Hello my friends! I’m Scott Satti, a mental health nurse practitioner. You can call me Scott, or Mr. Satti, or just Satti. I use he/him/his pronouns. I have more than 15 years’ experience working with people who struggle with addiction. I want to especially welcome those who are joining us for the first time today, including my student psychiatric nurse practitioner.
I hope you know you’ve joined a solution-focused, brief therapy group. Solution-focused means we are going to focus on our solutions to the problems and not the problems themselves. I’m going to help you reframe your thought process from “this is my problem” to “how am I going to handle this problem.” And it won’t really be me—you and other members of the group will be doing the work, wah-wah!
You may be used to therapy that asked about your childhood, or how you felt in high school, or encouraged you to talk about your past. Nope. We don’t do any of that. This is different. We are not going to give much attention to the past at all. My friends, we are going to look forward, paying attention to your goals going into the future.
Let’s start with introductions, my friends. What do you want to be called? What pronouns do you use? Who are you? Why are you here? Also tell us how long you’ve been with the group. Who would like to be first?
Introductions
The group members go around the room introducing themselves.
Marquis
“My name is Marquis, and I’ve been taking pain pills for my back and my wife noticed that recently I’ve been using 30-day supply in two weeks. I’m 56, but I’ve been feelin’ like 76 due to the pain. I use he/him and they/them pronouns. I’ve been coming for about a month now.”
Frances
“I’m a lifelong cocaine user, but it never interfered with life, but then I recently had a heart attack. My cardiologist said if I keep smoking it, I won’t live to see 45. And I’m 44. I use she pronouns? Like, what else would I use? I’m Frances, but you can call me Frankie. It’s my first time.”
Brea
“I’m Brea; that’s spelled b-r-e-a but pronounced ‘bree.’ Not telling you how old I am. It’s none of your all’s damn business. I only smoke weed, and I need a job, but I can’t pass any drug screen cuz I can‘t stop using it. I’m a woman. It’s my first time here.”
Jason
“I’m Jason and I’m 40. As you can see, I’m a guy. Drink maybe five or six nights a week and my gout is flaring up. My PCP said he won’t refill my gout medication until I get my drinking under control. I thought only old guys had gout. This is my, let me count, 1, 2, 3, 4. Four times.”
Jade
“Jade here, she, her, hers, 26 years old. My nurse practitioner said she won’t give me anymore Xanax until I get help. So I started buying them off the street. And then I thought…maybe I have a problem. This is my second meeting.”
Liam
“I’m Liam. Katerina, my partner, she said that she’ll leave if I don’t get my drinking under control. I tried on my own and can’t. This is my third session.”
Linn
“Linn. Alcohol’s my problem, too. My daughter won’t let me watch my grandbabies because she smelled alcohol on my breath. I’m 39. This is my first time.”
Maricela
“I was caught driving cross state lines with meth on me. They will knock down my charge if I remain sober. Oh, I’m Maricela, and if Linn’s 39, then I’m 29! Cuz I really am 39. And I’ve got a grandkid I haven’t even met because I don’t know where my kids are livin’. They won’t tell me. I been in therapy lots before, but this is my first time here.”
Kaz
“Kaz. 25. I got a DUI an’ they gave me court-mandated treatment. He pronouns, as if you couldn’t tell.”
Valeria
“Valeria here, 34. I had a DWI the other month and the court said I had to get treatment. This is my second meeting. I am not an addict; it was only weed.”
After Valeria finishes, Kaz speaks up. “So, Scott, how about you? Have you ever struggled with addiction?”
What is Scott’s best answer to this question?
““Kaz, my friend, I can appreciate why you are curious about that, but it’s not something I usually share with group members. We all have things we can do better and as I mentioned, I do have extensive experience working with people who struggle with addiction. Also, with this group, we aren’t here to focus on anyone’s past. We are here to create and find solutions to the problems we’ve been dealing with. This group focuses on the future.”
This is a good choice.
Appropriate, facilitative self-disclosure is an essential aspect of the art of group leading. It is not necessary to disclose details of your past or your personal life to make yourself known as a person or to empathize with the participants. A few words can convey a great deal, and nonverbal messages—a touch, a look, a gesture—can express feelings of identification and understanding.
