Songs in Group Psychotherapy for Chemical Dependence [1 ed.] 9781937440084, 9781937440077

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Songs in Group Psychotherapy for Chemical Dependence Alan D. Reitman

Songs in Group Psychotherapy for Chemical Dependence © 2011 by Barcelona Publishers All rights reserved. No part of this book may be reproduced in any form whatsoever without prior written permission from Barcelona Publishers. ISBN: 978-1-937440-07-7 EISBN: 978-1-937440-08-4 Distributed throughout the world by:

Barcelona Publishers

4 White Brook Road Gilsum NH 03448 Tel: 603-357-0236 Fax: 603-357-2073 Website: www.barcelonapublishers.com SAN 298-6299 Cover design: © 2011 Frank McShane

Dedication To my children Samuel Louis and Lauren Renee Reitman Sammy, you never cease to amaze me with your many gifts and talents. You succeed and exceed at everything you put your mind and heart to including baseball, basketball, roller skating, jump rope, music, fishing, swimming, and academics. I am so proud and happy to be your father. Lauren, you fill my heart with joy and laughter with your never ending singing of original songs, dancing, drawings, playing, funny faces and thoughtful questions. You will always be my "honey bunny monkey of love". I love you both with all my heart. You are the reason for my life.

Biography Alan D. Reitman Ph.D., LMHC, MT-BC graduated Temple University with a double degree in Music Education and Music Therapy with a piano concentration in 1983, a double Masters in the same fields in 1988, and a Ph.D. in Psychoeducational Processes and Music Therapy in 1997. He has worked with a variety of populations over the course of his 28 years as a music therapist, predominantly adolescents and adults with chemical dependence and emotional disturbance, as well as musicians with performance anxiety. Dr. Reitman has worked within several in and out-patient rehabilitation centers for chemical dependency, including Huntington Hospital (Pennsylvania), The Institute of Pennsylvania Hospital, Belmont Hospital (Pennsylvania), Atlantic Shores Hospital (Florida) and Inspirations for Youth and Families (Florida). Within these settings, as well as others, Dr. Reitman has developed several models of music therapy, including group music therapy approaches for clients in short term addiction settings, Music Video Group (a creative art therapy approach for at-risk adolescents), and a music-facilitated treatment for music and other types of performance anxiety. Dr. Reitman served on the editorial board of Music Therapy Perspectives, a quarterly journal published by the American Music Therapy Association from 1999–2005, He has presented at regional, national, and international conferences and served two terms as the President of the Florida Association for Music Therapy. Dr. Reitman served as Assistant Professor at the University of Miami for six years and currently works in private practice in Hollywood Florida.

Acknowledgements I would like to acknowledge the people who have collectively supported my efforts in creating this manual. As there are many types of support, there are many to thank. These include: Michelle Hintz-Reitman for her unwavering support both personally and professionally. My brother David for "having my back" when I needed him most. Dr. Kenneth Bruscia has been a lifelong mentor, inspiration, and dear friend. His incredible intellect and creative vision related to the applications of music in a myriad of therapy settings has had a profound impact on my professional career and life. His ongoing encouragement and support of my efforts have been invaluable beyond words. My music therapist friends and colleagues have inspired and supported my efforts in myriad ways. I would particularly like to thank Brad and Margene Biedermann and Cynthia Heller. Norman Council, Wendy Bukowski, and Robert Carter, Jr., colleagues and mentors at the Institute of Pennsylvania Hospital, have inspired a love of working with adolescents who were chemically dependent and emotionally disturbed in an active, effective, and spiritually moving manner that continues to influence my work and life. Mentor and substance abuse counselor Dr. Lockwood Rush allowed me to join his adolescent groups at the Institute of Pennsylvania Hospital. His deeply informed and caring approach provided me with the inspiration to continue to work with the chemically dependent population. Nancy Beck, Director of Therapeutic Activities, Belmont Hospital, Philadelphia, provided me with the freedom and encouragement that I needed to explore the many different approaches that form the basic structure for the protocols in this book. Mentor Dr. Warren Graditor, whose depth of experience and patient listening has helped to broaden and deepen my understanding of human behavior (especially mine). Terrence D. Gorsky, author, for allowing me to publish excerpts from one of his inspiring lectures. I encourage interested readers to visit his website at www.relapse.org. Frank McShane for taking the concept of integrating music therapy, group psychology, and additions theory and practice, and transposing it into the abstract prism that makes up the beautiful and thoughtful cover of this book.

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The people in recovery from chemical dependence who helped me to develop these protocols through their participation in my music therapy groups. Through them, I learned a great deal about the courage that it takes to face some of life’s most difficult challenges and make heroic changes. Thank you for providing me with the honor of working with and learning from your songs. The musicians who wrote and performed the songs that appear in this manual provided the music that has moved so many to explore themselves and make positive life changes.

IN MEMORIAM My mother Lois June was a gifted musician who provided countless volunteer hours to the community. She helped create Braille music for the visually impaired and helped raise money for innumerable charitable organizations. She gave me the lifelong gifts of music and empathy. She was a beautiful person whose smile lit the world all too briefly. My Father Sheldon was the first in his family to earn a college degree. He became a dentist who worked diligently to serve people at a time when dentistry was relatively crude. He did his best to make the experience "painless" for his many patients and approached his work with patience and diligence. He always made the most of what little time he had to spend with my brother and me, and he provided me with the gifts of perseverance and humor. My high school music teacher, lifelong mentor, and dear friend Harry Joe Brown. An immensely talented person, he created music the likes of which few people will experience in their lifetimes. It was a privilege and thrill to sing in his choir and other performing groups. He inspired me to go into the music profession, and mentored me in a way that steered my life in a positive and rewarding direction. Dr. Mel Silberman, former instructor in Temple University’s Psychoeducational Processes Program (PEP), introduced me to the active training model that helped me to integrate my backgrounds in music therapy and education in an effective and meaningful manner. Mr. Vernon Johnson, dedicated researcher in the field of chemical dependence, wrote the book I’ll Quit Tomorrow, which forms the foundational underpinnings of this manual. I am indebted to him for his insights.

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PERMISSIONS The author and publisher would like to acknowledge the following for their permission to reproduce the songs included in this book and the licenses issued by them.

Alfred Publishing LIVE IN THE SKY Words and Music by CLIFFORD "T.I." HARRIS, and KEITH MCMASTERS Copyright © 2006 WARNER-TAMERLANE PUBLISHING CORP. (BMI), CROWN CLUB PUBLISHING (BMI), EMI APRIL MUSIC INC. (ASCAP), and EMPTY HOUSE MUSIC PUBLISHING COMPANY (ASCAP) All Rights on Behalf of Itself and CROWN CLUB PUBLISHING Administered by WARNER-TAMERLANE PUBLISHING CORP. All Rights Reserved. Used by Permission. For Alfred Publishing's 50% control in World (excluding Europe). See Hal Leonard for their 50% control (including World). See Warner/Chappell Music for their 50% control in Europe.

GUILTY Words and Music by RANDY NEWMAN Copyright © 1973, 1975 WB MUSIC CORP. & RANDY NEWMAN MUSIC All rights on behalf of RANDY NEWMAN MUSIC Administered by WB MUSIC CORP. All Rights Administered by WB MUSIC CORP. All Rights Reserved. Used By Permission. For Alfred Publishing's 100% control in World (excluding Europe). See Warner/Chappell Music for their 100% control in Europe.

GIRL WITH GOLDEN EYES Words and Music by JAMES MICHAEL, DJ ASHBA, AND NIKKI SIXX Copyright © 2007 WARNER-TAMERLANE PUBLISHING CORP. (BMI), LITTLE BIG GUY MUSIC (BMI), WB MUSIC CORP. (ASCAP), and FIVE NINETEEN ASCAP PUB DESIGNEE (ASCAP), CHROME BONE MUSI (ASCAP), and SIXX GUNNER MUSIC (ASCAP) All Rights on Behalf of Itself and LITTLE BIG GUY MUSIC Administered by WARNER-TAMERLANE PUBLISHING CORP. All Rights on Behalf of Itself, FIVE NINETEEN ASCAP PUB DESIGNEE, and CHROME BONE MUSIC Administered by WB MUSIC CORP. All Rights Reserved for SIXX GUNNER MUSIC Administered by DOWNTOWN MUSIC PUBLISHING LLC All Rights Reserved. Used by Permission. For Alfred Publishing's 100% control in World (excluding Europe), and their 33.33% control in Europe. See Warner/Chappell Music for their 66.67% control in Europe.

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WHAT IT'S LIKE Words and Music by ERIC SHRODY Copyright © 1998 WB MUSIC CORP. and IRISH INTELLECT MUSIC All Rights Administered by WB MUSIC CORP. All Rights Reserved. Used by Permission. For Alfred Publishing's 100% control in World (excluding Europe). See Warner/Chappell Music for their 100% control in Europe.

