Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Created by the Recreation Therapy department at Highland Ridge Hospital Hayli Burnham TRS, CTRS and Amy McBride TRS, CTRS

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Coping Skills Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual Highland Ridge Hospital

Hayli Burnham TRS, CTRS

University of Utah

Amy McBride TRS, CTRS

University of Utah

This program was developed to assess and educate on positive coping skills methods and selfawareness to prevent risk of relapse for a successful recovery and maintained sobriety through group sessions that touch on specific goals that promote constructive decision making and overall awareness of triggers and other factors that may cause stress and increase the risk of relapse.

References
(2008). Drug Misue: Opiod Detoxification. Leicester: British Psychology Society. Substance Abuse/Chemical Dependency. (2011). Retrieved Oct 9, 2012, from University Neuropsychiatric Institute: http://healthcare.utah.edu/uni/healthlibrary/addictions.php Stumbo, N. J., & Peterson, C. A. (2009). Therapeutic Recreation Program Design 5th Ed. San Francisco: Pearson Education. Treatment Solutions. (n.d.). Retrieved Oct 9, 2012, from Treatmentsolutions.com: http://www.treatmentsolutions.com/therapies-organized-recreation/

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Contents
Highland Ridge Hospital .................................................................................................................. 3 Substance abuse and dependence ................................................................................................. 4 Intervention protocol ...................................................................................................................... 7 Rehab Out-patient Unit: Client Descriptions .................................................................................. 9 PROGRAM: Coping Skills: finding your inner medicine ................................................................ 12 Objectives and Performance Measures ........................................................................................ 14 Content and Process Description.................................................................................................. 15 Handouts: Color Characteristics ............................................................................................... 19 Handouts: Native American Symbols ....................................................................................... 20 Sequence Sheet............................................................................................................................. 21 Performance Sheet ....................................................................................................................... 23 Client Progress Notes .................................................................................................................... 24

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Highland Ridge Hospital

Highland Ridge Hospital is a mental health and chemical dependency treatment center with 24-hour psychiatric intake for mens womens, and adolescent treatment; inpatient psychiatric services; partial hospitalization/out-patient; day treatment; detox; and intensive in-patient rehab program. Mission, vision, values: Highland Ridge Hospital strives to help clients overcome psychological, emotional, trauma, and drug abuse barriers that they face every day through a residential treatment program with education, psychotherapy, recreational therapy, healthy living, and scheduled routines in one of our specialized departments whether inpatient or intensive outpatient. Highland Ridge Hospitals vision is to not only treat the disorder or addiction but to treat the whole person through a compassionate, experienced team of clinicians together in a fully integrated and customized treatment program to help you recover. The practices and programs used are safe, proven, reliable evidenced-based treatment protocols. Values: care, concern, compassion and competence, hope, trust, finding strength, overcoming obstacles, team work, work ethic, positive influences, leisure and recreation, healing, healthy lifestyles, productivity, routines, 12 step work, music, art, and education.

Diagnostic disorders: Anxiety, depression, dysthymia/trauma, self-harm behaviors, learning disorders, drug addiction, alcohol addiction, prescription drug addiction, illicit drug addiction, physical abuse, emotional abuse, sexual abuse, bipolar disorder, personality disorders, borderline personality traits, ADD, grief, and eating disorders. Populations served: Co-ed, all ages, treatment services include: 12-step programs, psychotherapy groups, psychoeducational groups, recreational alternative groups, community milieu groups, family groups, special issues groups, yoga, individual therapy, family therapy, and aftercare programs.