Linn
Before the next session begins, Linn arrives early and tells Scott she needs to talk privately with him. You are close enough to hear their interaction.
Linn
“It’s been, uh, well, that is, it had been a few weeks since I’d had a drink and Maya said I could babysit this coming weekend. But last night, I started thinking about how maybe all the kids would be too much, and what if something happened, and then Maya wouldn’t let me do it again? And then I thought maybe just one drink would calm me down. And well, I had more than just one drink. And I don’t want Maya to find out. Some of the kids in this group, Brea and Kaz, they went to high school with Maya. They are all the same age—same grade and everything. I’m afraid to say anything in group because it might get back to Maya that I drank again. I can’t have her finding out. They aren’t close or anything, but this isn’t a big city, you know.”
Scott replies, “Linn, people here care about you. Nobody would share things that happen in group, right? Did something happen in your childhood that makes you want to not trust others?”
Was this the right thing to say? Why?
Yes, Scott is Very empathetic with Linn. Alcoholics show a deterioration in socio-cognitive and communication skills, as well as in behaviors related to emotions. But an empathetic person can help alcoholics express their feelings without fear.
Scott speaks again.
“Wait a minute, let me step back, my friend. In this group, we encourage members to express their concerns and fears by talking directly to each other. Rather than tell me that you are afraid Brea or Kaz will talk to your daughter, you should talk directly to them, and probably the whole group. In addition, what do you think about talking with your daughter about the relapse? How can the two of you focus on building trust and finding a solution?”
Maricela Gives Advice
After Kaz’s interruption, Scott asks the new group members, “Ok then, I want you to think for a few minutes about what you want to get from this group. I know each of you has strengths and resources, such as resilience, courage, and ingenuity. You might recognize some of these already or you might need to figure some of them out. Each of you is in a different place in your addiction or recovery and that’s fine. This isn’t about the person next to you and what they say. It’s about your solutions and your goals. What will be different in your life when this problem is no longer prominent, has become irrelevant, or has even disappeared?”
After a few minutes of quiet, the group members give a brief statement on their goals for the group and the next session. As they do this, Maricela interjects advice to others several times.
What should Scott do after the third such statement of advice from Maricela?
Scott should say something to all the group members, including Maricela, about not giving advice, whether it is helpful or not.
This is a good choice.
It is the leader’s task to make sure that these “problem-solving interventions” do not become a pattern; they may cause enough irritation in other members to precipitate a confrontation with those who are quick to offer remedies for everyone’s troubles.
Scott works to establish goals with each new group member and gets updates on continuing goals for the others. “As we close, think about what you might do before we meet next time to keep your problems smaller. For instance, you could use a rating scale each day. See you in a week, my friends!”
Responding to Members
Scott’s Second Transcript
Welcome back my friends! I’m glad to see everyone is still getting here. We missed you last week, Kaz.
Maybe one of your goals can be making it on time to every meeting? Remember, we aren’t going to give any diagnostic labels in this group. If what you are doing is not working, I encourage you to experiment with doing something different. We are going to focus on what you are doing that is already working and encourage you to continue in that direction, wah-wah—things should get better!
Who would like to share today? Look back over your week and tell me what seemed to go slightly better than the week before.
Valeria
Valeria starts in, “My baby’s daddy left me with these damn kids, and I’m gonna have to move back into my mom’s shitty 1-bedroom rathole. You know how I went out for my birthday, got that DUI, and now I’m facing eviction? I can’t get into any other housing cuz of my drug conviction. It was just weed. I don’t know why that still matters. And I also have a felony from when I stole $300 from a Subway two years ago. Nothing will ever get better for me.”
How should Scott respond to Valeria?
Yes, yes, Valeria, my friend, you have challenges certainly, but what is working for you right now? I mean, what is one thing that is going well for you? Let’s start there.
This is a good choice.
Positive psychology concentrates on what is right and what is working for people rather than dwelling on deficits, weaknesses, and problems. This is appropriate to use in a solution-focused brief therapy group.