FLAWED DESIGN Words and Music by KEVIN KADISH, JESSE DRYFHOUT, and CHRIS MOERMAN Copyright © 2005 WB MUSIC CORP., SONG TOWER, SLOWGUY SONGS, YELLOW DART PUBLISHING, and AMYGDALA PUBLISHING All Rights on Behalf of Itself, SONG TOWER and SLOWGUY SONGS All Rights Administered by WB MUSIC CORP. All Rights Reserved. Used by Permission. For Alfred Publishing's 33.33% control in World (excluding Europe). See Anthem Entertainment for their 66.67% control in World. See Warner/Chappell Music for their 33.33% control in Europe.

REASON, THE Words and Music by DANIEL ESTRIN and DOUGLAS ROBB Copyright © 2003 WB MUSIC CORP. and SPREAD YOUR CHEEKS AND PUSH OUT THE MUSIC All Rights Administered by WB MUSIC CORP. All Rights Reserved. Used by Permission. For Alfred Publishing's 100% control in World (excluding Europe). See Warner Chappell/Music for their 100% control in Europe.

SOBER Words and Music by NATE HILLS, KARA DIOGUARDI, ALECIA MOORE and MARCELLA ARAICA Copyright © 2008 W.B.M. MUSIC CORP., DANJAHANDZ MUZIK, K'STUFF PUBLISHING, EMI BLACKWOOD MUSIC INC., PINK INSIDE PUBLISHING and YASLINA MUSIC All rights reserved on behalf of itself and DANJAHANDZ MUSIC Administered by W.B.M. MUSIC CORP. All Rights Reserved. Used by Permission. For Alfred Publishing's 28.33% control in World (excluding Europe). See EMI Blackwood Music Inc., Bug Music o/b/o Arthouse Entertainment LLC, and W.B.M. Music Corp. for their 66.67% control in World. See Yaslina Music Publishing Inc. for their 5% control in World. See Warner/ Chappell Music for their 28.33% control in World.

Hal Leonard Corporation REAL LOVE Words and Music by Michael McDonald and Patrick Henderson Copyright © 1980 Tauripin Tunes, EMI April Music Inc. and Monosteri Music All Rights for Tauripin Tunes Administered by Wixen Music Publishing, Inc. All Rights for Monosteri Music Controlled and Administered by EMI April Music Inc.

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All rights reserved. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 100% control in World.

FAMILY PORTRAIT Words and Music by Alecia Moore and Scott Storch © 2001 EMI APRIL MUSIC INC., PINK PANTHER MUSIC, TVT MUSIC INC. and SCOTT STORCH MUSIC All Rights for PINK PANTHER MUSIC Controlled and Administered by EMI APRIL MUSIC INC. All Rights Reserved. International Copyright Secured. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 50% control in World. See Reservoir Media Music for their 50% control in World.

SOBER Words and Music by Alecia Moore, Kara DioGuardi, Nathaniel Hills and Marcella Araica © 2008 EMI BLACKWOOD MUSIC INC., PINK INSIDE PUBLISHING, SUNSHINE TERRACE, BUG MUSIC, W.B.M. MUSIC CORP., DANJAHANDZ MUZIK and YASLINA MUSIC PUBLISHING INC. All Rights for PINK INSIDE PUBLISHING Controlled and Administered by EMI BLACKWOOD MUSIC INC. All Rights for SUNSHINE TERRACE Controlled and Administered by BUG MUSIC o/b/o ARTHOUSE ENTERTAINMENT LLC All Rights for DANJAHANDZ MUZIC Administered by W.B.M. MUSIC CORP. All Rights Reserved. International Copyright Secured. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 66.67% control in World. See Alfred Publishing's 28.33% control in World (excluding Europe). See Yaslina Music Publishing Inc. for their 5% control in World. See Warner/Chappell Music, Ltd., for their 28.33% control in Europe.

ANOTHER DAY TO RUN Words and Music by Bill Withers and Benorce Blackmon Copyright © 1972 INTERIOR MUSIC CORP. Copyright Renewed All Rights Controlled and Administered by SONGS OF UNIVERSAL, INC. All Rights Reserved. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 100% control in World.

LET IT GO Words and Music by Tom Douglas, Bill Luther and Aimee Mayo Copyright © 1995, 2007 Sony/ATV Music Publishing LLC, Tomdouglassmusic, Universal Music - Careers, Evansville Music and Little Blue Typewriter Music All Rights on behalf of Sony/ATV Music Publishing LLC and Tomdouglassmusic Administered by Sony/ATV Publishing LLC, 8 Music Square West, Nashville, TN 37203 All Rights on behalf of Evansville Music Administered by Universal Music - Careers All Rights on behalf of Little Blue Typewriter Music Administered by BPJ Administration, P.O. Box 218061, Nashville, TN 37221-8061 International Copyright Secured . All Rights Reserved. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 33.33% control in World. See Sony/ATV Music Publishing Company for their 33.33% control in World. See Little Blue Typewriter Music for their 33.33% control in World.

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PARADISE Words and Music by Vanessa Carlton Copyright © 2001 SONGS OF UNIVERSAL, INC. and ROSASHARN PUBLISHING All Rights Controlled and Administered by SONGS OF UNIVERSAL, INC. All Rights Reserved. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 100% control in World.

BECAUSE I GOT HIGH Words and Music by Joseph Foreman Copyright © 2001 UNIVERSAL MUSIC CORP. and AFROMAN MUSIC All Rights Controlled and Administered by UNIVERSAL MUSIC CORP. All Rights Reserved. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 100% control in World.

EASIER TO RUN Words and Music by Chester Bennington, Rob Bourdon, Brad Delson, Joe Hahn, Mike Shinoda, and Dave Farrell Copyright © 2003 by Universal Music - Z Songs, Chesterchaz Publishing, Rob Bourdon Music, Nondisclosure Agreement Music, Big Bad Mr. Hahn Music, Kenji Kobayashi Music and Pancakey Cakes Music All rights in the U.S. Administered by Universal Music - Z Songs International Copyright Secured. All Rights Reserved. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 100% control in World.

LIVE IN THE SKY Words and Music by Keith Mc Masters and Clifford Harris © 2006 EMI APRIL MUSIC INC., EMPTY HOUSE MUSIC, WARNER-TAMERLANE PUBLISHING CORP. and CROWN PUBLISHING All Rights for EMPTY HOUSE MUSIC Controlled and Administered by EMI APRIL MUSIC INC. All rights for CROWN CLUB PUBLISHING Controlled and Administered by WARNER-TAMERLANE PUBLISHING CORP. ALL Rights Reserved. International Copyright Secured. Used by Permission. Reprinted by Permission of Hal Leonard Corporation For Hal Leonard's 50% control in World. See Alfred Publishing's 50% control in World (excluding Europe). See Warner/Chappell Music for their 100% control in Europe.

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Reservoir Media Music FAMILY PORTRAIT "Family Portrait" Written by Scott Storch Published by Reservoir Media Music For Reservoir Media Music's 50% control in World. See Hal Leonard for their 50% control in World. See Warner/ Chappell Music for their 100% control in Europe.

Sony/ATV Music Publishing LET IT GO Aimee Mayo, Tom Douglas, Bill Luther © 2007 Sony/ATV Music Publishing LLC, Tomdouglasmusic and Publisher(s) Unknown. All rights on behalf of Sony/ATV Music Publishing LLC and Tomdouglasmusic administered by Sony/ATV Music Publishing LLC, 8 Music Square West, Nashville, TN 37203. All Rights Reserved. Used by Permission. For Sony/ATV's 33.33% control in World. See Hal Leonard for their 33.33% control in World and Little Blue Typewriter Music for their 33.33% control in World.

Little Blue Typewriter Music LET IT GO Aimee Mayo, Tom Douglas, Bill Luther © 2005, 2007 Little Blue Typewriter Music, Evansville Music, Careers-BMG Music, Sony/ATV Music Publishing LLC, Tomdouglasmusic All Rights Reserved. Used by Permission. All rights obo Little Blue Typewriter Music administered by BPJ Administration PO Box 218061, Nashville, TN 37221-8061 For Little Blue Typewriter's 33.33% control in World. See Hal Leonard for their 33.33% control in World and Sony/ATV Music Publishing for their 33.33% control in World.

Bruce Springsteen (ASCAP) MY FATHER'S HOUSE "My Father's House" by Bruce Springsteen. Copyright © 1982 Bruce Springsteen (ASCAP). Reprinted by permission. International copyright secured. All rights reserved. For Bruce Springsteen's 100% control in World.

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The Anthem Entertainment Group, Inc. FLAWED DESIGN Words and Music by KEVIN KADISH, JESSE DRYFHOUT, and CHRIS MOERMAN Copyright © 2005 WB MUSIC CORP., SONG TOWER, SLOWGUY SONGS, YELLOW DART PUBLISHING, and AMYGDALA PUBLISHING Courtesy of MARK-CAIN MUSIC, a division of THE ANTHEM ENTERTAINMENT GROUP, INC. 189 Carlton Street, Toronto, ON Canada, M5A 2K7. Reprinted by Permission. All rights reserved. For The Anthem Entertainment Group's 66.67% World control. See Alfred Publishing for their 33.33% control in World (excluding Europe). See Warner/Chappell Music for their 33.34% control in Europe.

