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Sex and Drugs, No Rock and Roll: Straight Talk in Group Therapy

11/25/2015 04:18pm ET | Updated November 23, 2016
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Naming the dangerous, irresponsible, and sometimes illegal activities people use to cope when they're distressed is important during group therapy. Sure as Meryl Streep will receive another Oscar nomination, group members will have indulged in at least one of these activities. Most people have. More than once, I gorged on a full pint of Ben and Jerry's, the prototypical embodiment of poor coping. It worked! I felt better. As I explain to my patients, these coping mechanisms all work. That's why, despite their downsides, we turn to them when we feel bad. In the group, I hold up my hands, spread my fingers as if I'm about to glove up for surgery, and count off the bad things: overindulgence in alcohol, drug abuse, excessive gambling, overspending, overeating, and compulsive sex. Occasionally someone will ask me to clarify the last item. "Picking up prostitutes in Tijuana," I respond. We live near the border. Everyone knows the kind of hoopla that takes place there. Quite commonly in the past, these patients, while blotto drunk, have punched someone or something and then verbalized, texted, or Facebook-messaged that they don't want to live anymore, causing great alarm. They understand my explanation.

All the bad things, clinically referred to as maladaptive coping strategies, change brain chemistry, and most will set off a cascade of happy hormones: dopamine, serotonin, or norepinephrine. But they're ill advised, they may contribute to addiction, and some are potentially lethal. Group members always seem surprised that I name the bad things, as if I've used a string of invectives. They're accustomed to hiding or lying about these behaviors. Acknowledging their existence defuses their power as well my patients' shame. Initially, the group members appear shocked, but then I see relief on their faces. They know they aren't alone. This is a potent therapeutic intervention.

If the maladaptive behaviors are paused long enough, brain chemistry returns to baseline. And there the underlying problems wait, like the most loyal hound. They don't go away -- they just nap by the front door. Instead of avoiding their feelings, I encourage patients to address their issues and use healthful coping tools as they struggle for emotional stability. Almost all people, by the time they're in their early twenties, have a small tool kit of harmless actions that will make them feel better. When distressed, however, it's hard to remember them. During those times, brains flood with stress hormones -- cortisol or adrenaline -- making it challenging to think straight. It's much easier to grab the supersized big Mac, or head to the casino for hours of booze and gambling. It's harder to remember that a good workout might have the same effect, minus the overdrawn bank account, hangover, and possible new sexually transmitted disease.

Reminding group members that they know how to take care of themselves is empowering. I ask them to write down their healthful coping activities; explaining this reinforces the information neurologically. With a small amount of encouragement from each other or me, they usually produce a short list of calming, soothing actions that are safe. Sometimes they have creative ideas, like outdoor "exploring." Other coping tools are often basic, things that require focus and provide instant gratification, like fixing machines or house cleaning. When cleaning is mentioned, I support the idea by quoting Amy Winehouse: "I stay up, clean the house. At least I'm not drinking." Amy serves as a strong example of the worst outcome if patients don't learn to utilize safe coping tools consistently. I urge group members to carry their lists with them or post them in their homes if they're comfortable doing so.

I've run this group twice a week for almost two years. As a therapist, there's nothing better than knowing I've helped a patient. Once after a session, a member took me aside and, in a small voice, confided, "I didn't want to come to this group, but it was nice."

Language has power. In group therapy, straight talk -- about compulsive sex, illegal drug use, and other maladaptive behaviors -- heals.