Engaging Kaz?
As the group continues, you notice that Kaz does not seem engaged today. He has been late to several sessions, left at least one session early, and skipped last week entirely. You catch him after the group ends and ask Kaz how he feels group is going.
Kaz
Kaz responds, “Hey, I’m just tryin’ to get this therapy thing completed, so I get the papers signed, so then I’ll be off my fucking probation.”
Scott steps in to respond. What is Scott’s most appropriate response?
Okay, Kaz, I get it. Your goal is to get off probation. My goal is to help you learn ways that you can live healthier and happier and if you want to get off probation, you are stuck with me for a couple more sessions. So, let’s talk about how we can find a workable solution, my friend.
This is a good choice.
This statement does not directly focus on stopping addictive behaviors and focuses more on enhancing preventative factors in Kaz’s life. This may help Kaz be more motivated to change.
Liam Speaks to Scott After Session
After the session, Liam pulls Scott aside while waving a piece of paper.
Liam
“Hey Scott. I got charged $150 for last week’s session. I called my insurance company and they said I only got six weeks of group therapy and it ran out already. I think it’s really helping, and I don’t want to stop, but they said they wouldn’t pay anymore. What can I do?”
Which Track are They On?
Scott’s Third Transcript
Welcome back, my friends. Remember that some of these steps we’ve been discussing in group may seem fairly obvious. All of us working together to construct solutions will not only help you master techniques, but also give you a deep understanding of where you are in your life. That will help you create new, better outcomes for yourself. Wah-wah!
Like Marquis said last week, each day is a day you can make a better choice than you did the previous day. So each day since he’s been coming to group is a day he’s making a choice. Each day, he’s not letting shame overcome him. He’s waking up and making a choice to stay sober, not to focus on the past. My friends, some day in the future, what’s that future look like for you? What is the future you want to get to?
Today, I’d like everyone to share one thing that went well this past week. Remember, once you can figure out what works, you can do more of that. Wah-wah!
Scott’s Third Transcript
Welcome back, my friends. Remember that some of these steps we’ve been discussing in group may seem fairly obvious. All of us working together to construct solutions will not only help you master techniques, but also give you a deep understanding of where you are in your life. That will help you create new, better outcomes for yourself. Wah-wah!
Like Marquis said last week, each day is a day you can make a better choice than you did the previous day. So each day since he’s been coming to group is a day he’s making a choice. Each day, he’s not letting shame overcome him. He’s waking up and making a choice to stay sober, not to focus on the past. My friends, some day in the future, what’s that future look like for you? What is the future you want to get to?
Today, I’d like everyone to share one thing that went well this past week. Remember, once you can figure out what works, you can do more of that. Wah-wah!
Jason
“I have been sober for three weeks and I have a doctor’s appointment next week to start back up on my gout medication. My doctor is going to be so proud of me!”
Maricela
“I am still struggling to maintain sobriety, so I started this week to go to group or AA every day.”
Frances
“I’m still using, but it is significantly less. I am taking each day one at a time and trying to use my coping skills.”
Jade
“Therapy and Lexapro ain’t helping my anxiety. I told ya I tried almost every street drug and Xanax is the only thing that helps.”
Linn
“My daughter will still not let me watch my grandbabies alone, so I asked her if I can watch them at her house while she does housework or just reads or watches tv in another room.”
Kaz
“I still don’t think I have an addiction, but I’m starting to see that I do need to make changes in my life. Notice I got here on time today.”
Marquis
“I‘m still struggling with pain. I live in constant pain. I just signed up for physical therapy and I’m going to give acupuncture a try.”
Valeria
“That lousy landlord is still being a jerk. I know I haven’t paid rent the past three months, but I offered to pay this month, and he still gave me an eviction notice.”
Brea
“Until I had to write it down, I didn’t realize how much I was smoking. I was able to make the decision to not smoke each day, and I haven’t felt this clear-minded in a long time. Also, I passed a drug screen and I start my new job next week!”
Which two group members are still on the problem track, instead of the solution track?
Jade
And Valeria
Scott comments, “From what they said in group today, Valeria and Jade are concentrating on problem-saturated stories. How can we help them move in a positive direction? How can we encourage them to experiment with doing something different?”