Yaslina Music Publishing, Inc. SOBER Words and Music by Alecia Moore, Kara DioGuardi, Nathaniel Hills and Marcella Araica © 2008 EMI BLACKWOOD MUSIC INC., PINK INSIDE PUBLISHING, SUNSHINE TERRACE, BUG MUSIC, W.B.M. MUSIC CORP., DANJAHANDZ MUZIK and YASLINA MUSIC PUBLISHING INC. Courtesy of EMI BLACKWOOD MUSIC INC., PINK INSIDE PUBLISHING, SUNSHINE TERRACE, BUG MUSIC, W.B.M. MUSIC CORP., DANJAHANDZ MUZIK and YASLINA MUSIC PUBLISHING INC. (ASCAP) Administered by David M. Ehrlich & Associates, 237 West 35th Street, 4th Floor, New York, New York, 10001. All Rights Reserved International Copyright Secured Used by Permission For Yaslina Music Publishing Inc.'s 5% control in World. See Hal Leonard's 66.67% control in World and Alfred Publishing's 28.33% control in World (excluding Europe). See Warner Chappell/Music for their 28.33% control in World.

Warner/Chappell Music, Ltd., Europe Division GUILTY "GUILTY" WORDS AND MUSIC BY RANDY NEWMAN © 1978 (RENEWED) WB MUSIC CORP. (ASCAP) AND RANDY NEWMAN MUSIC (ASCAP) ALL RIGHTS ADMINISTERED BY WB MUSIC CORP. For Warner/Chappell Music's 100% control in Europe. See Alfred Publishing's 100% control in World (excluding Europe).

LIVE IN THE SKY "LIVE IN THE SKY" WORDS AND MUSIC BY CLIFFORD 'T.I." HARRIS AND KEITH MCMASTERS © 2006 WARNER-TAMERLANE PUBLISHING CORP. (BMI) AND CLUB PUBLISHING CORP. (BMI) ALL RIGHTS RESERVED ON BEHALF OF ITSELF AND CROWN CLUB PUBLISHING ADMINISTERED BY WARNER-TAMERLANE PUBLISHING CORP. For Warner/Chappell Music's 50% control in Europe. See Hal Leonard for their 50% control in World and Alfred Publishing's 50% control in World (excluding Europe).

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GIRL WITH GOLDEN EYES "GIRL WITH GOLDEN EYES" WORDS AND MUSIC BY JAMES MICHAEL, DJ ASHBA AND NIKKI SIXX © 2007 WARNER-TAMERLANE PUBLISHING CORP. (BMI), LITTLE BIG GUY MUSIC (BMI), WB MUSIC CORP. (ASCAP), FIVE NINETEEN ASCAP PUB DESIGNEE (ASCAP) AND CHROME BONE MUSIC (ASCAP) ALL RIGHTS ON BEHALF OF ITSELF AND LITTLE BIG GUY MUSIC ADMINISTERED BY WARNER -TAMERLANE PUBLISHING CORP. ALL RIGHTS ON BEHALF OF ITSELF, FIVE NINETEEN ASCAP PUB DESIGNEE AND CHROME BONE MUSIC ADMINISTERED BY WB MUSIC CORP. For Warner/Chappell Music's 66.67% control in Europe. See Alfred Publishing for their 33.33% control in Europe and 100% control in World (excluding Europe),

WHAT IT'S LIKE "WHAT IT'S LIKE" WORDS AND MUSIC BY ERIK SCHRODY © 1998 WB MUSIC CORP. (ASCAP) AND IRISH INTELLECT MUSIC (ASCAP) ALL RIGHTS ADMINISTERED BY WB MUSIC CORP. For Warner/Chappell Music's 100% control in Europe. See Alfred Publishing's 100% control in World (excluding Europe).

THE REASON "THE REASON" WORDS BY DOUG ROBB, MUSIC BY DANIEL ESTRIN, CHRISS HESSE AND MARKKU LAPPALAINEN © 2003 WB MUSIC CORP. (ASCAP) AND SPREAD YOUR CHEEKS AND PUSH OUT THE MUSIC (ASCAP) ALL RIGHTS ADMINISTERED BY WB MUSIC CORP. For Warner/Chappell Music's 100% control in Europe. See Alfred Publishing's 100% control in World (excluding Europe).

SOBER "SOBER" WORDS AND MUSIC BY NATE HILLS, KARA DIOGUARDI, ALECIA MOORE AND MARCELLA ARAICA © 2008 W.B.M. MUSIC CORP. (SESAC) AND DANJAHANDZ MUZIK (SESAC) ALL RIGHTS ON BEHALF OF ITSELF AND DANJAHANDZ MUZIK ADMINISTERED BY W.B.M. MUSIC CORP. For Warner/Chappell Music's 28.33% control in World. See Hal Leonard's 66.67% control in World and Yaslina Music Publishing Inc.'s 5% control in World. See Alfred Publishing's 28.33% control in World (excluding Europe).

FLAWED DESIGN "FLAWED DESIGN" WORDS AND MUSIC BY KEVIN KADISH, JESSE DRYFOUT AND CHRIS MOERMAN © WB MUSIC CORP. (ASCAP), SONG TOWER (ASCAP) AND SLOWGUY SONGS (ASCAP) ALL RIGHTS ON BEHALF OF ITSELF, SONG TOWER AND SLOWGUY SONGS ADMINISTERED BY WB MUSIC CORP. For Warner/Chappell Music's 33.33% control in Europe. See The Anthem Entertainment Group's 66.67% control in World. See Alfred Publishing for their 33.33% control in World (excluding Europe).

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Table of Contents Dedication/ v Author’s Biography/ vi Acknowledgements/ vii Permissions/ ix Table of Contents/ xvii Part I: Introduction/ 1 Purpose of This Manual/ 3 Requisite Skills for Implementing These Protocols/ 6 Assessment Issues/ 6 Contraindications/ 8 Clinical Rationale for Protocols/ 9 How This Manual Is Organized/ 11 Steps in Using the Protocols/ 12 Part II: Protocols for Challenging Addictive Thinking/ 17 Rationale for Protocols 1–7/ 1 9 Protocol 1: Identifying the Consequences of Addiction/ 20 Song: Another Day to Run Clinical and Musical Considerations/ 20 Session Outline/ 24 Protocol 2: Identifying Denial and Addiction/ 28 Songs: Live in the Sky, Easier to Run Clinical and Musical Considerations/ 28 Session Outline/ 28

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Protocol 3: Entitlement and Addiction/ 33 Songs: Because I Got High, Wish You Were Here Clinical and Musical Considerations/ 33 Session Outline/ 34 Protocol 4: Identifying and Confronting “Stinking Thinking”/ 37 Song: Paradise Clinical and Musical Considerations/ 37 Session Outline/ 38 Protocol 5: Guilt vs. Shame and Recovery/ 41 Songs: Guilty, The Thrill is Gone Clinical and Musical Considerations/ 41 Session Outline/ 42 Protocol 6: Maintaining Awareness of the Consequences of Addiction and Identifying Coping Skills/ 46 Songs: What It's Like, Sober Clinical and Musical Considerations/ 46 Session Outline/ 47 Protocol 7: Identifying Progress in Recovery/ 50 Songs: Girl With Golden Eyes, Freebird Clinical and Musical Considerations/ 50 Session Outline/ 51 Part III: Protocols for Lifestyle Repair/ 55 Rationale for Protocols 8–14/ 57 Protocol 8: Forgiveness and Recovery/ 58 Songs: Let It Go, Drift Away Clinical and Musical Considerations/ 58 Session Outline/ 60 Protocol 9: The Impact of Addiction on the Family/ 63 Song: Family Portrait Clinical and Musical Considerations/ 63 Session Outline/ 64 Protocol 10: Narcissism and Addiction/ 67 Song: Flawed Design Clinical and Musical Considerations/ 67 Session Outline/ 69

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Protocol 11: Real Love/ 72 Songs: Real Love, Heart of Gold Clinical and Musical Considerations/ 72 Session Outline/ 73 Protocol 12: Identifying Reasons to Remain Sober/ 76 Songs: The Reason, Master Blaster (Jammin') Clinical and Musical Considerations/ 76 Session Outline/ 77 Protocol 13: Taking Care of Unfinished Business/ 79 Song: My Father's House Clinical and Musical Considerations/ 79 Session Outline/ 80 Protocol 14: Remaining Active in Recovery/ 83 Song: Takin' Care of Business Clinical and Musical Considerations/ 83 Session Outline/ 83 References/ 87 Appendices/ 91 A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P.

