Feel happy and relaxed with these 8 simple evidence-based strategies for reducing stress and improving mood
By Cassie Jewell, M.Ed., LPC, LSATP
Stress is the body’s reaction to an event or situation. Primarily a physiological response, stress is also experienced psychologically (i.e. worry). Too much stress is associated with mental health issues and chronic health problems.
Because we often have no control over stressors in our lives, it’s important to effectively manage stress.
Here are eight fast-acting stress relievers for short-term relief. (Click here for additional mood boosters.)
Less time sitting = Better mood. A recent study found that replacing sedentary behavior with sleep or light exercise (i.e. walking, gardening, etc.) improved mood. Substituting sleep was associated with decreased stress levels in addition to enhanced mood.
You’ll feel more relaxed and less stressed after receiving a head-and-neck or neck-and-shoulder massage. One study found that participants experienced reduced rates of both physiological and psychological stress after 10 minutes of massage.
When faced with a stressful situation, have your significant other present to ease your anxiety. If your partner is unavailable, visualize him/her; simply thinking of a significant other has comparable positive effects on blood pressure and stress reactivity.
Frequent laughter seems to be a buffer for stress; people who laugh a lot experience fewer stress-related symptoms. Researchers found that the more someone laughed, the less likely they were to feel stressed.
A list of some of the best memoirs detailing personal experiences with mental illness, substance use, and recovery
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
Recommended Memoirs About Mental Illness & Addiction
Drinking: A Love Story (1997) by Caroline Knapp
Amazon Description: “It was love at first sight. The beads of moisture on a chilled bottle. The way the glasses clinked and the conversation flowed. Then it became obsession. The way she hid her bottles behind her lover’s refrigerator. The way she slipped from the dinner table to the bathroom, from work to the bar. And then, like so many love stories, it fell apart. Drinking is Caroline Kapp’s harrowing chronicle of her twenty-year love affair with alcohol.”
A Drinking Life: A Memoir (1994) by Pete Hamill
Amazon Description: “Hamill explains how alcohol slowly became a part of his life, and how he ultimately left it behind. Along the way, he summons the mood of an America that is gone forever, with the bittersweet fondness of a lifelong New Yorker.”
Dry: A Memoir (2003) by Augusten Burroughs
Amazon Description: “You may not know it, but you’ve met Augusten Burroughs. You’ve seen him on the street, in bars, on the subway, at restaurants: a twentysomething guy, nice suit, works in advertising. Regular. Ordinary. But when the ordinary person had two drinks, Augusten was circling the drain by having twelve; when the ordinary person went home at midnight, Augusten never went home at all. Loud, distracting ties, automated wake-up calls and cologne on the tongue could only hide so much for so long. At the request (well, it wasn’t really a request) of his employers, Augusten lands in rehab, where his dreams of group therapy with Robert Downey Jr. are immediately dashed by grim reality of fluorescent lighting and paper hospital slippers. But when Augusten is forced to examine himself, something actually starts to click and that’s when he finds himself in the worst trouble of all. Because when his thirty days are up, he has to return to his same drunken Manhattan life―and live it sober. What follows is a memoir that’s as moving as it is funny, as heartbreaking as it is true. Dry is the story of love, loss, and Starbucks as a Higher Power.”
Girl, Interrupted (1993) by Susanna Kaysen
Amazon Description: “Kaysen’s memoir encompasses horror and razor-edged perception while providing vivid portraits of her fellow patients and their keepers. It is a brilliant evocation of a “parallel universe” set within the kaleidoscopically shifting landscape of the late sixties. Girl, Interrupted is a clear-sighted, unflinching document that gives lasting and specific dimension to our definitions of sane and insane, mental illness and recovery.”
Go Ask Alice (1971) by Alice
Amazon Description: “It started when she was served a soft drink laced with LSD in a dangerous party game. Within months, she was hooked, trapped in a downward spiral that took her from her comfortable home and loving family to the mean streets of an unforgiving city. It was a journey that would rob her of her innocence, her youth—and ultimately her life.”
Loose Girl: A Memoir of Promiscuity (2008) by Kerry Cohen
Amazon Description: “Loose Girl is Kerry Cohen’s captivating memoir about her descent into promiscuity and how she gradually found her way toward real intimacy. The story of addiction–not just to sex, but to male attention–Loose Girl is also the story of a young girl who came to believe that boys and men could give her life meaning.”
A Million Little Pieces (2005) by James Frey
Amazon Description: “At the age of 23, James Frey woke up on a plane to find his front teeth knocked out and his nose broken. He had no idea where the plane was headed nor any recollection of the past two weeks. An alcoholic for ten years and a crack addict for three, he checked into a treatment facility shortly after landing. There he was told he could either stop using or die before he reached age 24. This is Frey’s acclaimed account of his six weeks in rehab.”