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Substance abuse and dependence

Substance abuse disorder or substance-related disorders, this term encompasses both dependence on and abuse of drugs usually taken voluntarily for the purpose of their effect on the central nervous systems (usually referred to as intoxication or "high") or to prevent or reduce withdrawal symptoms. These mental disorders form a subcategory of the substance-related disorders (Behavenet.com). Substance abuse can take form in a broad array of addictions such as alcoholism, amphetamine, caffeine, cannabis, cocaine, hallucinogens, and opiates. DSM IV-TR criteria for substance abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: o recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) o recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) o recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) o continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights) The symptoms have never met the criteria for Substance Dependence for this class of substance. Substance dependence is the medical term used to describe abuse of drugs or alcohol that continues, even when significant problems related to their use have developed. Signs of dependence include: Tolerance to or need for increased amounts of the drug to get an effect Withdrawal symptoms that occur if the user decreases or stops using the drug and eventually find it difficult to cut down or quit Spending a lot of time to obtain, use, and recover from the effects of using drugs Withdrawal from social and recreational activities Continued use of the drug even though you are aware of the physical, psychological, and family or social problems that are caused by your ongoing drug abuse (healthcare.utah.edu). physical health problems (for example, thrombosis, abscesses, overdose, hepatitis B and C, human immunodeficiency virus [HIV], and respiratory and cardiac problems) mental health problems (for example, depression, anxiety, paranoia and suicidal thoughts)

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual social difficulties (for example, relationship problems, financial difficulties, unemployment and homelessness) Criminal justice problems (ncbi.nlm.nih.gov).

Symptoms and identified problems (may be treated with recreational therapy services): o Withdrawal from social activities o Withdrawal from healthy recreation activities o Depressed, hopeless, or suicidal feelings o Lack of coping techniques o Lack of communication skills Defining characteristics: o Getting high on drugs or getting intoxicated on a regular basis o Lying, especially about how much they are using or drinking o Avoiding friends and family members o Giving up activities they used to enjoy like sports or spending time with non-using friends o Believing they need to use or drink in order to have fun o Pressuring others to use or drink o Getting in trouble with the law o Taking risks, such as sexual risks or driving under the influence of a substance o Work performance suffers due to substance abuse before, after, or during working or business hours o Missing work due to substance use o Depressed, hopeless, or suicidal feelings Assessment criteria: o Level of drug use/dependence through interview and collateral interview o Level of mental health and psychological symptoms and severity through standardized testing from record review o Level of physical functioning and health through observation o Quality of life and stress management abilities o Recreation participation o Social support o Sufficient level of coping skills and proper interaction sources with people through interview and observation o The service users aspirations and expectations of treatment through interview Process criteria: o Stress management o Coping Skills o Anger Management o Communication Skills o Leisure Education 5|Page

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual Outcome criteria: o Patient will learn techniques to sustain overall well-being through stress management o Develop alternative coping skills o Increase social skills and social coping to reduce social anxiety o Understand which social interactions are beneficial and the others that are triggers o Understand how leisure skills and well-being coincide with stress management and coping for successful overall recovery o Increasing and strengthening bonds with friends and family and find resolution to frayed relationships o Proper health treatment and care o Encourage continued participation in after care with RT staff

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Coping Skills: Finding Your Inner Medicine

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Intervention protocol
Coping Skills and Problem Solving- relapse prevention o This program will assess and teach positive coping skills methods to prevent the risk of relapse of the clients based on the Relapse Prevention Model by Marlatt and Gordon (1985) and the Stress Coping Processes Model by Wills and Shiffman (1985). The program will consist of cognitive-behavioral group sessions that touch on specific goals that promote constructive decision making and overall awareness of triggers and other factors that may cause stress and increase the risk of relapse. Program description- goals to be met for clients through the coping skills management intervention program: o Recognizing and changing negative thoughts that might interfere with enjoying life o Focusing on the present and learn coping responses associated with new life experiences, and learn to deter away from past strategies and thought patterns o Differentiating the temptation to use associated with the thought of positive effects of drug or alcohol use o Identifying personal behavior and understanding what the stressors are in clients life o Focusing on personal progress and self-acceptance o Awareness of social pressures and an agreement with oneself to not participate o Social interaction and friendship skills o Identifying coping strategies for high risk leisure situations o Constructive leisure decision making for a chemical-free lifestyle o Become more reasoned and rational with responses Client problems: o Withdrawal from social activities o Withdrawal from healthy recreation activities o Depressed, hopeless, or suicidal feelings o Lack of coping techniques o Lack of communication skills o Lack of self-esteem o Lack of resources o Lack of support systems Referral criteria: o Physicians order or referral o Therapist referral o Educational counselors referral Contraindicated criteria- not equipped for: o Individuals that are a harm to others 7|Page

