Clinical Programming

KLEAN’s clinical program has been developed based on substantial research conducted on the effects of developmental or complex trauma and subsequently comparing the efficacy of various treatment approaches.

The research illustrates a correlation between the experience of such trauma and the development of highly maladaptive coping patterns (e.g., addictions, compulsive behaviors) and impaired functioning (e.g., impulse control and modulation of emotional states, sustaining interpersonal relationships), as well as difficulties with legal, educational, and social functioning.

The most recent research supports the assertion that memories of trauma and related feelings are stored in the body, typically outside of conscious awareness. Van der Kolk, a clinician, researcher and teacher in the area of posttraumatic stress and related phenomena since the 1970s, concluded that therapists treating psychological trauma need to work with the body as well as the mind, and stated, “The memory of the trauma is imprinted on the human organism” (2007).

This data, led to the inclusion of more holistic approaches (i.e. accessing and integrating mind, body, and spirit) within KLEAN’s clinical programming, in addition to more traditional or mainstream therapies such as ‘talk therapies’ and medications.

The objective of the clinical work holds strong implications for treatment, and allows for the integration necessary for improved emotional regulation, healthier attachments and mastery with executive functioning, with the ultimate goal as sustained sobriety.

Process Group

Group Description: Co-facilitated, this is a process group focusing on individual’s interpersonal/personal issues, which aims to provide a corrective emotional experience. The group members are collectively encouraged to allow their adult thoughts and feelings to modify their earlier traumatic experiences.

Clinical Objective: No one, no matter how well educated or skilled, has a talent for or knows everything, with two facilitators, working as a team, this provides more resources to pick up on individual’s non verbal communication, metacommunication and help gauge participants’ reactions and notice whether people seem to tracking with the process. According to the International Institute for Facilitation and Change, “Collaboration between facilitators of different gender, ethnicity, nationality, age, etc. sends a positive message about the value of diversity in leadership and brings a broader perspective to the group’s process” (Briggs, 2012).

Psycho education- Addiction and the Brain

Group Description: A lecture on the neuroscience of mental health while additionally, providing an arena for clients to process how their addiction affected their interpersonal relationships.

Clinical Objective: Addictions are like parasites that sneak into the most powerful circuits in the brain- those that govern our basic survival instincts- and, by hijacking those circuits and manipulating their core biochemistry, profoundly influence our thoughts and behaviors. This group helps individuals gain a deeper understanding of how “addiction” affects the brain and when provided with this knowledge, one can learn tools for rewiring such unconscious brain activity (Montgomery & Ritchey, 2010).

Reintegration

Group Description: A psycho educational and interactive group, facilitated by a dynamic therapist whom engages all participants in thought-provoking content and personal experience.

Clinical Objective: Implementing an evidence-based Cognitive Behavioral Therapy theoretical framework, (Butler, Chapman, Forman & Beck, 2006 as cited in Gregory, 2008, p. 2) clients learn to identify how coping strategies are connected to core beliefs and how to manage factors that can often trigger relapse. These factors include cognitions, feelings, behaviors and physical reactions.

Women: Sex, Love and Relationships

Group Description: Facilitator brings in readings from well-renowned authors around sex; love and relationships and group members discuss their reaction to subject matter.

Clinical Objective: Research suggests that addicted women are also more likely than addicted men to be in relationships with drug-abusing partners or spouses (Bloom and Covington, 1998; Bride, 2001; Kauffman et al, 1997; Manhal-Baugus, 1998; Nelson-Zlupko et al, 1995; US Dept. of Health and Human Services, 2003) and to identify relationship problems as a cause for their substance abuse (Kauffman et al, 1997). As explained by Dr. Montgomery and Ritchey, “dysfunctional relationships ‘dramas’ are an extremely important and widespread manifestation of emotional addiction” (p. 88). The authors further outline that individuals who are consistently abused are almost always attracted at some level to abusive men, and almost always repeatedly place themselves in situations that can lead to their being abused. This is a result of unconscious addictive dynamics (2010). By processing these findings and gaining awareness of our unconscious desires clients are able to begin creating new healthy intuitive behaviors.