Parched: A Memoir (2006) by Heather King
Amazon Description: “In this tragicomic memoir about alcoholism as spiritual thirst, Heather King—writer, lawyer, and National Public Radio commentator—describes her descent into the depths of addiction. Spanning a decades-long downward spiral, King’s harrowing story takes us from a small-town New England childhood to hitchhiking across the country to a cockroach-ridden “artist’s” loft in Boston. Waitressing at ever-shabbier restaurants, deriving what sustenance she could from books, she became a morning regular at a wet-brain-drunks’ bar—and that was after graduating from law school. Saved by her family from the abyss, King finally realized that uniquely poetic, sensitive, and profound though she may have been, she was also a big-time mess. Casting her lot with the rest of humanity at last, she learned that suffering leads to redemption, that personal pain leads to compassion for others in pain, and, above all, that a sense of humor really, really helps.”
Prozac Nation: Young and Depressed in America (1994) by Elizabeth Wurtzel
Amazon Description: “Elizabeth Wurtzel writes with her finger in the faint pulse of an overdiagnosed generation whose ruling icons are Kurt Cobain, Xanax, and pierced tongues. In this famous memoir of her bouts with depression and skirmishes with drugs, Prozac Nation is a witty and sharp account of the psychopharmacology of an era for readers of Girl, Interrupted and Sylvia Plath’s The Bell Jar.”
Smashed: Story of a Drunken Girlhood (2005) by Koren Zailckas
Amazon Description: “Garnering a vast amount of attention from young people and parents, and from book buyers across the country, Smashed became a media sensation and a New York Times bestseller. Eye-opening and utterly gripping, Koren Zailckas’s story is that of thousands of girls like her who are not alcoholics—yet—but who routinely use booze as a shortcut to courage and a stand-in for good judgment.”
Tweak: Growing Up on Methamphetamines (2009) by Nic Sheff
Amazon Description: “Nic Sheff was drunk for the first time at age eleven. In the years that followed, he would regularly smoke pot, do cocaine and Ecstasy, and develop addictions to crystal meth and heroin. Even so, he felt like he would always be able to quit and put his life together whenever he needed to. It took a violent relapse one summer in California to convince him otherwise. In a voice that is raw and honest, Nic spares no detail in telling us the compelling, heartbreaking, and true story of his relapse and the road to recovery. As we watch Nic plunge into the mental and physical depths of drug addiction, he paints a picture for us of a person at odds with his past, with his family, with his substances, and with himself. It’s a harrowing portrait—but not one without hope.”
Collaborates with Harvard Health Publications to provide a wide range of unbiased, motivating resources and self-help tools for mental, social, and emotional. 100% nonprofit; dedicated to Morgan Leslie Segal, who died by suicide when she was 29.
An extensive, completely free collection of articles on social skills and getting past social awkwardness. It’s written by someone who’s struggled socially himself, and who has degrees in psychology and counseling.
“I had absolutely no direction in my life. I was a loose cannon. An unguided projectile… I viewed life in a negative, nihilistic, cynical, and overall pessimistic way.”
By Kevin Mangelschots
Depression, also known by some as the silent killer. And for good reasons.
Little did I know I was going to find this out firsthand.
Early on in life, before the age of 16, everything was perfect. I had loving parents and, in general, a loving family. I had plenty of friends. I excelled in sports and did well in school.
Things were easy back then. The only ounce of responsibility I had was making sure I got passing grades. And what if I didn’t listen in school and got detention as a result? Well, he’s still a young kid who’s figuring out life. Got into a fight? Well, he’s still a young boy who doesn’t always thinks before he acts.
But my perfect world didn’t last.
My Experience with Depression
Around the age of sweet 16, my life started changing rapidly.
I stopped feeling happy and optimistic. At first, I thought it was just a phase everyone my age went through and that it would pass as quickly as it came. But it didn’t. I had a difficult time adjusting to my ever-changing environment and handling the pressure I believed was being put on me.
I didn’t know what I wanted for my future. My friends and schoolmates already knew what they were going to study when they went to college the next year. I, however, did not. I had no direction in life. I was a loose cannon, an unguided projectile, an immature and wild kid, busy with partying and drinking.
I started getting into frequent fights; I’m not a violent person, but the anxiety, negative emotions, feelings of helplessness, and an overall sense of feeling lost in this world led to physical confrontations with others. The fights were a reflection of my poor mental state.
Then I turned 18. My parents told me it was time to start taking responsibility for my choices and actions because this time “it was for real.”
In college, I decided to pursue the field of nutrition. Not because I had a strong desire to become a dietician, but rather, because people I knew from my home town were going this route, and I figured since I was interested in exercise/health, it might be a good fit.