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual o Clients in detox Training and Credentials o Licensed in the State of Utah as a TRS or MTRS and nationally certified as a CTRS o Current CPR or First Aid certification o Behavior management training o Training will include the understanding of: program handbook RT policies and procedures charting requirements and proper documentation group therapy leading and facilitating skills Risk management: o insurance o security staff and cameras o keeping sharp or dangerous objects inaccessible to clients/patients o locking utility rooms or closets Outcomes expected: o Client will be able to be aware of and cope with emotions that may cause relapse o Client will develop stress management skills o Client will have a better understanding of surroundings and stressors/triggers o Client will gain knowledge and experience social skills for building proper drug free friendships and positive relationships outside of treatment o Client will find ways for enjoyment of life and recreation without chemical use o Client will gain awareness of unhealthy social situations and peer pressure o Client will understand their own beliefs, values, and abilities to overcome substance abuse and be given tools to have a successful life without risk for relapse Program evaluation: o Clients will fill out assessments/evaluations on their treatment as a whole, individual sessions, staff, and other program tools o Client assessments will include a scale and questionnaire as to whether or not the client feels the program has improved their coping skills and gained the knowledge and tools necessary for relapse prevention o Evaluations and feedback by therapists o Evaluations by family members of clients

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

Rehab Out-patient Unit: Client Descriptions

Heather: Patient is a 37 year old white female, who is an alcoholic. She began drinking at the age of 15 and was raised with a religious background. Patient states she has underlying issues about her beliefs and resentment towards her church. Patient has abused other drugs such as cocaine and prescription medications in the past. She has been married twice and has 3 children she supports in a two bedroom apartment. She was once very active in a womans exercise group but now spends most of her time drinking alone. Individual treatment objective: 1. Patient will identify 3 personal strengths and 2 personal values during the group activity, as judged by the TRS. 2. At the conclusion of group, patient will present her personal medicine bag and verbally connect how her strengths and values can help build positive coping skills, as judged by the TRS. Specific behaviors: Shows signs of depression Lack of interest Fairly social Barely makes it to her part time job at the grocery store She is rarely involved with helping her children get to school, homework, family activities, and meals Jenna: Patient is a 29 year old white female admitted for alcoholism. She is divorced with one 5 year old child. Her previous spouse was physically and verbally abusive. She was working full time trying to put her ex-husband through engineering school, and she could not provide enough income to maintain the household or pay tuition. Patient is what you call a functional alcoholic, she attends work regularly though most times still hung over. Patient is currently living in her parents basement and takes ca re of her daughter, but every other moment is spent drinking. She has 2 DUIs and is serving community hours. She recently came clean to her family and friends and is eager to get sober. Individual treatment objective: 1. Patient will verbally identify 3 personal strengths and 2 personal values during the group activity, as judged by the TRS. 2. At the conclusion of group, patient will present her personal medicine bag and verbally connect how her strengths and values can help build positive coping skills, as judged by the TRS. Specific behaviors: Very social Usually the first to answer questions Questions her own ability 9|Page

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual She hides her drinking from her family and friends She manages to take care of her daughter but drinks and often gets in trouble with the law