Goal Sheet for Group Members/ 93 Another Day to Run/ 94 Live in the Sky/ 95 Easier to Run/ 98 Because I Got High/ 100 Paradise/ 102 Guilty/ 103 What’s it Like/ 104 Sober/ 106 Girl with Golden Eyes/ 108 Let it Go/ 110 Family Portrait/ 111 Flawed Design/ 115 Real Love/ 118 The Reason/ 119 My Father’s House/ 120

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Songs in Group Psychotherapy for Chemical Dependence

PART I: INTRODUCTION

Purpose of This Manual The purpose of this manual is to provide group music therapy protocols that support and encourage recovery from chemical dependence. Although these protocols have been created for ease of application in the clinical setting, they are not meant to be considered end products. Rather, they are meant to provide outlines within which the creative therapist may explore various applications and alternative approaches. All of these protocols incorporate several methods of music therapy. Music therapy may be defined as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 1998). This definition applies to both individual and group work. Music therapy relies on over 50 years of research and clinical practice. Music therapists use this knowledge to inform their music interventions, which are geared to foster a therapeutic relationship that helps to promote health-related change. The methods of music therapy incorporated in this manual focus heavily on the use of songs. These songs, sung by both male and female performers, represent a variety of cultures, age groups, and perspectives, much like the members of any particular therapy group. Songs represent a powerful tool for the therapist, and as Dr. Kenneth Bruscia (1998) most adeptly noted: Songs are ways that human beings explore emotions. They express who we are and how we feel, they bring us closer to others, they keep us company when we are alone. They articulate our beliefs and values. As the years pass, songs bear witness to our lives. They allow us to relive the past, to examine the present, and to voice our dreams for the future. Songs weave tales of our joys and sorrows, they reveal our innermost secrets, and they express our hopes and disappointments, our fears and triumphs. They are our musical diaries, our life stories. They are the sound of our personal development. Because of these myriad connections, songs provide easy access to a person’s emotional world and to the thoughts, attitudes, and beliefs that emanate from it. Given the aims of psychotherapy, songs can greatly facilitate the process and provide a very effective vehicle for emotional change. Several different methods can be used to introduce songs into the psychotherapy session. (pp. 9–10) The three primary methods of music therapy incorporated in this manual include listening and discussion, songwriting, and song performance. Listening and discussion involves choosing a piece of precomposed music and listening to it as a group, most usually within the framework or related to a framework of a particular theme or topic. The purpose of the listening is to provide the impetus for a group discussion based on the thematic material of the song(s) presented. What establishes listening and discussion as a therapeutic experience is that it is guided by an experienced therapist with particular therapeutic goals in mind, within the context of a therapy session. To that effect, 3

listening and discussion experiences may address several therapeutic goals simultaneously. These include providing a safe vehicle within which group participants may project their feelings. Quite often, it feels safer to discuss feelings in relation to a third party — for instance, the protagonist of a song — rather than initiate description of one’s own feelings, especially when those feelings have been well protected via various mechanisms of defense. Other goals related to listening and discussion include helping to develop a sense of group cohesion, empathy, trust, validation, and a springboard for further/more challenging group work. Songwriting is another music therapy method that engages clients in a variety of creative processes geared to attaining therapeutic goals. There are many types of approaches to songwriting, and this manual incorporates several of them. They are generally arranged in order from least to most difficult with regard to the need for group cooperation and the level of group intimacy. For instance, the manual starts with fill-inthe-blank-style songwriting, which demands less independent structuring than a full rewrite of a song or more freestyle lyrics which come later in the manual. Because songwriting is an active music therapy intervention (as opposed to listening and discussion, which is considered more receptive with regard to the level of client effort/risk), skillful use of this method can help promote the development of group processes and coping skills related to maintaining sobriety. With regard to maintaining sobriety, creative processes involved in songwriting assist group members to identify alternatives to alcohol or drug abuse. Accordingly, related therapeutic goals addressed by songwriting include learning to work together in a productive manner, increased selfexpression, increased frustration tolerance, following through with things to completion, and increased problem-solving skills. Song performance is another active form of music therapy wherein a group is provided the structure and opportunity within which to perform a song. This activity is the most threatening of the three activities being mentioned, as it involves the most amount of perceived risk. The psychological factors associated with chemical dependence frequently include perfectionism, often based on extreme self-criticism (as well as other types) while in the throes of addiction. Learning how to take and cope with risks in relatively novel situations (which these experiences will represent for many in your treatment groups) is a huge part of the recovery process. Facing one’s short-term fears (e.g., of social criticism) for long-term gains (e.g., social/self-acceptance) is a crucial aspect of providing a performance component to the group process. In addition, song performance allows the group to enjoy themselves in a healthy and sober way, push through the limits of what participants thought may have been their limitations, experience positive peer feedback, experience group support (e.g., via instrumental playing … a model for NA/AA group support), experience healthy ways to manage leisure time (e.g., for some, this may be the first time picking up an instrument or singing as a leisure experience), and promote healthy, as opposed to pathological, narcissism. As a whole, then, the protocols presented in this manual have been designed to address the following goals, which are based on chemical dependence and group dynamic goals, as addressed within a music therapy context: increasing understanding of self; increasing self-expression and communication skills; taking responsibility for self; increasing the ability to work with others in a productive manner (putting “talk” into 4

“walk”); increasing problem-solving skills; following through with things to completion; taking one step at a time; increasing frustration tolerance; learning productive ways to manage leisure time; learning to be less of a perfectionist and more self-accepting; learning to take risks toward personal growth; learning to give and receive constructive feedback; and having fun in a healthy, sober way. The protocols have been designed to be easily implemented by therapists who have the prerequisite skills (see below). They are generally ordered according to where they might best fit along a continuum, although they may be used on an asneeded/appropriate basis. Prior to each protocol is a brief description of the clinical and musical considerations. These considerations provide the reader with this therapist’s original frame of reference for the application of the related protocol. Each protocol is divided into several sections, providing the therapist with a purpose, therapeutic objectives, material list, and procedure (broken down into relative time frames). Sample group member responses are also provided, along with song rewrite samples and a related individual progress note. These protocols may be used as one-time stand-alone interventions (e.g., without prior client contact or follow-up, per se) or as part of a continuum of treatment. This feature is important because the turnaround rate (or discharge and admission rate) at short-term facilities is often unpredictable due to a variety of factors (e.g., relapse, insurance issues, health issues requiring medical attention or hospitalization, etc.). Under these circumstances, a client may be in treatment for one or two sessions and then not engaged in treatment for another several weeks, if at all. Therefore, if a client attends only a single session, he or she stands to benefit from that session, as each session addresses the topic identified in a manner that has logical beginning, middle, and end points. There is no “Part B” to any of these protocols, as they may stand alone as a full experience. On the other hand, because these protocols are arranged in general timeline order according to issues addressed in treatment, persons remaining in the group will be engaged in a relatively natural process of group dynamics that moves from least to most threatening with regard to level of depth, risk-taking, and social cooperation. The protocols incorporate an insight-oriented treatment approach, in that the experiences within the protocols invite participants to explore personal issues and peerrelated behaviors in relation to the themes being discussed. With regard to insight orientation, the focus of the protocols is on becoming aware of and challenging current maladaptive thinking patterns related to chemical dependence, associated unhealthy negative emotions, and related self-defeating behaviors. As such, the treatment approach represents goal-directed rational emotive-, cognitive-, or reality therapy–based approaches. These approaches utilize re-educative goals, which are different from reconstructive (e.g., psychoanalytic or transformative) aims in that they focus on behavioral change (e.g., readjusting one’s environment, goal modification, selfactualization) as opposed to accessing and resolving unconscious conflicts. As such, the level of treatment represented by the protocols in this manual most closely aligns with what Bruscia (1998) refers to as “insight music therapy.” In insight music therapy, “the therapist uses music experiences and the relationships that develop through them as the means of bringing clients greater insights about themselves and their lives, while also inducing necessary psychological changes therein” (p. 218). 5

The protocols are based on the author’s extensive work with individuals who are chemically dependent. As such, they have been tested and revised through repeated implementation within various outpatient and residential chemical dependence treatment settings.

Requisite Skills for Implementing These Protocols These protocols are designed for experienced therapists who are certified or licensed to practice within their profession. As such, the protocols are best suited for use by Boardcertified music therapists, licensed mental health counselors, licensed clinical social workers, certified addiction professionals, licensed marriage and family therapists and psychologists. They may also be suitable for use by graduate students under clinical supervision. In addition, an understanding of group dynamics and chemical dependence is important to proper implementation of these protocols. The protocols also require functional skills on piano or guitar, as well as voice. “Functional music skills” means that the therapist can play and sing music that is inviting and engaging to the clients, supports and encourages their efforts at musicmaking, and allows for a feeling of accomplishment even in cases where the group members choose not to sing. If the therapist is not facile on instrument, karaoke versions of the songs for songwriting may be used for accompaniment.

Assessment Issues While the protocols help to establish basic group preparation and procedure, basic information about each client is needed to determine appropriate group placement, to select the most relevant protocols for each group, and to monitor the potential dynamics of members within each group. Unfortunately, therapists employing this manual may not have access to client records or even treatment team meetings. For instance, a therapist functioning as a consultant may have time only to “touch base” with staff for a few minutes prior to leading groups in order to ascertain the appropriateness of particular clients for group. In addition, it’s often the case that the group leader will not have the option to delimit group size (e.g., in some rehabilitation facilities, it is not uncommon for 15 or so people to participate in such groups) or determine who may or may not be most appropriate for group participation. Knowing the functional level of clients, at least at a basic level, will help when it comes to dividing groups into subgroups, such that each group has a similar makeup with regard to potential leaders (e.g., those with some level of motivation and insight) and followers (those who may not be particularly motivated but may at least participate at some level in the group process). While formal assessment may not always be feasible, the therapist minimally needs to determine where each client is in the recovery process. These protocols are most productively incorporated during the third and fourth stages of recovery (e.g., Early Recovery and Life Repair), as outlined by Gorski (2010) below: 6

Stage 1: Pretreatment Intervention Period This period includes the active addiction stage prior to therapeutic intervention. An intervention of some sort, preferably by family members trained to communicate their concerns in some manner, often with the help of a professional interventionist or rehabilitation specialist, is often required to help a chemically dependent person break through their denial enough to see a rationale for treatment.