Newsflash, it wasn’t.
I quit school two months in. Turns out choosing what course to study based on friends rather than what you want in life is not the smartest idea. (Who would’ve thought, right?)
The following year, I gave it another try. This time I studied occupational performance. Long story short, I managed to earn a college degree despite my depression.
After I graduated and started working as an occupational therapist in a physical rehabilitation center, things got better. I was motivated to help people relearn lost skills, improving their quality of life.
But in time, my thoughts turned dark again, becoming negative and nihilistic. I slept less and my sleep quality was poor. I would randomly wake up at night and cry because I felt so terrible. I withdrew from friends and family. I even discovered a way to measure the severity of my depression; when my mood worsened, I craved alcohol. Drinking was a way to self-medicate.
I continued to plow away at work, but an excessive sense of responsibility, perfectionism, and anxiety was eating away at my mental health. I was head deep into my depression.
One day, I woke up and found I couldn’t get out of bed. I had nothing left in the tank. I realized I needed to take some time off work to deal with my depression and get my life in order again. I called my parents and asked to come home.
At first, I didn’t leave the bedroom. There were successive days I didn’t get up to eat or shower. I was in constant mental pain. It was hell on earth.
One evening, I managed to get out of bed and sat down to eat dinner with my parents. They were silent, and looked tired and sad. Until this moment, my depressive haze prevented me from seeing how my illness impacted my family. I decided: that’s it, no more. It was my guilt that fueled the decision to fully contend with my mental illness.
Up until now, I was only living for myself, not participating and valuing what my parents, family, and others did for me. So, something needed to change. I needed to turn my life around. And with my life, my attitude.
I started seeing a psychologist and taking antidepressants. I took a sincere look at self, including undesirable traits I’d been afraid to face. I set goals for myself. And when I had zero desire to get out of bed, I pushed through. I made sure I did something useful every day.
After several months of therapy and medication, life became manageable. I talked more, was less irritable, and as a result, my life and that of those around me improved. At times I even looked forward to things!
How Depression Changed Me
Although the depression was tough on me, and there were times I didn’t know if I was going to make it, it brought about some positive changes.
I became more mature and resilient; I learned to put things in perspective and take necessary responsibility. But the two most significant aspects that changed were my so-called “intellectual arrogance” and the pessimistic way I viewed life.
Before, I considered myself a fairly intelligent fellow. The problem with this was that I overvalued intelligence, viewing other aspects in life as inferior.
Moreover, my attitude was overwhelmingly cynical and negative. What I failed to realize is that focus shapes experience. And if you only pay attention to the negative, you miss the beauty life has to offer. Now, I actively search for the good and beautiful things happening around me.
What Helped Me Get My Depression Under Control
In addition to medication and therapy, I found the following to be helpful:
☑ Seeking help. We can’t do everything on our own, no matter how much we’d like to. There are times when you will need help to cope with your depression. In addition to professional help, seek support from family and trusted friends. You may find that feeling heard and understood is what carries you through the darker days.
☑ Setting goals. I had no desire to do anything in life. I had no goals. For severe depression, I would advise setting smaller goals you think you would mind doing the least (minimal effort) and/or goals which you found important in the past (before your depression took over).
☑ Taking responsibility. Although depression can be debilitating, practice taking responsibility for the things in life under your control. For me, it was easy to blame others for everything that went wrong, believing the world to be wretched and unfair, but it didn’t do me any good.
☑ Exercising. Mental health and physical health go hand-in-hand. Exercise releases endorphins, the “feel good” brain chemicals related to pleasure. If you don’t enjoy exercise, try a hobby that requires some level of physical exertion. As an additional benefit, engaging in exercise can take your mind off the stressful things in life.
My Depression Warning Signs
For me, there are clear signs that indicate my depression is coming back or worsening. Keep in mind that warning signs vary from individual to individual. What might be a warning sign for me may not for you.
☑ My desire to do anything decreases. Hobbies I enjoy like weightlifting and running suddenly mean very little to me. But it’s not just about hobbies. Things like getting out of bed and showering suddenly become difficult because I have zero motivation or energy.
☑ My thoughts get darker and more negative. It becomes increasingly tough to see the positive things in life or the positive in people. I become cynical and pessimistic.
☑ Overthinking. I tend to overthink when things go bad, which is basically what depression is for me: feeling bad.
☑ Anxiety. Negative thoughts and overthinking lead to increased levels of anxiety. My anxiety about the little things in life may seem insignificant to others who don’t have a mental illness, but a simple act such as calling or visiting a friend can freak me out and lead to rumination.
☑ Ruminating. Intrusive thoughts run through my head and there’s no “off” switch.