Liz: Patient is a 27 year old female who voluntarily sought outpatient treatment for her alcohol abuse. She is currently in the air force reserve. Patients family support system struggles with addiction and abusive relationships. Patient shows signs of depression and has verbally stated she feels sad when she attends AA meetings. Recreation activities she enjoys include art, pole dancing and sky diving. Individual treatment objective: 1. Patient will verbally identify 3 personal strengths and 2 personal values during the group activity, as judged by the TRS. 2. At the conclusion of group, patient will present her personal medicine bag and verbally connect how her personal strengths can help build positive coping skills, as judged by the TRS. Specific Behaviors: Emotionally sensitive Regular smoker Hates her job working for the air force Her craving level was at a 10 this weekend and is still high today Believes she can get through her addiction without the support of friends or family Devin: Patient is a 24 year old father of two who has an addiction to opiates. His drug of choice is cocaine and he is currently struggling with strong cravings to use. Patient has many recreational activities he enjoys such as motor cross, camping, fishing, and hunting. Most of these activities he associates with using. The mother of his children also has an addiction and has recently been released from jail. Patient verbally states at the beginning of every group that each day he feels better than the day before. Individual treatment objectives: 1. Patient will verbally identify 3 personal strengths and 2 personal values during the group activity, as judged by the TRS. 2. At the conclusion of group, patient will present his personal medicine bag and verbally connect how his personal strengths can help build positive coping skills, as judged by the TRS. Specific Behaviors: High level of cravings this week Verbally states his determination to be sober Worried he will struggle with this addiction for the rest of his life Regular smoker Struggles with tracking his mind off using 10 | P a g e

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual Courtney: Patient is a 23 year old female admitted for alcohol abuse. At the age of 13 she was hospitalized for her first alcohol poising and has a family history of alcoholism. Patient states she cannot sleep and feels tired all the time. Recreation interests are not very specific but generally include exercise or music. Patient verbally admitted to using other drugs in the past and this is her second time through rehab. Individual treatment objectives: 1. Patient will verbally identify 3 personal strengths and 2 personal values during group activity, as asked and judged by the TRS. 2. At the conclusion of group, patient will present her personal medicine bag and verbally connect how her personal strengths can help build positive coping skills, as judged by the TRS. Specific Behaviors: Hardly makes eye contact Slouches in her chair Patient will participant or respond when promoted, otherwise is quiet and reserved Often late to group Regular smoker Very general in all of her responses Eric: Patient is a 36 year old male admitted for alcohol and drug abuse. He is a father of seven children with a supportive wife at home. Patient shows signs of anxiety and becomes irritable quickly. Some recreational activities he enjoys are hunting, traveling and weight lifting. Patient has consciously decreased his weight since the beginning of his admittance and plans to continue until he reaches his desired goal. Individual treatment objectives: 1. Patient will verbally identify 3 personal strengths and 2 personal values during the group activity, as judged by the TRS. 2. At the conclusion of group, patient will present his personal medicine bag and verbally connect how his personal strengths can help build positive coping skills, as judged by the TRS. Specific behaviors: Irritable Social Regular smoker Manipulates the group or therapists to give him the answer to questions that require him to reflect deeply about himself Hayli Burnham TRS, CTRS Amy McBride TRS, CTRS 11 | P a g e

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual

PROGRAM: Coping Skills: finding your inner medicine

Purpose: To assess and educate on positive coping skills methods and self-awareness to prevent risk of relapse for a successful recovery and maintained sobriety through group sessions that touch on specific goals that promote constructive decision making and overall awareness of triggers and other factors that may cause stress and increase the risk of relapse. IMPLEMENTATION DESCRIPTION Population This program is for out-patient substance abuse treatment programs. The content was developed for patients of adolescent and adult ages. Clients must have receptive and expressive language and be able to make verbal contributions that are authentic and relevant in nature. Each participant must be able to concentrate for 20 minutes at the end of the intervention for cognitive group processing. This program would be optimal in a group size no bigger than 8-10. Due to group processing being the educational piece of the program, it would be ideal to have a group no less than 2. Program Length and Duration This program was designed for the duration of the out-patient 6 week program. Each session will last 50 minutes and is scheduled once a week for the length of the program. A period lasting less than four weeks may not provide enough contact with the group to grasp relevant information and apply to personal lives. Program Context This program can be implemented in any agency serving the described population. Thus, the program could be used with in-patient and out-patient treatment programs. This program should be utilized within experienced substance abuse treatment settings whether hospital based such as Highland Ridge Hospital, residential such as The Haven, or community-based settings such as First-Step House. Staff One professional staff member is required per session. The staff member must have knowledge of substance abuse treatment, group facilitation techniques including sequencing and discussion, knowledge of psychiatric and emotional conditions of the patients, and the ability to utilize facilitation and behavioral-management techniques. The staff member is required to have the following: State licensure: TRT, TRS, or MTRS National certification: NCTRC Crisis Prevention Institute (CPI) certification CPR and first aid certification

