Vignette: a therapy group

The group in question was a slow-open, group-analytically informed group for people with substance misuse. Its members were people abstinent of drugs and alcohol (the background to the group is discussed in further detail in Weegmann, 2006b). The following occurred some years into the life of the group.

Jeremy was anxious and began the group by reporting, "I have something to say, I think it's best to be honest and not do what I used to, which is to tell everyone after the event when things only get a whole lot worse." He continued, "I've had some difficulties since I stopped medication [Jeremy was drug free for three months] and find it hard to deal with the stress I am under. I used twice last week, but not since".

Elliot inquired, "What did you use, the usual ...?." Jeremy replied, "Yes, the usual [an "over the counter" drug] ... I got it from a different chemist, but felt guilty when I went in twice during the same week . it was like, they can see through me, what I'm up to'". He described recent decisions in his life and an uncanny feeling of being on the brink of either a success or disappointment—things could go either way. Elliot was keen to hear how much he consumed and what it felt like going into the chemist shop, adding, "Do you feel we can see through you as well?" Jeremy said that people in the group don't see through him, because, as they actually know him, he does not need to pretend. Jeremy was "hyper", suggestive of an excitement mixed with fearfulness.

Robert said, "It is no use lecturing you, as you are aware of what you are doing and your patterns . I'm glad you told us at the start." Robert talked about his own sense of foreboding: "I can't put my finger on it, but something you said, Jeremy, about being on a kind of brink ... with me I get high if I think I've had a success and that's dangerous if it gets a hold ." Robert told the group more about "unstable feelings" and how difficult it is for him to judge his actions realistically: "It's like I'm so unsure, I get discouraged when things are not going well and artificially lifted when they are—then I start to dream of all kinds of things, that I've really made it—like the world's best teacher—on a different plane of reality and all that nonsense." Others nodded in seeming identification. Meanwhile, Sarah spoke of her previous "experiments" with alcohol, thinking each time that she could get away with using it without adverse consequences. She illustrated what she meant with amusing tales of old, bringing a few smiles.

Inwardly, I felt concerned about Robert—was he on the brink of a relapse and trying to communicate the danger he was in? I was struck by the shared mood of uncertainly and semi-excitement, as though it was hard for group members to trust their feelings. I addressed Robert, saying, "Robert, your situation reminds me of the words of the poet, who says 'He who would ride a tiger must make sure he can first dismount'" and followed this up by wondering aloud whether his was a stage of psychological readiness to relapse that, unless checked, might lead into actual, full-blown relapse.

Group members knew the meaning of the tiger metaphor. Robert agreed he was "riding on something", and wanted to pull back. Elliot introduced another story, emblematic he said of the addict, in which a frog turns to a scorpion for a ride across a swollen river. The scorpion assures the frog that he won't sting, but then he does: "Why did you do that?" asks the frog, to which the scorpion retorts, "Sorry, but it's in my nature."

At this point others came in and spoke about ongoing difficulties in life and whether they could be faced. Short cuts and avoidance was tempting. "We are all addicts at the end of the day," said one, echoing the theme, "it's in our nature". At this point, I said, "Today, I sense that Robert's situation has made people feel excited—like Robert himself— and the group was kind of high just talking about slips and using. Maybe there is a temptation in times of stress to join the opposition and find short cuts? But I think Robert is also trying to help us to think through the sober side, the real worry that you can get side-tracked into thinking that using drugs again is the best way out. So there may be a lot of uncertainty for people here—how do I keep my feet on the ground? How can I encourage myself, without going overboard? What is manageable for me?"

The group moved on into other areas, with one member talking about an impending holiday. There was discussion about the idea of "taking the group with me" and what this might mean. One person spoke about how they try to "conjure the group" in some situations, in order to remain "clear and clean".

 
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