At Castle Craig the whole community of patients is one big group. There are lots of informal groups: in the patients’ dining room; outside in the smoking area; if they share a bedroom they will form a small group; while in the transport being taken to outside AA and Narcotics Anonymous meetings (they also go to Gamblers Anonymous).
The formal groups are more structured because they are facilitated by a therapist. They include more specialised groups like gambling, grief and trauma groups – there’s a whole range of them.
The aim of group therapy is to help patients access their emotions in a way they have not been doing before. Alcoholics and addicts are not aware at an emotional level what their drug of choice is doing to them; they may feel it is a solution whereas the reality is that it is destroying them.
A consequence of addiction is emotional discomfort – pain. Addicts and alcoholics subject themselves and their families to lots of pain. A way out of the pain is using drugs. Group therapy is the most effective way of processing this pain — if they’re going to get clean and sober and into recovery.
In residential treatment there are some common factors shared by all the patients: they’re all addicted; they know a lot about addiction; they have all tried to do something about it and not just passively sat back and watch it happen; they’ve all tried stopping, controlling it, talking to people, asking for help. The goal of group therapy is to get them in touch with their feelings and this can lead them to the right conclusions.
In group therapy the patients get to know each other. They form non-judgemental relationships with each other, in the sense that each of them understands the problem, the struggle they are all having, why they have had to lie and manipulate.
We don’t differentiate between alcoholics or addicts as they have the same problem — a problem with the brain. Their defences allow them to stay sick. Group therapy is about breaking down these defences.
Members of a group will be open about some information, like their name or career – areas where there’s no angst — but there’s another area that they won’t talk about and that is the secrets. But the secrets are a problem because that’s where a lot of the emotional pain is, and that’s where the big emotional relapse factors are. These secrets gnaw away at them.
We are trying to break the powerful relationship they have with alcohol and drugs and replace it with another type of relationship – with themselves and with others.
Group therapy in a residential context is very powerful. There’s a huge amount of emotional support. You can move quite quickly to an emotional depth, knowing that you have the support of the community that is hard to do in an outpatient setting.