☑ Irritability. I become increasingly irritable; I’m in a foul mood all of the time and the smallest things piss me off.
☑ Increased desire to self-medicate. I experience a strong desire to drink. Alcohol impacts the brain by triggering a release of dopamine. This rush of dopamine creates feelings of pleasure and happiness.
☑ Decreased sleep quality. My overall sleep quality gets worse, partly due to constant overthinking and ruminating. Anxiety and stress are also big factors. And when I’m able to fall asleep, I wake up throughout the night.
Depression is a terrible disease that may go unnoticed if the signs aren’t recognized or known. A person with depression might attempt to maintain a positive front, possibly because they don’t want to complain or they’re afraid of being misunderstood.
There are multiple symptoms of depression; my symptoms went hand-in-hand, playing off one another and creating a vicious circle of negative thoughts that sucked the energy and lust for life from me.
Depression symptoms are different for different people. Learning to identify the symptoms will help you to recognize depression in others. Furthermore, an increased awareness enhances empathy and enables you to better support someone with depression.
I give the following advice to anyone with depression:
☑ Don’t give up.
☑ Seek professional help.
☑ Seek support from your family and close friends.
☑ Set goals and work hard to achieve them.
☑ Take responsibility for the things you can control.
Is there a cure for depression? No. Do I think I will ever be totally depression-free? Maybe. What I do know for sure is that my illness is manageable and livable at the moment. I look forward to what the future has in store for me. Which is a lot more than I anticipated at first.
A resource list with links to useful sites, free assessment tools, low-cost trainings, printable PDF toolkits/guides, and more
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
This is a resource guide for suicide prevention and recovery. The guide includes links to educational sites, a list of free assessments, links to trainings, recommended books, helpline information, links to online support communities, recommended mobile apps, and more.
☑️ Lifetime – Suicide Attempt Self-Injury Count (L-SASI)InstructionsScoring | (Source: University of Washington Center for Behavioral Technology) The L-SASI is an interview to obtain a detailed lifetime history of non-suicidal self-injury and suicidal behavior. Citations: Linehan, M. M. &, Comtois, K. (1996). Lifetime Parasuicide History. University of Washington, Seattle, WA, Unpublished work.
☑️ Non-Suicidal Self-Injury Assessment Tool Brief Version | Full Version | Assessment tool created by Cornell Research Program on Self-Injury and Recovery
☑️ Suicidal Behaviors Questionnaire | SBQ with Variable Labels | SBQ Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SBQ is a self-report questionnaire designed to assess suicidal ideation, suicide expectancies, suicide threats and communications, and suicidal behavior. Citations: Addis, M. & Linehan, M. M. (1989). Predicting suicidal behavior: Psychometric properties of the Suicidal Behaviors Questionnaire. Poster presented at the Annual Meeting of the Association for the Advancement Behavior Therapy, Washington, D.C.
☑️ Suicide Attempt Self-Injury Interview (SASII)SASII Instructions For Published SASII | SASII Standard Short Form with Supplemental Questions | SASII Short Form with Variable Labels | SASII Scoring Syntax | Detailed Explanation of SPSS Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SASII (formerly the PHI) is an interview to collect details of the topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of non-suicidal self-injury and suicidal behavior during a target time period. Major SASII outcome variables are the frequency of self-injurious and suicidal behaviors, the medical risk of such behaviors, suicide intent, a risk/rescue score, instrumental intent, and impulsiveness. Citations: Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, Reliability, and Validity of a Scale to Assess Suicide Attempts and Intentional Self-Injury. Psychological Assessment, 18(3), 303-312.
☑️ University of WA Suicide Risk/Distress Assessment Protocol | (Source: University of Washington Center for Behavioral Technology) Reynolds, S. K., Lindenboim, N., Comtois, K. A., Murray, A., & Linehan, M. M. (2006). Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior. Suicide and Life-Threatening Behavior (36)1, 19-33. Linehan, M. M., Comtois, K. A., &, Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232.
A collection of recommended reading and other resources for grief and loss
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
This resource guide is for clinicians as well as for anyone who is grieving. This grief and loss guide includes a list of recommended books (for both adults and children); free printable PDF workbooks and handouts; and links to education and support sites.