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual Space Sessions will consist of activities or tasks that require a table and chairs. Use a group room, gym, communal or outdoor space that will fit the number of patients attending. Room should include white board, trash can, and is in close proximity to a restroom. Special Considerations This program intervention incorporates Native American culture and beliefs, it is very important for the TRS to know the cultural background of each individual in the out-patient program. This intervention takes the cultural content as its inspiration for patients recovery and does not advocate the adoption of beliefs unto the patients. After reviewing client information TRS should make his/her best judgment as to what content and material is presented to the group. Equipment Table, seating for each patient 1 table: 6-8 patients 2 tables: 10 patients Medicine Bag Activity Box, must include 12 piece set of mesh bags Beads: red, blue, green, white, yellow, and orange Bead containers: 6 for each color Fabric and bead glue: 4 bottles per group Fabric paint: 2 bottles Extra material bag: feathers, design beads, leather string 2 example medicine bags Hand-outs Folder Native American symbol sheet: 1 per patient Color Meanings sheet: 1 per patient Medicine bag history Included is the Native American Prayer CD player Native American songs and instruments CD White board Dry-erase marker Dry-eraser

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Out-patient Chemical Dependency Group Facilitation Manual

Objectives and Performance Measures

Program: Coping Skills: finding your inner medicine TPO 1. Develop knowledge, positive coping skills, and strategies EO 1. To identify patients personal strengths and values that assists and supports their motivation and resiliency for maintained sobriety. PM 1. During group processing, patients will identify 3 personal strengths and 2 personal values that will help them build positive coping strategies, the response and reflection will be judged by the TRS. EO 2. To demonstrate knowledge and awareness of triggers and high risk situations. PM 1. During group intervention, patients will write a list of triggers and high risk situations they have experienced and state strategies to reduce or eliminate the situation, the response and reflection will be judged by the TRS. TPO 2. Develop self-awareness by improving self-esteem consisting of self-worth, self-image, and self-concept. EO 1. To acquire a better understanding of self and build confidence to face life outside of treatment. PM 1. Upon request, patient will journal one page after each group about what he or she recognizes or believe about themselves including both positive and negative aspects, which will be reviewed by the therapist. EO 2. To identify 10 positive qualities about themselves. PM 1. Upon request, patient will develop and elaborate on 10 positive qualities they possess that will help build self-esteem and courage to accomplish a positive and healthy recovery.

TO1 EO1 PM1

Terminal objective: goals Enabling objective: objectives Performance measure: measurement of objective or evaluation criteria

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Out-patient Chemical Dependency Group Facilitation Manual

Content and Process Description

PROGRAM: Coping Skills: finding your inner medicine Session 2 EQUIPMENT: Table and seating, medicine bag activity box, handouts folder, medicine bag history, Native American songs and CD player, and dry-erase markers. TPO: 1 Develop positive coping skills and strategies EO: 1 To identify patients personal strengths and values that assist and supports their motivation and resiliency for maintained sobriety CONTENT PROCESS 1. Check-in & Recall Start check-in: A check-in is similar to introductions at the After everyone is seated, greet and welcome beginning of each group session where new the group by thanking them for being on time people can learn names and the staff can use and being present today. Begin the session by information given for patient notes and asking the following: charting. An attendance sheet will be filled out Lets go around and say our names, conditions (alcoholism/addict), and how at the beginning of the session and filed in the youre feeling physically, emotionally, Rec Log folder so that the therapist can and spiritually. know what activity was done recently and o TRS will fill out each patients who attended. A check-in in a substance abuse check-in responses on setting also involves the patient identifying attendance sheet why they are there: Hi, my name is Joe and o TRS will participate in check-in Im an alcoholic. This may be helpful for Recall the first therapy session, as it is a identifying their drug of choice and a little bit prelude into the whole course of treatment of their background. and how all of the sessions will tie into coping skills for recovery. Each session will build upon each other.
2. Introduction to Activity:

Creating a personal medicine bag to carry throughout the journey of recovery and remind patients of their personal strengths and values to help in sobriety. Other sessions throughout treatment will be focused around learning strategies such as identifying triggers and high risk situations which will also have related object pieces that will serve as reminders or totems that will be put inside the bags. This bag can be also something they can use to hold their sobriety chips or coins (i.e.