Men’s Issues

Group Description: Facilitator brings in topics around common male issues, male characteristics and relationships. Group members discuss their reaction to subject matter.

Clinical Objective: According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2003), current research indicates that pathways to substance abuse are different for men than women, and therefore, must be treated uniquely. According to SAMHSA, (2003), such differences, impact men’s decision to seek treatment, remain in treatment and achieve successful outcomes.

Regrettably, researchers found some discrimination was evidenced in mixed groups, as male clients tend to yield to interruptions from other men but not from women in the group. . Additional research indicates that in co-ed groups, male group leaders receive greater positive responses from participants for their suggestions than female leaders (Hodgins et al, 1997).

Community Group

Group Description: Facilitator meets with the community as a whole to review the week and provide a safe space. The objective of the group is to ensure all clients’ needs are being met, as well as further develop group cohesion.

Clinical Objective: In order for clients to build rapport among each other, group cohesion is essential. By providing a democratic group, the facilitator is able to focus on members’ establishing trust and feeling empowered. According to Crowe and Grenyer, (2008), perceptions of levels of conflict and group members’ ability to work actively and purposefully in treatment did predict outcome.

Coping Skills

Group Description: Coping skills are those skills that we use to help us get through difficult situations in life. Coping skills can be positive or negative. Substance abuse is a negative coping skill that provides short-term relief or distraction to individuals struggling with addiction. Participants in this interactive group learn healthy, positive, coping skills for dealing with their issues.

Clinical Objective: This group challenges the common assertion that problem behaviors and emotions are beyond our control and gives individuals the tools to regulate them. Participants in this group role-play to recreate real-life situations that lead to problematic behavior. The problematic behavior is assessed and targeted through identifying its antecedents and consequences by analyzing the chain of events, both internal and external, the culminated in the problem behavior. Controlling variables in the behavioral chain analysis are identified – such as the precipitant, vulnerability factors, cognitions, and emotions as well as the negative consequences for oneself and the environment. Participants help generate a list of options for taking care of their identified needs. Alternative coping strategies are proposed for key problematic links in the chain, and alternative outcomes are imagined.

Relationship with Self

Group Description: Merriam – Webster ‘s dictionary defines “self” as, “the union of elements (as body, emotions, thoughts, and sensations) that constitute the individuality and identity of a person”. Successful interpersonal relationships are contingent upon one’s ability to relate to himself or herself. A person’s struggles to relate to the external world and those within it, is typically a bi-product of one’s disconnection with his or her own internal world. This group provides the space for clients to begin connecting within themselves and also among themselves. This group combines psycho-education with practical application allowing clients to explore who they are and even who they are not.

Mindfulness & Meditation

Group Description: This group is an innovative relapse prevention program that integrates mindfulness practices with evidence-based cognitive and behavioral strategies. Participants gain awareness of their own inner experiences, step out of habitual patterns of thought and behavior that can trigger relapse, and acquire concrete skills to meet the day-to-day challenges of recovery.

Clinical Objective: The practice of intentional, nonjudgmental awareness of moment-to-moment experience has been practiced since ancient times. For thousands of years, wisdom traditions have recommended mindful awareness practices in a variety of forms to cultivate well-being. According to Dan Siegel, mindfulness expert, “science is now confirming these benefits” (2010, p. 66). Siegel continues to explain that, “the ways we intentionally shape our attention in mindfulness practice induce long-term changes in brain function and structure. This is the principle of neuroplasticity- how the brain changes in response to repeated experience” (2010, p. 68).

Psychodrama

Group Description: Participants explore internal conflicts by acting out their emotions and interpersonal interactions in the safety of a contained group. The group utilizes improvisation, spontaneous dramatization, role-playing and dramatic self-presentation for clients to investigate and gain insight into their lives and primary relationships.