Ambiguous Loss: Learning to Live with Unresolved Grief (2000) by Pauline Boss, Ph.D. (176 pages)
Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief (2017) by Joanne Cacciatore, Ph.D. (248 pages)
The Grief Club: The Secret to Getting Through All Kinds of Change (2006) by Melody Beattie (368 pages)
Grief Day by Day: Simple Practices and Daily Guidance for Living with Loss (2018) by Jan Warner (272 pages)
The Grief Recovery Handbook, 20th Anniversary Expanded Edition: The Action Program for Moving Beyond Death, Divorce, and Other Losses including Health, Career, and Faith (2009) by John W. James & Russell Friedman (240 pages)
Healing a Teen’s Grieving Heart: 100 Practical Ideas for Families, Friends and Caregivers (Healing a Grieving Heart Series) (2001) by Alan D. Wolfelt, Ph.D. (128 pages)
How to Survive the Loss of a Love (2006) by Melba Colgrove, Ph.D., Harold H. Bloomfield, MD, & Peter McWilliams (208 pages)
It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand (2017) by Megan Divine (280 pages)
I Wasn’t Ready to Say Goodbye: Surviving, Coping and Healing After the Sudden Death of a Loved One (2008) by Brook Noel & Pamela D. Blair, Ph.D. (292 pages)
No Time for Goodbyes: Coping with Sorrow, Anger, and Injustice After a Tragic Death, 7th ed. (2014) by Janice Harris Lord (240 pages)
Permission to Mourn: A New Way to Do Grief (2014) by Tom Zuba (121 pages)
Resilient Grieving: Finding Strength and Embracing Life After a Loss That Changes Everything (2017) by Lucy Hone, Ph.D. (256 pages)
Unattended Sorrow: Recovering from Loss and Reviving the Heart (2019) by Stephen Levine (240 pages)
When Things Fall Apart: Heart Advice for Difficult Times (2016) by Pema Chodron (176 pages)
The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief (2015) by Francis Weller (224 pages)
Recommended Books for Children & Adolescents
The Fall of Freddie the Leaf: A Story of Life for All Ages (1982) by Leo Buscaglia (32 pages, for ages 4-8)
Healing Your Grieving Heart for Kids: 100 Practical Ideas (Healing Your Grieving Heart Series) (2001) by Alan D. Wolfelt, Ph.D. (128 pages, for ages 12-14)
Healing Your Grieving Heart for Teens: 100 Practical Ideas (Healing Your Grieving Heart Series) (2001) by Alan D. Wolfelt, Ph.D. (128 pages, for ages 12-18)
The Invisible String (2018) by Patrice Karst (40 pages, for ages 4-8)
The Memory Box: A Book About Grief (2017) by Joanna Rowland (32 pages, for ages 4-8)
Tear Soup: A Recipe for Healing After Loss (2005) by Pat Schwiebert & Chuck DeKlyen (56 pages, for ages 8-12 years)
When Dinosaurs Die: A Guide to Understanding Death (Dino Tales: Life Guides for Families) (1998) by Laurie Krasny Brown (32 pages, for ages 4-8)
When Someone Very Special Dies: Children Can Learn to Cope with Grief (1996) by Marge Heegaard (32 pages, for ages 9-12)
When Something Terrible Happens: Children Can Learn to Cope with Grief (1992) by Marge Heegaard (32 pages, for ages 4-8)
Recommended Books for Clinicians
Creative Interventions for Bereaved Children (2006) by Liana Lowenstein (205 pages)
Grief Counseling and Grief Therapy, Fifth Edition: A Handbook for the Mental Health Practitioner (2018) by William Worden, Ph.D. (352 pages)
Grief Counseling Homework Planner (PracticePlanners) (2017) by Phil Rich (272 pages)
In the Presence of Grief: Helping Family Members Resolve Death, Dying, and Bereavement Issues (2003) by Dorothy S. Becvar (284 pages)
Transforming Grief & Loss Workbook: Activities, Exercises & Skills to Coach Your Client Through Life Transitions (2016) by Ligia Houben (264 pages)
Treating Traumatic Bereavement: A Practitioner’s Guide (2014) by Laurie Anne Pearlman, Ph.D., Camille B. Wortman, Ph.D., Catherine A. Feuer, Ph.D., Christine H. Farber, Ph.D., & Therese A. Rando, Ph.D. (358 pages)
A list of recommended reads, including workbooks and textbooks, for mental health professionals
Compiled by Cassie Jewell, M.Ed., LPC, LSATP
This is a recommended reading list for mental health clinicians. The first section includes recommendations for both professionals and consumers. The next section includes suggested workbooks for therapy and/or self-help. The “Textbooks” section is comprised of required reading that I found valuable as a counseling grad student. In the “PracticePlanners Series” section, I included the planners I’ve relied on the most. The last section includes additional reads that have been helpful to me in both my professional and personal life.
A resource guide for clinicians who facilitate counseling groups
By Cassie Jewell, M.Ed., LPC, LSATP
Throughout my counseling career, group therapy has been a focal part of what I do. I’ve worked mainly in residential settings where groups take place several times a day.
Initially, group counseling terrified me. (What if I can’t “control” the group? What if a member challenges me? What if I can’t think of anything to say? What if everyone gets up and leaves? – that actually happened, once – and on and on. What made group therapy especially intimidating was that if I “messed up,” an entire group of people [as opposed to one person] would witness my failure.)