Today you will create your own personal medicine bag that you can carry with you through your journey to recovery. Throughout the sessions in the program you will learn the skills, strategies and knowledge that will create the content of your bag. Does anyone know that meaning of a medicine bag? Is anyone familiar with the Native American Culture? Can anyone share with the group the history of the medicine bag? 15 | P a g e

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual 30 days sober, 1 year sober).
3. Medicine Bag: History and Content

Many cultures throughout history and in the present day have held the belief that holding objects of importance close to your heart is beneficial, even vital. Native American people, Australian aboriginals, as well as shamans in various cultures, have and still do create and carry medicine bags for luck, guidance, protection, and healing. Traditionally the medicine bag, usually a beautifully decorated leather pouch, contained items like feathers, herbs, stones, ashes, animal parts like teeth or bone, or mementos from special experiences. The contents of a medicine bag will change throughout life as the needs of the individual change. These internal totems also aid the carrier to gather magical items, increase knowledge and aid personal growth through lifes journey. Medicine bags have long been associated with vision quests. These quests are individual journeys to self-discovery and identity. The content and design of the bag are as unique as their carrier, providing personal strengths and values.
4. Activity Directions:

Wrap up discussion and read the history of the medicine bag

Create and design the medicine bags using colors and symbols to represent your personal strengths and values that will assist you throughout the journey of recovery.

After hearing the history and meaning of the medicine bag lets begin to create our own, we would like you to reflect on your own personal strengths and values that will assist you in sobriety and translate that into the design of the bag. Here are some materials to help you identify and symbolize your strengths: Hand out bags, 1 each 16 | P a g e

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual Open bead containers, placed in the center of the table Hand out color and symbol meanings sheet, provided on the next page We will wrap up 20 minutes before the end of group to share your creations and their relation to your personal strengths and values. So please put genuine thought and reflection into your designs. Ask if there are any questions Assure clarification

5. During Activity:

Play music, optional and determined by therapist During the activity TRS will: Assist in reflection if patient needs guidance Provide support Provide creative guidance Assure group language/discussion is appropriate Walk amongst the group Ask questions Observe and assess client behaviors Provide 10 minute warning prior to wrap-up
6. Processing and group discussion:

Is there a color that represents who you are? How might this symbol relate to your personal identity/values? When you are making a difficult decision is there a certain value that helps direct your choice?

About 20 minutes before the group ends, ask the patients to kindly straighten up their work space and prepare to present their medicine bag designs.

During group processing therapists are: Documenting patients ability to respond Depth of reflection Individual treatment objectives Assuring the respect is given to the presenter Directing reflection and conversation if

Ask each patient to describe how their design reflects their personal strengths and values and how they will help then throughout sobriety. Guidance may need to be assisted to get the group started and in full attention. Process questions: Please present your medicine bag to the group and share the represented meaning of your design How does your design reflect your personal strengths and values? 17 | P a g e

Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual needed Thanking each patient for sharing Why is it important to have values in life? What representation on your medicine bag reflects your values? Personal strengths? How can your personal strengths and values help you build positive coping skills? We all have personal strengths that we uniquely and inherently possess, please share with the group specific examples of how these strengths will help you maintain sobriety? How do your values motivate you? How do your strengths establish resiliency for your maintained sobriety? How is spirituality important in regards to the 12 steps?