Clinical Objective: In early recovery from addiction, addicts may not benefit from revisiting painful, historical material that can trigger relapse, however once stabilized; avoiding painful material can actually undermine the recovering person’s ability to develop a sense of self, which can also lead to a relapse or a less-satisfying life and relationship. As outlined by Dayton, “psychodrama, with its unique ability to concretize virtually any moment along the developmental continuum of a client’s life, offers a unique approach to working with the mental, emotional, and behavioral aspects of loss. Psychodrama allows for a therapeutic intervention that involves and engages the full psychological, emotional, and sensorial person in his or her appropriate relational world or social atom” (2005, p. 16).

Process Group

Group Description:  A process group looking at individual’s interpersonal/personal issues which aims to provide a corrective emotional experience, in which group members are collectively encouraged to allow their adult thoughts and feelings to modify their earlier traumatic experiences.

Clinical Objective: A psychodynamic oriented process group expected to increase emotional awareness and relational understanding between self and others. The group as a whole shapes its own unique culture, common values and norms thus, creating a meaningful context upon which it can evolve and grow at its own pace. The life of this group parallels different developmental stages of growth and maturity. The group inherently knits together with an abundance of experiences forming and emulating a social microcosm that bears its own unique culture and identity (Yalom, 1995). A natural phenomenon that unfolds is the way individuals, and sub-groups alike repeat the many characteristic ways once developed to survive the stressors and strains in family systems. Members may remind each other of significant others in they’re past or present, which consequently surfaces feelings, thoughts and ideas.

Distorted Perceptions

Group Description: This interpersonal process group is designed for the younger population within. In this smaller, more intimate group, participants are provided a safe space to discuss and process issues relevant to their lifecycle phase.

Clinical Objective: This group challenges long-standing perceptions that a younger population has about their addictions. Individuals struggling with addiction often believe they are unworthy of love and/or success and that the substance is their greatest need. These beliefs often lead to feelings of ambivalence about beginning the long road of sobriety. Often this results in justifying substance abuse, rationalizing behaviors, minimizing the severity of addictions, and externalizing the cause. These distorted perceptions allow negative thinking to continue and consequently, destructive behaviors remain unchanged. It follows that thinking must change in order for behavior to change. Participants in this group will identify ways to change their thinking to foster positive, healthy behavior.

Goals

Group Description: is a goal-directed interactive psychotherapy group. The focus of this group is to establish measureable goals that generate solutions to psychosocial stressors. Family roles are also examined in an effort to explore the systems that perpetuate the cycle of substance abuse and maladaptive relationships. Group members are encouraged to actively participate and respond to peers and therapist in an effort to build insight and awareness around personal goals.

Clinical Objective: Goals are one of the most fundamental elements of substance abuse treatment. Prior studies have identified three successful approaches including a three-stage process: effective planning, doing and accountability (Henshaw, 2012). The first part of the process assists a person in getting clear about what they truly want in life, about that which will assist them in being authentically happy. The second part is about discovering and becoming clear as to what the individual has to do repeatedly to achieve what they want. And the last component is about gaining assistance in this creative process, assistance that will help to ensure the person’s eventual success. In addition, what makes this process especially powerful is that the individual also has the opportunity to confront and work through that which has been truly stopping them in life and that will attempt to stop them again in completing this exercise.

Psychodrama Process

Group Description: Participants are provided the opportunity to process the interactions they acted out the day prior in psychodrama. The goal is for clients to further investigate and gain insight into their own psychodrama and internal experience.

Clinical Objective: In early recovery from addiction, addicts may not benefit from revisiting painful, historical material that can trigger relapse, however once stabilized; avoiding painful material can actually undermine the recovering person’s ability to develop a sense of self, which can also lead to a relapse or a less-satisfying life and relationship. As outlined by Dayton, “psychodrama, with its unique ability to concretize virtually any moment along the developmental continuum of a client’s life, offers a unique approach to working with the mental, emotional, and behavioral aspects of loss. Psychodrama allows for a therapeutic intervention that involves and engages the full psychological, emotional, and sensorial person in his or her appropriate relational world or social atom” (2005, p. 16).