Stage 2: Withdrawal This recovery period occurs just after being admitted to a treatment setting. Few issues can be adequately resolved during this period, as the chemically dependent person is suffering from anguish. It is a difficult psychological period, as the person in recovery is fighting with wanting to use. The role of the therapists and family is to provide support for the participant to stay drug-free and actively invested in treatment. Without such support, relapse potential is great, especially since the person in recovery will most likely have few coping skills.

Stage 3: Early Recovery — Challenging Addictive Thinking This recovery stage involves challenging addictive thinking. The person in recovery needs to turn inward and evaluate his or her relationship with drugs, including how they got to this point in their lives: where they’ve been and where they want to go. Once the person has committed to stop using, they need to honor that commitment with the personal integrity involved in the process of becoming clean and sober. This stage also includes the entanglement between sober and addiction-related thinking. Therapists and family members focus on increasing understanding of codependency issues and understanding what effects the addiction has had on the family.

Stage 4: Middle Recovery — Lifestyle Repair This is where the hard work of redefining who the recovering person is and what others expect of them takes place. Key questions include “Who am I and what do I believe others expect of me in the world?” And reciprocally: “Who are other people and what do I expect of others as a condition of belonging?” These issues include gender, authority, and peer- and subordinate-related issues. More critical thinking is expected by group members and integrated into treatment during the middle recovery period. However, it’s important to remember that cognitive restructuring takes place from the moment of contact with treatment.

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Stage 5: Late Recovery — Ongoing Depth Therapy This level of care is predominantly outpatient/aftercare, wherein the person in recovery continues to repair the damage of drugs and alcohol. The person in recovery has learned how mood-altering drugs often lead one to accept distorted thinking or use the euphoric effects of drugs simply to deny what is happening. In this stage, the person in recovery more deeply addresses distorted thinking and related emotional/behavioral consequences. They explore issues related to what makes us human, including the ability to reshape oneself. As noted above, the stages of treatment that are most conducive to the interventions in this manual include Stages 3 and 4, early and middle recovery, respectively. However, people entering into rehabilitation facilities are primarily in Stages 2 and 3, withdrawal and early recovery. As it turns out, however, due to constant turnover rates related to client census in rehabilitation facilities, creating a workable treatment group is almost always possible. For instance, while you may have two or three people in the stage of withdrawal, more people will be in the stage of early recovery. It is also not unusual to have people who have been in the rehabilitation center for 60 to 90 days or more, who may actually be in middle recovery and will more than likely constitute the behavioral and emotional leaders of the group.

Contraindications It is important to constantly assess for level of participation and reaction to topics being presented. A client in withdrawal or early recovery who is intent on sabotaging the group can easily do so if not engaged in an appropriate manner. Reasons for such acting out may include not feeling prepared to confront defense mechanisms, severe personality disorder/DSM Axis II issues, experiencing withdrawal, poor social skills or social anxiety, or experiencing difficulty with the topic for reasons that have yet to be determined. Ways of assisting this person may include pairing them with a more experienced group member or inviting the client into the group in a practical way (such as requesting that they provide technical assistance with the equipment). If the client refuses to participate, they may still glean something from observing the group. However, if they are unable to observe without distracting, it is best that the client be removed from the group environment until such time that they can handle peer interaction appropriately. Otherwise, you will sacrifice the group’s integrity for one person. Also, you may risk splitting or ostracizing within the group. The therapist must also be prepared to handle emotional reactions while maintaining the integrity of the group. Frequently, the guilt and shame associated with addictive behaviors is buttressed by a false sense of pride or bravado. Breaking through this persona is quite often very challenging, as doing so often exposes the recovering person to a great deal of pain. This is one of the reasons that all of the protocols below function both to confront addiction-based behaviors and to provide coping mechanisms to help deal with the pain associated with having acted against one’s values, despair, etc.

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Despite having provided coping mechanisms within groups, there are times when a participant’s experience is such that it is not contained within a group experience. It is not realistic to believe that therapy works in a linear manner. Quite often, people seem to be getting worse during the first stages of treatment. This often happens as a result of the end of a “honeymoon” period, wherein the participant has been on their best behavior for any number of reasons. However, once increased trust and risk-taking start to take place, as well as a dropping of defenses, a variety of different emotional/behavioral responses may occur. For instance, someone may have reactions that include grief, anger, depression, anxiety, and so forth. This is not unusual at all, especially in early recovery. The therapist using this manual should be prepared for these types of reactions and make sure to communicate to appropriate staff the nature of the group focus (so that you are on the same page, and those who may not be in a place to tolerate group can be supported in opting out). In addition, should someone have a strong reaction to group, it is important to alert staff so that they may follow through after group. In this manner, your work won’t take place in a vacuum and often becomes extraordinarily valuable in terms of opening up forward-moving treatment interventions related to recovery.

Clinical Rationale for Protocols Action-oriented Interventions The philosophy behind these protocols is that people learn by doing, as opposed to only listening and talking. This is the basic philosophy of active training models (e.g., Silberman, 1998). The protocols provide in-the-moment opportunities for use by participants in enacting and working work with/through many of the issues associated with chemical dependence. Music therapy fits this philosophy well because it is experiential and actionoriented. It invites participation through intrinsically motivating factors such as emotional engagement, positive memories, enjoyment of the creative process, and mutually understood meaning. It engages group members at an action-oriented level through group sharing, creative problem-solving, and performance. It is important to engage participants in a manner that respects their dignity, intelligence, and individuality. To that effect, the protocols incorporate as many “inroads for participation” as possible. Within these inroads for participation, clients have the opportunity to express their personal views and take control of the direction of a particular discussion, issue, nonverbal expression, etc. This is an important aspect of the protocol design, as many of the participants within these groups have lost a sense of control to their addiction(s).

Integration of Verbal and Nonverbal Self-Expression The protocols integrate verbal and nonverbal forms of self-expression through music. Music provides a nonthreatening vehicle through which underlying emotions may be explored, identified, and expressed. As Goethe noted, “Music begins where words end.” 9

The structure of music also provides a metaphor for infinite possibilities within certain limitations, which parallels the structure of a sober lifestyle and may help to internalize a sense of empowerment and enjoyment related to sobriety. For instance, many hundreds of popular songs contain very similar forms, such as Intro, Verse I, Chorus, Verse II, Bridge, Chorus, and Outtro, and make use of limited harmonies (e.g., four chords or so). Similarly, many hundreds of classical pieces, such as Bach’s two-part inventions or Mozart’s sonatas, were written within the confines of the predominant style(s) of the time. The point is that although the protocols in this manual are delimiting in some ways (e.g., time frames, structure, theme-centered), they create infinite possibilities in other ways (e.g., choices of topics, various approaches to structuring the groups, guided lecture approaches, song choices, songwriting approaches, and performance options). They also allow for the evaluation and continuing development of particular interventions. In the sense that they may be replicable to some degree, they also avail themselves to research and training.

Creation of a Nonthreatening Environment: Utilizing the Power of the Group The protocols in this manual are designed to establish a nonthreatening environment that fosters increased self- and interpersonal awareness. This increased awareness defines the therapeutic learning process in small groups and allows for personal, goaldirected change to take place. For instance, group process goals may include the instillation of hope, a sense of universality, the imparting of information, altruism, the development of socializing techniques, imitative behavior, catharsis, the corrective recapitulation of the primary family group, group cohesiveness, and interpersonal learning (Furiman& Butler, 1983). The structure of the protocols in this manual allows for all of the above goals and learning experiences to take place within a nonthreatening group experience. These experiences proceed in a relatively developmental manner, such that the depth and breadth of issues addressed is increased as group cohesion and intimacy increases. For instance, within-group experiences include initiating the session as a large group to share individualized group participation goals. This fosters a general understanding of each other’s treatment issues/foci, starts to establish a sense of trust (via sharing of personal goals and related issues), and initiates the establishment of cohesion and interpersonal learning. As the group progresses, participants may remain together as a large group for the listening and discussion experience. This group experience allows for the safe expression of thoughts and feelings, which continues to increase cohesion through sharing reactions, appropriate risk-taking, validation (which helps to instill a sense of universality), and empathy. Community bonding and sharing helps to increase group members’ openness to a guided lecture/learning experience. Within these experiences, the imparting of 10

information takes place, both from the therapist and from peers. The fact that the group is topic-driven helps to provide the participants with a sense of control and hope, as shared information empowers them to take action on important issues related to their addiction. Participants also get feedback with regard to their input, helping them to learn to regulate their presentation of self. The groups are often broken into smaller subgroups. This allows for more interpersonal communication and risk-taking, as well as increasing the overall sense of cohesion. It also allows for more risk-taking with regard to providing and receiving feedback. Within these more intimate groups, recapitulation of the primary family group issues may take place as well, and participants may receive more constructive feedback with regard to how to cope with such issues/related behaviors. They also have the opportunity to practice these behaviors within the resulting therapeutic milieu. As the group proceeds into the creative songwriting/performing process, group members are once again given the opportunity to express basic emotions and examine their emotional experiences. Within these cumulative group experiences is where therapists tend to see many of the group goals listed above addressed behaviorally. For instance, as they form a small performance group (e.g., blues group), cohesion increases, emotional expression increases, universality increases (e.g., via shared emotional expression and experiences), instillation of hope is obtained (e.g., via participating in a non–drug-related experience that is indeed enjoyable and inspiring), and so forth. It is important to remember that the protocols presented in this manual are presented in the spirit of an architectural or “skeletal” outline. The idea of a skeletal outline means that while everything is there for the practitioner to run a successful group, practitioners are urged to adapt the protocols to their styles and patient/setting needs. In this manner, the protocols remain dynamic, engaging, clinically relevant to the patient, and culturally relevant to the particular treatment center in which the practitioner works.

