Purpose & Goal
The purpose of therapy with any client, yet in particular the women at Angela House, is to engage them in a process that allows them to tap into experiences, feelings and thoughts that they have avoided all of their lives through the use of drugs, alcohol, prostitution, shoplifting and any other compulsive behavior. These compulsive behaviors, also known as acting out behaviors, have ruled their lives.
The goal of therapy is to become more in touch with the feelings that drive
these behaviors and to learn slowly how to tolerate these feelings with less acting out behaviors. The basis of this is acknowledging feelings that have been cut off from the client in order to survive in their environment.
The psychotherapy offered to the women at Angela House is just the beginning of therapy for the women we see. Yet in all likelihood for the majority they will not continue even though it would be beneficial. The majority (99.9%) of the women come to us with major trauma issues in their lives and short-term therapy is not realistic for them. However, we provide many avenues for the women to learn to begin to trust, identify and talk about feelings and learn how to care for their psychological/emotional well being in addition to their physical well being in new, different and healthier ways.
Individual Therapy- “Recognizing and Changing Patterns of Behaviors”
Therapy is like balancing a tight rope act. There is the introduction (naming) of feelings that must be done slowly so as not to overwhelm the client and push them out the door. Tolerating these long lost feelings involves teaching and exposing clients to venues that allow them to express these feelings in a safe place where they will not be judged for their feelings yet can be exposed to new ways of handling the feelings and thoughts. There are no great tricks for this except to accept the client where they are at without judging them. This takes a great deal of trust on the part of the women to allow themselves to reveal these feelings to themselves much less a stranger (psychotherapist, Ms. Brown, Sister Maureen, house managers, or people in recovery meetings). This is a slow process with many bumps in the road. Encouraging and teaching the residents how to build a support network is an essential element of their work at Angela House. Many clients believe that therapy has no purpose in their lives. They are over the past and don’t want to look back. However, therapy doesn’t have to focus strictly on the past because their most recent relationships and behaviors will reveal life long patterns that have dominated their lives and are recapitulations of early more influential relationships. Individual therapy is a place to start the process of accepting cut off parts (feelings, thoughts and experiences of themselves. Tolerating these feelings, thoughts and experiences and recognizing patterns of behavior and changing these patterns as needed are the primary goals of therapy whether in individual or group psychotherapy.
Group Psychotherapy – “Building trust in Oneself and Others”
Group psychotherapy or process group is a whole different experience for clients and much more threatening to each woman at Angela House. Again, this is a big step up in trust to discuss/air your dirty laundry/be vulnerable in a group setting. The goal of group therapy is to help the women at Angela House learn to trust themselves and others, and to learn how to handle conflict more appropriately. I initially added the process group to the individual psychotherapy because I felt the need to be connected to all the women in a different setting. Instead of hearing about problems/conflicts in one-one therapy, where it is easier (though not easy) to talk about, I encourage women to deal with the conflict more directly in group and hopefully it can be a safe place to do that. Usually there is coaching that goes on in one-on-one therapy to aid the client in the group setting. And when in group psychotherapy, how one handles themselves and hears, defends and reacts to others is usually an indicator of how they handle trust, confrontation, anger and fear in the “real” world.
Irvin Yalom (leading authority on group psychotherapy) refers to this as the group becoming a microcosm of the client’s outside world experiences. And group can hopefully provide a corrective experience to that of the primary family group. And there is a process to the group where clients have to build trust in others before they truly engage. And most of the women at Angela House trust other women only as far as they can throw them. Confronting someone gets caught up in the prison mentality of not snitching on anyone ever. Revealing other’s secrets even if they are deadly to that person is a difficult barrier to overcome for the women. The goals of group psychotherapy are to build trust in oneself and others, learn that you aren’t alone in your feelings/thoughts (universality), build another source of support, learn more effective social/interpersonal skills and to build hope.
Shame Resilience Group – “Relapse Prevention 101”
I introduced the Shame Resilience Group after attending a 2-day workshop presented by Brene Brown, PhD who is recognized as a Shame researcher and the writer of the book and curriculum upon which the course/group is based. This group, unlike process group, is usually felt to be a safer group since it is largely educational although very therapeutic for the women. So this group provides information in a format that is more accessible for most of the women. Also, this course is typically taught in 12 weeks and therefore has an end to it. The goal of the shame resilience group is to teach the women how to recognize shame, learn to talk about it and lessen the chances of acting out when experiencing shame. This is called developing shame resilience according to Brene Brown. And I can also introduce other basic emotions that we act out and relapse over. I will use any opportunity to discuss directly in a non-threatening mode the need to recognize feelings and to handle them in a more positive/healthy manner. This is relapse prevention 101.
Identifying feelings and triggers (areas of vulnerability) is one of the primary steps of relapse prevention. Although the Shame Group is less threatening it still involves trust to talk and reveal oneself in the group. It also emphasizes the need to build a support network that is non-judgmental and accepting. And that cannot be emphasized too often.
To reiterate, the process is a delicate balancing act in which we must introduce new information, emotions, and memories, and confront enough but not push so hard that the women flee from too much reality/emotional discomfort. For women who are open to it, I offer to see them after they leave Angela House. Many do take advantage of this therapy even if it’s only on a crisis basis. But that indicates to me that we have accomplished some of our goals, if they can call us when they are in trouble before heading down the same road again.
– Teresa Doyle, M.A., L.P.C., L.M.F.T., L.C.D.C.