I got over it, of course. Group facilitation wasn’t always comfortable and I made many (many!) mistakes, but I grew. I realized it’s okay to be both counselor and human; at times, humans say dumb stuff, hurt each other’s feelings, and don’t know the answer. By letting go of the need to be perfect, I became more effective. Group facilitation is now one of my favorite parts of the job.
This resource guide provides practical information and tools for group therapy for mental health practitioners.
Group Therapy Guidelines
Group therapy is an evidence-based treatment for substance use and mental disorders. An effective group calls for a skilled clinician to meet treatment standards. Professional associations, such as the American Group Psychotherapy Association, develop best practice guidelines based on scientific data and clinical research.
SAMHSA promotes research-based protocols and has published several group therapy guides for best practice, including TIP 41: Substance Abuse Treatment: Group Therapy, Substance Abuse Treatment: Group Therapy – Quick Guide for Clinicians, and Substance Abuse Treatment: Group Therapy Inservice Training (a training manual), in addition to group workbooks/facilitator guides for anger management, stimulant use disorder, and serious mental illness.
The book itself is small in size but packed with helpful information and creative ideas. As a new counselor lacking in clinical skills, I supplemented with activities to engage the clients. Group Exercises for Addiction Counseling never failed me.
A more recent discovery of mine. This guide provides detailed instructions accompanied by thought-provoking discussion questions for each intervention. I was impressed with both the quality and originality; an instant upgrade to “house-tree-person.”
You need only Google “icebreakers” and you’ll have a million to choose from. I’m not listing many, but they’re ones clients seem to enjoy the most.
Activity1. My most highly recommended icebreaker activity involves passing out blank slips of paper to each group member and instructing them to write a “fun fact” about themselves, something no one else in the group would know. I provide them with examples (i.e. “I once had a pet lamb named Bluebell” or “I won a hotdog eating contest when I was 11 and then threw up all over the judges’ shoes”). Depending on the crowd, you may want to tell clients not to write anything they wouldn’t want their peers to know. (I adopted this guideline after a client wrote about “sharting” himself.) Once everyone has written something, have them fold their papers and place in a container of some sort (a gift box, paper bag, plastic bowl, etc.) Group members take turns passing around the container (one-at-a-time) and picking a slip to read aloud. They must then guess who wrote it. (I give three guesses; after that, I turn it over to the group.)
Activity 2: A similar but more structured activity is to write out questions ahead of time and have clients take turns drawing and answering the questions. Questions can be silly, thought-provoking, or intending to illicit a strong emotional response (depending on the audience and goals for the group).
Activity 3: “People Search” involves a list of traits, feats, talents, or experiences. Each client receives the list and is given x amount of time to find someone in the group who is a match; that individual will then sign off. The first person to have their list completely signed sits down; they win. I typically let clients continue to collect signatures until two additional people sit down. (Prizes optional, but always appreciated.) During the debriefing, it’s fun to learn more (and thereby increase understanding and compassion).
Activity 4: “First Impressions” works best with group members who don’t know each other well. It’s important for group members to know each other’s names (or wear name tags). Each group member has a sheet of paper with various “impressions” (i.e. judgments/stereotypes). For example, items on the list might be “Looks like an addict” and “Looks intelligent.” Clients write other group members’ names for each impression. In addition to enhancing a sense of community, this activity provides an avenue for discussing harmful stereotypes and stigma.
Activity 5: Affirmations groups can be powerful, generating unity and kindness. The effect seems to be more pronounced in gender-specific groups. There are a variety of ways to facilitate an affirmations group, ranging from each person providing an affirmation to the client on their right to individuals sharing a self-affirmation with the group to creating a self-affirmation painting. Another idea is to give each client a sheet of paper. (Consider using quality, brightly-colored paper/posterboard and providing markers, gel pens, etc.) Clients write their name on it and then all the papers are passed around so each group member has the opportunity to write on everyone else’s sheet. Once their original paper is returned to them, they can read and share with the group. This can lead to a powerful discussion about image, reputation, feeling fake, etc. (Plus, clients get to keep the papers!)
Activity 6: “Most Likely to Relapse/Least Likely to Relapse” works best with a well-formed group and may require extra staff support. It’s good for larger groups and can be highly effective in a therapeutic community. Clients receive blank pieces of paper and are tasked to write the names of who they think is most likely and least likely to relapse. After writing their own name on the sheet, they turn it in to staff (effectively allowing staff to maintain a safe and productive environment). Staff then read each sheet aloud (without naming who wrote it). If they choose, clients can share what they wrote and provide additional feedback. (Most do.) Clients selected as “most likely” (in either category) have the opportunity to process with other group members and staff.