How This Manual Is Organized This manual contains three sections. Part I provides an overview and introduction to the manual. Part II contains seven protocols for using song discussion and songwriting to challenge addictive thinking. Part III provides another seven protocols for working on lifestyle repair. Each protocol consists of these sections: Purpose, Objectives, Materials, and Procedure. Sample songs are provided when appropriate, and each protocol ends with a sample progress note taken from previous sessions using that protocol. In order to maintain confidentiality, the sample notes are based on conglomerates of various patient responses and do not include any identifying information such as name, date, treatment location, etc. Therefore, any resemblance to a particular patient is completely coincidental. Specific instructions on how to use the protocols are provided below.

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Steps in Using the Protocols There are several steps that are important to consider with regard to choosing and implementing the protocols in this manual. Given the nature of these steps, it is important that the therapist make sure to spend the appropriate amount of time preparing for the implementation of the group session. Without adequate preparation, the therapist may implement a protocol that is not relevant for the level of treatment, group dynamic, musical responsiveness, or musical abilities of the group. There also needs to be some time left at the end of the group for “debriefing,” as noted below. Steps in using the protocols are described below.

Preparation 1) Assessment: The therapist must determine what stage of recovery most of the group members are engaged in (see the stages above as outlined by Gorski). In addition to each individual’s recovery stage, it is important to consider where the group is with regard to its development as a group. For instance: Are they just getting to know each other or do they have a treatment history together? Are they able to effectively and noncritically communicate with each other? Do they work cooperatively? Are they ready to take risks regarding personal sharing? And so forth. The therapist should also be assessing each member’s musical experience and abilities as well. This type of assessment may be conducted via an interview at time of admission. This interview may take the form of a brief 1:1 interview (if the therapist has access to clients), via an assessment form administered upon admission, or via an informal interview prior to or at the onset of group (e.g., while reviewing client goals). Some useful information to glean includes the presence of formal instrumental or vocal training, participation in ensembles (e.g., choir, band), musicians in one’s family, musical preferences, and musical dislikes. 2) Choose the appropriate protocol: It is important for the therapist to determine which protocol is most suitable for the group based on the above assessment(s). For ease of use, the protocols have been sequenced according to recovery stage, group development, and musical readiness. Thus the earlier protocols are reflective of groups that are in early stages of recovery (e.g., addressing issues of denial), just starting to work together as a group (e.g., learning about each other and the norms of the group, tentative with regard to risk-taking), and just starting to work together within a musical context. 3) Familiarize yourself with the music: The therapist needs to listen to the songs to be discussed by the group to ensure that both the lyrics and the music are suitable to their culture, age, religious orientation, and so forth. Sometimes the lyrics may be appropriate, but the music may or may not be. For instance, a rap song may be more appropriate for young adults but not older adults. In addition, while rap styles may be appropriate for young adults, certain rap songs might be too musically stimulating for a particular group. 12

Should the recommended music not match the nature of a given group, the therapist should find a suitable alternative song. The therapist also needs to prepare the music for the songwriting segment of the session. The simplest way to do so is to go online and find the piano chords or guitar tabs for the melody and use those to accompany the group. If the therapist is not facile on an instrument, it will be important to find a way to suitably accompany the group. This may include having a friend record an accompaniment that can be used or purchasing a karaoke version of the song. In either event, the therapist should find music that is in a key that can be performed comfortably by both the therapist and the group members. 4) Prepare all of the appropriate materials: The therapist must then consult the protocol to ensure that they have all of the materials necessary to conduct the session. In most cases, these materials include client goal sheets; the prerecorded song choice(s) for the group; a CD player or some other type of playback device with quality speakers; pens/pencils and paper for client goal sheets, scribes, and songwriting; large writeon/wipe-off board or chalkboard; assorted percussion instruments (enough for all group members); and, when required, a sample song layout for songwriting. The percussion instruments should include bongos, congos, claves, hand drums, djembes, tambourines, guiros, and shakers (cylinders with beads/beans in them that are shaken to make sound) preferably all of good quality. It is also helpful to have a microphone and small amplification system for the therapist or “lead singer,” as this will help the singer be heard above the percussion sounds and add a quality of professionalism to the sound. The therapist will need to make sure that their instrument of choice (e.g., piano or guitar) or karaoke equipment and recording is prepared. You should never rely solely on a client to accompany you, as they may not be available or may need to be pulled out of the group for any number of reasons. It is always a good idea to have an extra guitar or two on hand for clients who may be available to accompany you (or perform on their own, depending on their musical ability). Finally, in cases where you are able to get releases from all group members, it is especially nice to be able to record the final song and provide a recording to each group member for keepsake purposes. Since there are many recording options, select the one that best suits the situation. Be sure to use a release that meets the legal requirements of the state and institutional setting. Also, make sure to protect the confidentiality of the client by not allowing names or other identifying information to be recorded.

Implementing the Protocol 1) Opening the session: At this point, the therapist is ready to implement the protocol. The first part of every session involves the establishment of group norms, especially for newly formed groups. Allowing the group to have a say in this process gives them a role in the ownership of the group. This helps to ensure more genuine and appropriate participation. Hence, the group is solicited for a brief list of what they would deem as acceptable group behaviors that would allow for a therapeutic environment. Typical norms include “no devaluing.” This includes not devaluing or harshly criticizing someone’s contributions to a group (musical or nonmusical), the music being presented 13

(e.g., someone may or may not like the music per se, but may relate to the lyrics), the instruments (e.g., via handling roughly or damaging), or one’s self. Other norms may include allowing one person to speak at a time, providing constructive feedback to peers, and participating to the best of one’s ability. After norms have been established, the therapist hands out a copy of the “Goal Sheet for Group Members” to each group member (see Appendix A). This goal sheet is based on the most common goals associated with clients with addiction (as derived from goals indicated by M.R. James (1988, b) and this therapist's clinical experience). The goal sheet provides group members with a framework for thinking about their specific treatment objectives prior to engaging in the group. It also allows the therapist to conduct a brief assessment of group member's motivation to treatment and treatment level. Finally, the goal sheet provides a means for group members to support each other's efforts in the attainment of their objectives, by perhaps providing gentle reminders to hold group members accountable during the group, as well as assisting with goaldirected feedback at the end of the group. Once the goal sheets are handed out, the group members are asked to choose a goal for themselves or write one based on what they are working on in treatment, and then be prepared to share the reason for their goal choice with the group. After all of the group members have chosen a goal, the therapist asks for a volunteer to start by sharing the goal they chose and the reason they chose that goal. As group goals are being presented, the therapist or group members may briefly comment on the chosen goal. This is a good time for the therapist to clarify, validate, and personalize goals. In addition, the therapist may use this time to identify parallels and distinctions between group members. This discussion needs to be paced and kept brief, however, as this is not the focus of the group. After the first group member shares their goal, the therapist should ask that group member to choose another group member and so on until everyone has shared their goals and reasons for choosing them. In this manner, the group learns about each other’s focus for the group. This comes into play at the end of the session, when the group gives feedback to each member. Once the goals of all of the members have been presented, the therapist asks the members to place their goal sheets under their seats to be reviewed at the end of the group. 2) Initiating the discussion: Next, the therapist proceeds with the song listening and discussion section of the protocol. A full sample session is described in the Clinical and Musical Considerations section for Protocol 1: Identifying Consequences of Addiction. This sample session provides a detailed description of how to run sessions and provides a model for implementation of the protocols; however, this should in no way delimit the therapist’s own creativity and spontaneity in dealing with each group appropriately. The session description is provided simply as a guide.