Scotts calls for a break and asks Valeria and Jade to speak with him briefly.
“My friends, I’ve been listening to each of you talk about your updates. I’ve noticed that both of you appear to still be stuck on ‘these are my problems.’ This group should be helping you focus on solutions to your problems. Think about your statement, Valeria, about your landlord being a jerk. How can you reframe that to changing the relationships with your landlord, or finding resources to pay the rent, or such? That is, here is the problem, what is the solution?
“Same with you, Jade. You are focusing on your anxiety and on not being able to get the drug you think you need. What other solutions could you use to treat anxiety? Let’s not just look at one addictive, habit forming solution. What are other solutions—individual therapy, maybe antidepressants, have you heard about meditation apps?
“Let’s work on reframing your thoughts, my friends. Your group mates are here to help guide you in reframing your thoughts so you can handle these situations better. What do you think? Can you work on this with us?
“I’ve been listening to each of you talk about why you are here today. I appreciate you for taking the step in coming to this group to make things better for you. For a change of pace, let’s talk about the times before your problem started to interfere in your life. What were you doing at those times that kept the problem at bay?
“You have talked about times when the problem bothered you less. Now let’s consider what you might do before we meet next time to keep these problems smaller.”
Scott comments, “From what they said in group today, Valeria and Jade are concentrating on problem-saturated stories. How can we help them move in a positive direction? How can we encourage them to experiment with doing something different?”
Scotts calls for a break and asks Valeria and Jade to speak with him briefly.
“My friends, I’ve been listening to each of you talk about your updates. I’ve noticed that both of you appear to still be stuck on ‘these are my problems.’ This group should be helping you focus on solutions to your problems. Think about your statement, Valeria, about your landlord being a jerk. How can you reframe that to changing the relationships with your landlord, or finding resources to pay the rent, or such? That is, here is the problem, what is the solution?
“Same with you, Jade. You are focusing on your anxiety and on not being able to get the drug you think you need. What other solutions could you use to treat anxiety? Let’s not just look at one addictive, habit forming solution. What are other solutions—individual therapy, maybe antidepressants, have you heard about meditation apps?
“Let’s work on reframing your thoughts, my friends. Your group mates are here to help guide you in reframing your thoughts so you can handle these situations better. What do you think? Can you work on this with us?
“I’ve been listening to each of you talk about why you are here today. I appreciate you for taking the step in coming to this group to make things better for you. For a change of pace, let’s talk about the times before your problem started to interfere in your life. What were you doing at those times that kept the problem at bay?
“You have talked about times when the problem bothered you less. Now let’s consider what you might do before we meet next time to keep these problems smaller.”
Concerning Behavior
Before, during, and after another group session, you notice the following. Which of them are concerning? Why?
Outside, you see Brea and Valeria smoking what looks like a joint before coming in.
Concerning
Linn cries while talking about how her daughter once again refused to let her babysit. After the session, Maricela gives her a short hug then sits with her drinking coffee.
Concerning
Brea and Valeria sit next to each other, edging their chairs close together. When others are sharing, they often elbow each other and whisper comments.
Concerning
You notice Silvio looks sick today.
At one point, Kaz interrupts Valeria and Brea’s chatter and tells them to “Shut up, lesbos.”
Concerning
You overhear Jade tell Maricela that she saw Brea and Valeria at party last weekend, and they were “more than just friends if you know what I mean. I’m pretty sure they hooked up.”
Concerning
Marquis says that his pain is so bad he wants to find out how to get more pain pills. He adds that he isn’t doing this, just that he wants to.
At the end of the session, Kaz asks Silvio for a cigarette and a ride home. Silvio gives him a cigarette but not a ride.
You talk with Scott about your concerns regarding Valeria and Brea’s behavior as well as what Kaz said. He asks you how you would address it. He reminds you that in SFBT group, leaders have the tasks of setting limits, establishing group rules, informing members of their rights and responsibilities, and protecting members. In particular, he notes that as the leader, he disavows the role of expert, preferring a more collaborative stance.
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