Access group therapy worksheets and handouts here.
In need of fresh material? It can be easy to fall into a rut, especially if you’re burnout or working with a particularly challenging group. The following three PDF downloads are lists of ideas for group topics. I also included two links to sites with helpful suggestions.
As a group facilitator, consider incorporating some sort of experiential activity, quiz, handout, game, etc. into every session. For example, start with a check-in, review a handout, facilitate a discussion, take a 5-minute bathroom break, facilitate a role-play, and then close the group by summarizing and providing clients with the opportunity to share what they learned. If that’s not feasible, provide coffee or snacks; sitting for 45 minutes is difficult for some, and 90 minutes can be unbearable.
Another idea is to have a “fun” or “free” group in the curriculum. Ideas include going bowling, having a potluck, Starbucks run, game group (i.e. Catchphrase, Pictionary, etc.), escape room, nature walk, etc.
Dealing With Challenges
Clients are not always willing therapy participants; some are court-ordered to attend or there to have privileges restored. Some attendees may be there “voluntarily,” but only to save their marriage or keep a job, not believing they need help. In residential treatment, clients attend mandatory groups as part of the daily schedule — participate or you’re out.
Even when attendance is truly voluntary, a group member may be in a bad space. Maybe they’re stressed about the rent or just got into a fight with their significant other. Or what if the AC is broken and the group room is 80 degrees? What if a client has unpleasant body odor or bad breath or an annoying cough?
Multiple factors combine and it’s suddenly a sh**show. (I’ll never forget the client who climbed onto a chair to “rally the troops” against my tyranny.) Anticipating challenges is the first step to effectively preventing and managing them.
Click here for an excellent article from Counseling Today that addresses the concept of client resistance.
Tips for dealing with challenges
If possible, co-facilitate. One clinician leads while the other observes. The observer remains attuned to the general “tone” of the group, i.e. facial expressions, body language, etc.
Review the expectations at the beginning of every group. Ask clients to share the guidelines with each other (instead of you telling them). This promotes a collaborative spirit.
After guidelines are reviewed, explain that while interrupting is discouraged, there may be times when you interject to maintain overall wellness and safety. (Knowing this, a client is less likely to get angry or feel disrespected when/if it happens.)
If you must interrupt, apologize, and explain the rationale.
Avoid power struggles at all costs, especially when a client challenges the benefits of treatment. (The unhealthier group members will quickly side with a challenger, leading to a complaint session.) Challenging the efficacy of treatment (or you as a clinician) is often a defense mechanism. Sometimes, the best response is simply “okay,” or none at all… and keep moving. You can also acknowledge the client’s perspective and ask to meet with them after group (and then get back on topic). If the group is relatively healthy, you may want to illicit feedback from other group members.
If a client becomes angry or tearful, give them time to vent for a moment or two (don’t “Band-Aid”); they may be able to self-regulate. (If they do self-regulate, share your observations and offer praise.)
If a client’s anger escalates to a disruptive level, ask them to take a break. At this point, their behavior is potentially triggering to other group members. Don’t raise your voice or ask them to calm down. Direct them step out and return when they’re ready. You may have to repeat yourself several times, but remain firm and calm, and they will eventually listen.
If a client is disrespectful (cursing at you or another client, name-calling, insulting, etc.) while escalated, let them know it’s not okay, but don’t attempt to provide feedback. (A simple, “Hey, that’s not okay,” will suffice.) Bring it up with the client later when they’re able to process.
Once the client who has been disrespectful leaves the room, acknowledge what happened and let the group know you will follow up with the client. If another client wants to talk about it, ask them to share only how it made them feel, but stress that it’s not okay to talk about an absent group member. (“How would you feel if we talked about you when you weren’t here?”) Strongly suggest that they wait until the person returns (and is open) to have a group discussion.
After a major blow-up (and once everyone is calm), it can be beneficial for the group to process it with the person who escalated. Group members can empathize/relate, share their observations and/or how it made them feel, and offer feedback.
If other disruptive behaviors occur in group (side conversations, snoring, etc.) address them in the moment (without shaming, of course). Point out the behavior and explain how it’s disruptive to the group. Refer back to the group guidelines. Ask group members to comment as well. If you let a behavior persist, hoping it will eventually stop, you’re sending the message that it’s okay, not only to the person who is disruptive, but to the entire group. This impacts the integrity of the group and opens things up for additional disruptive behaviors.
For clients who monopolize, who are constantly joking, or who attempt to intentionally distract by changing the topic, point out your observations and encourage group members to give feedback.
If, on the other hand, clients seem disengaged or unmotivated, seek out their feedback, privately or in the group, whichever is clinically appropriate.