Follow-up 1) Review of the goal sheet for group members (debriefing): Once the group has been completed, it is important for group members to review how they addressed their goals 14

in the session. This allows each individual to evaluate their personal level of commitment to the recovery process and to the group, while also providing opportunities for feedback between group members (a model for communication outside of the treatment setting). It also provides the therapist with valuable information related to group member progress and ongoing assessment information. 2) Ask for song input: At the end of each group, the therapist may ask group members for song ideas that they feel would be appropriate for future sessions. This is usually dependent on whether there is an appropriate level of group commitment and it seems people will take the task seriously. The therapist should provide appropriate caveats, such as making sure that the song addresses an issue related to chemical dependence, does not advocate violence, does not have a great deal of cursing, etc. The therapist should make clear that while all songs are given consideration, they may or may not be used in a future session depending on their appropriateness. Appropriate songs chosen by the group can be substituted for songs given in any of the protocols and can really make a difference for the group member who chose the song. It also helps to expand the therapist’s repertoire of appropriate music. 3) Communicate with the treatment team: The therapist should next communicate with the treatment team about the group session and how each member responded. This can be done via meetings or notes. This helps to initiate and maintain a dialogue with other treatment team members regarding what happens in the song session and how the group members are responding within this context. Sometimes, group members will respond differently within a therapeutically designed music experience than in any other context (e.g., because they may be less defended), and this is important information for other staff to hear both for treatment-related purposes and for the purpose of sustaining the contribution of such experiences to the program. 4) Collect/record appropriate research data: The goals sheets have a Likert Scale component, as well as a narrative component, that make the information gleaned suitable for research purposes. The therapist may also utilize other data collection methods for research purposes as well, as long as the appropriate institutional review boards have reviewed and approved the proposed research.

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PART II: PROTOCOLS FOR CHALLENGING ADDICTIVE THINKING

Rationale for Protocols 1–7: Challenging Addictive Thinking The protocols for challenging addictive thinking deal directly with the issue of denial and addiction. Denial is usually the first and most predominant barrier to treatment associated with chemical dependence. Until the chemically dependent person accepts that they have a potentially life-threatening problem, it is unlikely that they will be motivated to receive help. Accordingly, The First Step in AA’s 12-Step model reads: “We admitted that we were powerless over alcohol — that our lives had become unmanageable.” Denial may be a useful coping skill with regard to surviving painful issues on a day-to-day basis. In the case of addiction, however, denial acts like an autoimmune response, creating an almost impenetrable self-defeating wall of defenses that mask the guilt, shame, and anxiety associated with the realities of chemical dependence. Gorski (2010) outlined the “Big 5” most common denial-related defenses. These include Avoidance (e.g., completely avoiding the topic); Absolute Denial (e.g., “Me drink? I don’t drink!”); Minimizing (e.g., “Yes, I drink, but it’s not as bad as everyone thinks”); Rationalizing (noting all the logical reasons why they drink); and Blaming (e.g., “It’s not my fault!”). Related defense mechanisms of rationalization and minimizing may help to compartmentalize issues until we are ready to cope with them more productively. In the book I’ll Quit Tomorrow, Vernon Johnson (1990) eloquently outlines how denial emerges in the progression of addiction. He points out that as the dependence on alcohol (or drugs) progresses, one starts to act in a manner that contradicts their inherent and often long-cherished values. Denial emerges as a helpful tool to cope with this contradiction between behaviors and values. For instance, if a person values his friends but in a drunken stupor acts violently or sexually inappropriately toward one of them, he may note that “it was just one evening of fun that got a little out of hand.” As the chemically dependent person starts to lose more and more of the things they cherish, the denial becomes more entrenched. For example, after a DUI, a person may note “of course I was positive for alcohol — they tagged me just after I got out of the bar” and/or “it was a faulty breathalyzer.” Finally, when confronted by peers and family, the chemically dependent person often says: “I can quit anytime I want. I don’t have a problem!” Or, “So I like a drink now and then, I still have a job, and it doesn’t really affect my life in any important manner … the only person I’m affecting is myself, it’s none of your business,” etc. The relative isolation and loss of touch with reality involved in denial make it a difficult defense to address therapeutically. If it is not addressed early in recovery, the chemically dependent person will most likely not benefit from treatment, as they won’t see any need for it. That person will probably return to the people, places, and things associated with their addiction.

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Protocol 1: Identifying the Consequences of Addiction Clinical and Musical Considerations and Session Description The clinical and musical considerations section of this first protocol has been elongated to include a session description. This session description has been provided in order to allow the reader a basic sense of how the author conducts an entire session. The clinical and musical considerations sections that follow simply provide a conceptualization and rationale for the related protocol. The first protocol makes use of the Bill Withers song “Another Day to Run” (1972, track 8) (Appendix B). This song was initially shared with me by a friend and fellow music therapist, Brad Biederman, MMT, MT-BC, when I was starting to develop this model. The lyrics of this song begin with, “If you don’t look inside your mind and find out what you’re running from, tomorrow may be just another day to run.” I felt that these lyrics exemplified the concept of denial. The voice of the song is coming from a friend who notes: “I don’t want to waste your time, but I’m talking to you like a son, tomorrow may be just another day to run.” The lyrics to “Another Day to Run” also open up the door for a group discussion related to why someone would want to engage in group addiction treatment in the first place. Vernon Johnson (1990) created a great rationale for group psychotherapy of chemical dependence in a metaphor he called the “Johari Window” (p. 134). This “window” has four panes that depict the benefits of peer feedback in the treatment process. For instance, in Pane One it is noted that both you and others have access to information you are open about. In Pane Two, only you have access to your secrets (which can be self-defeating and isolative, and perhaps cause distorted perceptions to thrive). Pane Three describes how only others have access to your blind spots. This is an extremely important concept for the person in denial to grasp, as it helps them to consider the importance of opening up to constructive feedback within the treatment process, even though it may be painful to acknowledge self-defeating behaviors and underlying emotions (e.g., guilt, shame, etc.). Finally, in Pane Four, it is evident that neither you nor others are privy to hidden (or unconscious) motivations for maintaining addiction (e.g., secondary gains, acting out related to early childhood influences, etc.). These hidden motivations may or may not be brought to light as one identifies and accepts their blind spots. The eventual goal is to have one large “open” pane, wherein there are few secrets, blind spots, or hidden motivations to one’s behaviors. The Johari Window is introduced near the onset of this group (e.g., after listening to and discussion about “Another Day to Run”) because it helps to conceptualize the importance of constructive feedback in the group therapy process. Receiving constructive feedback about one’s blind spots with an open mind can make a huge difference in one’s ability to see oneself as they are perceived by others and helps to open the door to emotional release and personal expression. This is a tremendously helpful process both within the treatment setting and within the friends and families of those with addictions. For example, accepting feedback from a peer group may generalize to accepting feedback from one’s family. In addition, taking responsibility for one’s actions 20

in the group may generalize to taking responsibility for one’s actions within their families. Finally, taking responsibility within the family encourages familial support, which, in turn, assists the treatment process. The next step of this protocol involves dividing the group into smaller subgroups (preferably with no more than six persons in a group if possible; e.g., if 15 people are present, divide into three groups of five). Requesting a “scribe” allows the group to take the responsibility for their work. In essence, a scribe is responsible for writing out the responses of the group to the questions/issues presented, which will be further used for a songwriting experience. This also provides the scribe with a sense of leadership and helps to ensure that interest is retained in the subject, as group members work to support the scribe’s efforts (rather than the therapist per se). This is a great way to start to imbue personal responsibility in treatment and provide a sense of accomplishment, importance, and control to people who feel particularly torn down at this moment in their lives. Identifying consequences to chemical dependence helps to open the door to address the defense mechanisms, such as denial, that help to perpetuate addictions. In this protocol, the scribe is asked to interview peers with relation to questions directly associated with denial. The first such question is: “What were the worst consequences that you suffered as a result of your chemical dependence?” This question tears directly into the heart of denial, by asking the chemically dependent person to acknowledge that yes, their dependence had a profound effect on their life. Peers are asked to listen carefully and “confront” in a constructive manner. For instance, if a person reports that they can’t identify any consequences to their dependence, have them listen to others’ responses and see if they can find something they relate to. If they still can’t identify consequences, help them to explore the impact that the dependence most likely had on the many aspects of their lives (e.g., friends, family, work, finances, self-acceptance, health, etc.). The second question, asking what specific behaviors served to maintain the addiction, provides the opportunity to develop insight into maladaptive behaviors and influences. It is often challenging to address this question, as for many, some of their best friends may be chemically dependent as well. To acknowledge this fact is painful, as it means that they will most likely have to give up/avoid that relationship until their friends deal with their own addiction-related issues. Once again, the influence of peers plays an important role within these small group discussions. The final question, “What are two or three behaviors that will serve to maintain your sobriety?,” helps to establish a sense of personal responsibility and helps the group member to identify a wide variety of coping skills. This provides the chemically dependent person with the beginnings of a personal “road map” toward sobriety. Once that road map has been forged within the context of a supportive and reflective treatment experience with several peer experts (often more impactful than unit directors, therapists, etc.), the group member has a marker for progress and peers who can now be involved in helping that person to walk the walk through consistent compassionate and/or constructive feedback. Having engaged in the often moving experiences associated with working together in the above manner, the group now moves into the songwriting portion of this 21