Guided Imagery

Group Description: Tapping into the heart’s wisdom through guided imagery and visualization is an ancient practice that has been used as a healing tool in most of the world’s cultures and is an integral part of many religions. Everything we do is processed through the mind with images, including smells, sounds, tastes, and visual images. Imagery is a way that the mind speaks to the body. Guided imagery is a useful tool for helping treat those with substance abuse because it works to eliminate known triggers to drug or alcohol use by allowing participants to engage in exercises that will calm the mind. Group members learn how to properly relax the body and muscles through a natural, alternative method instead of turning to substances for relief.

Clinical Objective: The goal of this group is for clients to effectively cope with stress and triggers, which are both huge risk factors in sobriety. Kaufman confirms, “at its best, guided visual imagery may promote a literal healing in the best sense of the word. It can be an effective technique for the treatment of chronic stress” (Kaufman, pp. 196-197). Moreover, explains Kaufman, the stress response is fundamentally mediated by the sympathetic nervous system whose primary function is to arouse individuals to action. While highly adaptive in the short term, long-term sympathetic arousal has many negative effects on the mind-body. Thus, the treatment of stress must involve a reduction in sympathetic activity if individuals are to return to healthier states of functioning. Such treatment exists in the form of mind-body relaxation responses.

Yoga in Recovery

Group Description: Hatha Yoga uses postures (asanas) and stretches in combination with the breath to develop flexibility and relaxation. There are many styles of Hatha Yoga. All styles of Hatha Yoga, however, encourage proper alignment of the body and bring balance, strength, and calmness to the practitioner. Our Hatha Yoga classes are based on the classic and ancient practices with attention to alignment and the deeper layers of yoga. This class is designed for students to learn correct alignment and breathing in basic yoga postures, ideal for individuals who are interested in practicing mindfulness. Regular practice relieves stress, improves mood, and deepens appreciation for all aspects of life by bringing health to the body and peace to the mind.

Clinical Objective: Van der Kolk , a well renowned psychiatrist noted for his research in the area of post-traumatic stress since the 1970s first became interested in yoga several years ago, after he concluded that therapists treating psychological trauma need to work with the body as well as the mind. “The memory of the trauma is imprinted on the human organism,” (Van der Kolk). “I don’t think you can overcome it unless you learn to have a friendly relationship with your body.” Similarly, addiction specialists in private practice, rehabilitation programs, and 12-step recovery programs are starting to recognize that the mind-body-spirit approach of yoga is a great adjunct therapy to conventional treatments for drug, alcohol, and food abuse as well as addictive behaviors like gambling and shopping. “Yoga treats the biology and the psychology of an addict,” explains New York City addiction psychotherapist Mary Margaret Frederick, Ph.D. “Addicts are profoundly out of control internally. They have knee-jerk panic reactions and tempers. The will and determination yoga requires helps people regain control over their body and their mind.”

Grief and Loss

Group Description: LaVona Traywick explains, “There are no simple answers to complex issues. Everyone grieves differently…There is no “right” way to grieve (2007). This Grief and Loss group is designed to create a safe and sacred place to both grieve and honor the lost but not forgotten. This group does not discriminate with respect to type of loss one is grieving. Some come to this group to mourn the loss of a family member, a friend, a part of themselves, a lifestyle they used to lead, and/or substances they are leaving behind. Alternatively, some come away from the group with a sense of having honored that which they lost.

Clinical Objective: Grief is a natural process to death and dying.  It is not pathological in nature, but rather, is a necessary response to helping heal from the overwhelming sense of loss when a loved one dies.The loss of a loved one, either due to death, relationship breakup or divorce elicits similar feelings irrespective of the cause of the loss. This group focuses around how to approach grief, in its many forms, and introduces the five stages of loss created by Elisabeth Kbler-Ross (2012). The 5 stages of loss are referred to by its acronym DABDA (denial, anger, bargaining, depression, acceptance) based on the sequence of emotions experienced during grief.