they provide peer feedback and require members are accountable to one. Other support groups vary with group goals and member needs and include facilitating desilting discussion among members while maintaining appropriate group boundaries, which can be a little difficult, especially with untrained if there are no trained facilitators there. These groups can help the group the whole group work through obstacles and conflicts. So if you’ve got people that are arguing within the group remember, this is a microcosm. This is a little family, whether it’s a support group or any other kind of group. These people meet every week and there are going to be conflicts, so we want to help people work through these and develop acceptance and regard for one another support groups ensure that interpersonal struggles among group members do not hinder group development. So if you’ve got a relationship budding between two people, not unheard of, or if you’ve, got a huge conflict, getting ready to happen between two people. You want to make sure that doesn’t interfere with the group process, so you may need to handle that outside of the group, or you know, figure out how to address it. Interpersonal process groups recognized conflicting forces in the mind, some of which may be outside of one’s. Awareness determines a person’s behavior, whether it’s helpful or unhelpful. So interpersonal process groups help people identify the developmental influences and other things that have gotten them to where they are, that influence, how they act and react the way they do currently, and bring a lot of stuff into awareness. Oh, that makes sense that I react that way because that’s how my mom used to react or when I did that when I was a kid I got in trouble for it whatever the case may be interpersonal process groups delve into major developmental issues. Searching for patterns that contribute to the problem or interfere with recovery abandonment issues is one that comes up a lot looking at the family of origin and their coping skills. We want to learn. What did you learn when you were growing up that is? You are using now and how effective is that for you, these groups use psycho dynamics or the way people function psychologically to promote change and healing and rely on the here-and-now interactions of members. So we’re focusing on all this stuff. That made you who you are and gave you the tools that you have right now, how’s that working for you? So there are multiple types of groups that are available to assist clients in achieving their goals. We view current coping skills as creative adaptations to what they’ve learned and ways to get their needs met. They may not be the healthiest coping skills, but they are serving a purpose. So we want to look at the way. Clients are coping acting interacting. Just look at their behaviors and ask ourselves what’s the benefit to that? What’s motivating is that, because we always choose the behavior. That seems – and I emphasize the word seems to have the most reward to it, based on reward and effort groups, help strengthen the healthy skills, but they also help point out some of the unhealthy ones, and again a lot of times it has more to it. If it comes from a peer, as opposed to, if it comes from a therapist skills required to facilitate groups, overlap significantly a lot of my psycho, groups are also kind of skills groups. I kind of do a psycho, ed skills blend when I do groups that are, my style though, and the group facilitator needs to figure out his or her style because you’re going to set the tone for your group. Not everybody is going to thrive in your group. Just like not everybody is going to mesh with you as an individual therapist, knowing your style and being confident is one of the first steps to having a really strong group experience. Types of groups include psychoeducational, which provides your knowledge, and classroom-type format. Skills development provides takes the information that knowledge and helps people translate it into skills. Okay. Now I know what an unhelpful thought or a cognitive distortion is. What do I do about it? Skills group is the: what do I do about it and let’s practice it. So when I have this thought, what can I do? Cognitive behavioral groups kind of integrate those but focus strongly on what’s going on with the individual and the thoughts if you think, of the ABCs, the automatic beliefs that may be perpetuating or maintaining the unpleasant consequences and support groups are those groups that Are not facilitated by a trained facilitator or by a clinical facilitator. In some groups like smart recovery, the facilitators are trained, but they’re, not necessarily clinicians and group members are accountable to one another more so than accountable to a group leader who starts the group by telling people what they’re going to learn and do and why it’s useful to them make them care, give them that global perspective of what’s going to happen and then go through the information step by step or sequentially. So all of your learners are getting as much as possible provide an overview of what you’re talking about have written material like I said, if copies are a big issue where you come from it’s, not unheard of, or if you just don’t like making lots of Xerox copies, write it on a whiteboard and encourage clients to bring a notebook and write it down. Clients will remember things better if they have to write them down because they’re going. To paraphrase it, which is a form of kinesthetic learning before they write it down most likely because they want to write down as little as possible, discuss the material and apply it ask for their input. How do you deal with this? What do you think about this option? How could you use this? How could you have used this last week and what do you think you might? How do you think you might use it next week and give me an example of what that would look like for you? Can also have them roleplay, maybe they’re having somebody in the group having a particular issue with a supervisor or roommate. You may choose to roleplay that in a group and have them apply a skill that you’re talking about. Have each group member close by identifying one thing they got at a group and how they are going to use it in their recovery plan. Again, it brings it back to caring, has the kind of tie it up into a neat bow, and is able to walk out with one tool. Yep give them two too many tools in one group and they’re going to walk out, and none of them are going to get used. You give them one tool and they walk out. They may try to use it throughout the week and then next week in the group, you can ask them how’d it go. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube, you can attend and participate in our life. Webinars with doctor Snipes by subscribing at all CEUs comm, slash counselor toolbox. This episode has been brought to you in part by all CEUs com providing 24 7 multimedia, continuing education, and pre-certification; training to counselors therapists, and nurses, since 2006 use the coupon code consular toolbox to get a 20 discount off your order. This month,As found on YouTubeHi, My name is James Gordon 👻🗯 I’m going to share with you the system I used to permanently cure the depression that I struggled with for over 20 years. My approach is going to teach you how to get to the root of your struggle with depression, with NO drugs and NO expensive and endless therapy sessions. If you’re ready to get on the path to finally overcome your depression, I invite you to keep reading…