If there’s a general level of disengagement, bring it up in the group. Remain objective and state your observations.
Anticipate that at times, people may not have much to say. (And while yes, there’s always something to talk about, that doesn’t mean someone is ready to or has the emotional energy to.) Maybe they’re distracted or tired or feeling “talked out.” It’s good to have backup plans: watch a psychoeducational film, take a walk in the park, listen to meditations or music, provide worksheets, education reading material, or coloring sheets.
Always keep in mind a client’s stage of change, their internal experiences (i.e. hearing voices, social anxiety, paranoia, physical pain, etc.), external circumstances (i.e. recent medication change, loss of housing, conflict with roommates, etc.), and history of trauma. What looks like resistance may be something else entirely.
✅ Adverse Outcomes in Group Psychotherapy | Roback, H. B. (2000). Adverse outcomes in group psychotherapy: Risk factors, prevention, and research directions. The Journal of Psychotherapy Practice and Research, 9(3), 113–122.
✅ Differences that Make a Difference | Change-Caffaro, S., & Caffaro, J. (2018). Differences that make a difference: Diversity and the process group leader. International Journal of Group Psychotherapy, 00: 1-15.
✅ Group Interventions| Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(Suppl 4), S514–S521.
✅ Group Therapy for Substance Use Disorders | Wendt, D. C., & Gone, J. P. (2017). Group therapy for substance use disorders: A survey of clinician practices. Journal of Groups in Addiction & Recovery, 12(4), 243–259.
✅ All About Group and Team Facilitation | (Source: The Free Management Library) This site provides free resources for managers, entrepreneurs, and leaders; much of the content on facilitation and teams is applicable to group facilitation
(Updated 5/20/20) A list of movies about mental health and substance abuse – includes PDF printable discussion questions
By Cassie Jewell, M.Ed., LPC, LSATP
Movies About Addiction & Mental Illness
The following is a list of films about substance use and mental disorders that are appropriate to show in treatment settings. This post includes movie summaries and downloadable PDF handouts with questions for discussion. Please note that some of the films on this list are graphic and may not be appropriate for children or adolescents.
Hint: The handouts contain spoilers; do not provide until after the movie ends.
103 minutes (1 hour, 43 minutes), R-rating for language and drug use
Summary: Julia Roberts plays a mother, Holly, whose 19-year old son, Ben, surprises her by returning home for Christmas. Ben is newly in recovery; his addiction has placed a tremendous strain on the family in the past. Ben’s younger siblings are happy to see him, but Holly, fearing that he is not ready, is apprehensive. That evening, the family attends church. When they return, they find their home burglarized and the dog missing. Ben blames himself, believing someone from his past took the dog to get his attention; he leaves to look for the dog. Holly goes with him, but they’re later separated, and Holly attempts to track Ben. Eventually, she ends up at an abandoned barn where she finds her son on the floor, unresponsive. The movie ends with her administering Narcan to Ben.
127 minutes (2 hours, 7 minutes), R-rating for strong language and content relating to drugs, sexuality, and suicide
Summary: Winona Ryder plays Susanna, a young woman with borderline personality disorder, who is sent to a psychiatric hospital after a suicide attempt in the late 1960s. She befriends Lisa (Angelia Jolie), who carries a diagnosis of sociopathy (antisocial personality disorder). Initially, Susanna is in denial about her mental condition and is not open to treatment. However, she reaches a turning point after a tragedy.
123 minutes (2 hours, 3 minutes), PG-13 rating for mature thematic elements including substance abuse/recovery, some sexual situations, language, and brief violence
Summary: Trevor (Haley Joel Osment) starts a chain reaction of goodness for a social studies project with a plan to change the world for the better. In this film, Trevor is a high school student whose mother, Arlene (Helen Hunt), struggles with alcoholism and whose father is abusive. He rises above unfortunate circumstances with the kindhearted idea to do a good deed, but instead of requesting payback, asking the receiver to “pay it forward” to at least three people – and on and on. While the movie has a bittersweet end, the message is uplifting and powerful.
Summary: Charlie is an unpopular high school freshman, a “wallflower,” who is befriended by two seniors, Patrick and Sam (Emma Watson). The movie is about their friendship and Charlie’s personal struggles with the recent suicide of his friend and his own mental illness. Throughout the film, Charlie has flashbacks of his aunt, who died in a car accident when he was 7. It’s eventually revealed that Charlie’s aunt molested him; a sexual encounter with Sam triggers Charlie’s repressed memories. Charlie has a mental breakdown.
Other great resources for using clinical films as therapeutic interventions include the book Movies & Mental Illness: Using Films to Understand Psychopathy, 4th ed. (by Danny Wedding and Ryan M. Niemiec) and the site Teach With Movies.