7. Wrap-Up:

It is important to conclude this session insuring each patient had the equal opportunity to present and reflect on their design. Oh, Great Spirit Whose voice I hear in the winds, And whose breath gives life to all the world, hear me, I am small and weak, I need your strength and wisdom. Let me walk in beauty and make my eyes ever behold the red and purple sunset. Make my hands respect the things you have made and my ears sharp to hear your voice. Make me wise so that I may understand the things you have taught my people. Let me learn the lessons you have hidden in every leaf and rock. I seek strength, not to be greater than my brother, but to fight my greatest enemy myself. Make me always ready to come to you with clean hands and straight eyes. So when life fades, as the fading sunset, my Spirit may come to you without shame.

Thank the group as a whole for participating and sharing their personal strengths and values. Inform the group to bring their medicine bags with them each day as they will be an important part in future sessions. Give a brief introduction or information on the next sessions topic As we part, I would like to read you a Native American prayer to give you some closing words to take home, if there anyone who may be uncomfortable with this?

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Handouts: Color Characteristics

Red: Energy Strength Power Determination Passion Desire Love Leadership Willpower Green: Growth Harmony Freshness Ambition Peace Orange: Enthusiasm Happiness Creativity Attraction Success Encouragement Desire Yellow: Joy Happiness Intellect Energy Freshness

Blue: Depth Stability Trust Loyalty Wisdom Confidence Intelligence Faith Truth

White: Goodness Innocence Purity Beginning

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Handouts: Native American Symbols

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Sequence Sheet
COPING SKILLS: finding your inner medicine TPO EO DESCRIPTION Preparation Before Group Set up table and chairs Put medicine bag material in the center of the table with the lids closed Set up CD player with disk inside Double check you have handouts, a copy of medicine bag history, check-in folder, and any extra documents you may need Greet and welcome group Direct them to a chair that is set-up around a table Thank them for being present and on time Conduct check-ins Ask who would like to go first Continue until each patient states their check-in: name, condition, and feelings Therapist documents patients response on attendance sheet for rec therapy log and documentation for patient charts Summarize/recall previous group session Mainly summarize take home points or important content discussed/experienced Introduce Activity Therapist will introduce medicine bag activity and assess the groups familiarity on the subject by asking them if anyone knows the meaning or history of a medicine bag Therapist reads medicine bag history 1 1 Activity Directions Therapist will explain the design of the bag must represent and reflect personal strengths and values that will help them through their journey in sobriety Write down the words personal strengths and values on the white board Assure clarification, give examples, and answer questions Distribute medicine bags and handouts while

SESSION NO. 2

TIME (MIN) 20 min

Every session

2 min

Every session

4 min

Every session

2 min

4 min

4 min

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Coping Skills: Finding Your Inner Medicine

Out-patient Chemical Dependency Group Facilitation Manual explaining the symbolism of colors and designs Open bead containers and share examples Inform the group to prepare to share their designs with the group and how it represents their personal strengths and values Ask for questions and assure clarification During Activity 2 Play Native American songs, this should be based upon the best judgment of the therapist Therapist should be present for support, assistance, and assure the environment is safe and effective for group work Share with the group when they have 10 minutes left Processing: 2 Ask the group to finish their last task and put down any materials Once attention is provided start group processing Go around the group until each patient has presented medicine bag Thank each individual for sharing Acknowledge each patient and provide feedback, clarification, and individual direction Document observed behavior and individual responses Wrap-Up Every Session (excluding Thank the group for their participation and Native American presentations Prayer) Inform the group to bring their medicine bags with them each day Give a brief introduction to the next session and topic Read Native American Prayer Clean-Up Every Session Once the group is dismissed clean up and organize medicine bag material Finish any documentation Put back table and chairs If needed, replace any material

20 min

1 2

1 1

10 min

10 min

4 min

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Out-patient Chemical Dependency Group Facilitation Manual

Performance Sheet
PROGRAM: Coping Skills- Session 2 STAFF: DATE: Enabling Objectives EO 2. Demonstrated knowledge and awareness of triggers and high risk situations EO 1. . Identified personal strengths and values TPO 1. Developed knowledge, positive coping skills, and strategies

NAMES: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

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Client Progress Notes

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