protocol. Within this section, group members are provided with a sample of 12-bar blues structure. I have found that sharing several prerecorded 12-bar blues songs may expedite this process (e.g., Eric Clapton’s version of Ellas McDaniel’s [1957] “Before You Accuse Me” and/or Stevie Ray Vaughan’s [1983] “Pride and Joy”). While listening, peers may wish to play along on percussion instruments while they get the feel of the structure and rhythm of the song(s) and playing together as a group. It also provides a nice break and segues into the songwriting portion of the group. From here, the therapist may guide the participants into 12-bar blues songwriting via several processes. If the group is made up of mostly nonmusicians, use the prerecorded blues songs to help them to learn about the concept of beats, measure (or bars), and the basic method of counting measures involved in a 12-bar blues pattern. Then you may wish to discuss various forms of 12-bar blues (e.g., AAB, simplest). Having played along, counted measures, and learned about the blues form from recordings, the therapist may wish to proceed with live music-making (as opposed to playing along with a recording). I have found that having the group play along on percussion first is useful, as it is least threatening. The therapist may then manipulate the dynamics, pacing, and instrumentation of the song to encourage more expressive playing. When I first introduce the blues pattern, as people are playing along, I will sing a simple AAB patterned lyric. For instance, after repeating line “A” (e.g., “I woke up this morning, feeling oh so blue”), I stop the music and ask the group “So what would make me feel so blue in the morning?” This helps to demonstrate the songwriting process and solicits increased interaction. Group members may say any number of things, such as “I lost my girlfriend, and I didn’t know what to do.” This response is then used to create the “B” line for the song. Next, I replay the newly created song, with the group members singing backup. For instance, “therapist: ‘I woke up this morning, feeling oh so blue’; backup vocals: ‘oh so blue, oh so blue.’” This is a relatively nonthreatening way to introduce into the group singing, which is often the most threatening form of group expression, as it involves a person’s own voice as the instrument. The group often laughs during this portion of the session, which helps to “break the ice” a bit further and allows for increased cohesion, trust, intimacy, and expression. This exercise/musical experience also helps group members to learn more about their peers through both verbal and nonverbal modes of communication. Finally, the small groups are told that they are now going to become a blues bands. Their task involves incorporating what they have shared in their small groups into their group songs and performing them for their peers. They will also need to come up for a name for their groups within the allotted time frame. This is one of the most rewarding parts of the group, as group members take on the challenge of converting the treatment center into a blues stage. If approached in a respectful manner, as above, group members are usually more than willing to engage in this process, which is the most challenging up to this point, as it requires peers to interact in what is for most a novel experience. This approach is similar to the Outward Bound adventure program experiences, such as Training on Ropes and Experiencing Challenge (e.g., TREC courses), that are often used as team-building challenges for 22

corporations and in various treatment settings. Within the Outward Bound approach, self-identity is explored via team-building group experiences that foster trust, communication skills, problem-solving, risk-taking, acceptance of peer feedback, and learning how to be flexible with roles (such as leader vs. follower). Within counselingbased interventions, Outward Bound professionals often make use of Glasser’s Reality Therapy principles, which focus … … on the here and now and how to create a better future. It emphasizes making decisions and taking action and control over one’s own life with discovery of what they really want and whether what they are currently doing is actually bringing them nearer or further from that goal (Outward Bound, 2011). All of the above facets are involved in group songwriting, as peers work diligently to complete a group challenge. They take risks via sharing personal material and playing or singing in the final product, they problem-solve via coming up with rhyming and/or appropriate lyrics, they build trust via sharing and following up with the process they started, and they learn to share roles (among many other things). Constructive peer feedback related to their engagement in the group helps participants to continue to develop an emerging sense of self in sobriety. As the blues song is composed via the above creative process, peers frequently find themselves laughing, in the position of receiving praise for their rhyming contributions, validated for their expressions by peers, etc. In this sense, these groups could be referred to as “Inward Bound.” The small groups are then asked to perform their pieces for their peers. This is often an incredibly powerful experience on many dimensions. For some, it is the first time that they’ve experienced live music, as a performer or an appreciator, without being high. Learning that they can have fun in a healthy, sober manner is often the beginning of accepting that there is life after addiction and that a sober lifestyle may indeed prove worthwhile. Once again, group members often laugh with each other, are inspired by each other, take risks toward personal growth, and validate one another’s lived experiences through song. The sense of accomplishment after these performances is often quite palpable. After the performance, peers are asked to pick up their group goal sheets and give each other constructive feedback related to how they felt they addressed their goals within the group. Because this is such a multifaceted group, there are often many opportunities for participants to address the goals they chose. In situations where a person has a hard time identifying how they met a goal, peers may provide helpful feedback, or the person may find that they addressed a goal they were not expecting to address within the group. This final “debriefing” period allows for recognition and validation of group members’ accomplishments and helps to provide a nice recovery period prior to moving into the rest of their day.

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Session Outline Songs: “Another Day to Run” (Bill Withers) and original 12-bar blues Purpose: To increase awareness of consequences, personal strengths, and weaknesses related to chemical dependence. Objectives: Participants will … Identify and acknowledge the negative effects of chemical dependence Identify maladaptive behaviors and coping mechanisms related to addiction Use the above information to write and perform an original group song for their peers Materials: Goal sheets for group members Prerecorded song related to denial and addiction (e.g., “Another Day to Run” by Bill Withers) CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Sample blues song layout (either written on board or handout) Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of denial and addiction, such as Bill Withers’s “Another Day to Run” (Appendix B). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to and explain why. (15 minutes) The therapist provides a guided mini-lecture related to the concept of why group psychotherapy is useful in overcoming chemical dependence. A succinct and useful explanation of this can be found in the metaphor of the “Johari Window,” in Vernon Johnson’s I’ll Quit Tomorrow (1990, p. 134). (5 minutes) The therapist may also wish to include an illustration of the progression of chemical dependence here. A pertinent description provides an explanation for 24

how the defense mechanism of denial is formed as one acts against their values. A good example of this is provided in Chapter 3 of I’ll Quit Tomorrow (Johnson, 1990, pp. 27–34). The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following three questions: (15 minutes) What were the worst consequences you suffered as a result of your chemical dependence? What are two or three behaviors that serve to maintain your chemical dependence? Group members are asked to provide in a constructive manner validation or examples of other such behaviors of which the person may not be aware. What are two or three behaviors that will serve to maintain your sobriety? Group members are asked to provide in a constructive manner validation or examples of sobriety-related behaviors in which they have seen their peer engage and of which the person may not be aware. Each group is going to act as if they are a musical band. Prior to doing so, they will listen to and play along with an instrumental blues song performed by the therapist. The song is then written using the material generated in group and the following procedure: (20 minutes) The therapist introduces the 12-bar blues song style. Group members play along on percussion and melody instruments. The therapist briefly presents the structure of the song (e.g., verse identifies the consequences of dependence, verse two identifies behaviors that maintain the addiction, verse three identifies behaviors that will help maintain sobriety). To break the ice, the therapist asks all of the group members to assist in creating a sample song line on the board, using a fill-in-the-blank format as follows: Sample 12-Bar Blues Structure: Verse 1: (Consequences) Been down so low, I felt __________________________ Been down so low, I felt __________________________ I felt _______________________________________ Verse 2: (Weaknesses) I need to look at _______________________________ I need to look at _______________________________ 25

Need to _____________________________________ Verse 3: (Strengths) If I use ______________, it will ___________________ If I use ______________ and ____________________ Got to use ____________, if I____________________ (15–20 minutes) Each group chooses a name for themselves. Next, they are asked to determine how they will perform the song. (10 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10–15 minutes) Blues Song Example: Verse 1: (Consequences) Been down so low, I felt suicidal Been down so low, I felt homicidal I felt like I was gonna die, and there was no hope. Verse 2: (Weaknesses) I need to look at the way I use folks and how I get what I think I need I need to look at how I keep going back to people, places, and things Need to stop look and listen, if I’m gonna find sobriety. Verse 3: (Strengths) If I use my motivation, it will help me stay alive If I use my dedication and my creative drive Got to use my senses, if I want to stay alive. Sample “Identifying Consequences of Addiction” Progress Note: X was alert and oriented, affect depressed and anxious. He chose goals #7 and #5 for his group focus, noting: “I need to increase my frustration tolerance and problem-solving skills, I’ve been coming off meth for 9 months!” With regard to “Another Day to Run,” he noted: “I need to look into my mind to find out what I’m running from … I’ve been running for years … every day seems like the one before.” With regard to how it felt to hit bottom: “Useless, hopeless, suicidal.” With regard to behaviors that served to maintain his addiction: “Procrastination, isolation, self-condemnation.” With regard to behaviors that may serve to maintain sobriety: “Talking it out, outreaching.” X remained active and participated in the blues songwriting session, acting as a scribe for his group. He also participated in the performance, playing percussion with peers. He reported meeting his goals via “I met the goals using goals 12, 9, and 2” (e.g., having fun in a healthy and sober 26

way, learning to take risks toward personal growth, and increasing self-expression and communication skills, respectively).

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Protocol 2: Identifying Denial and Addiction Clinical and Musical Considerations Protocol 2 is similar to Protocol 1 with relation to its focus on denial and addiction. The music, rap followed by techno-rock, is particularly suited for adolescents and young adults. The lyrics of the first recommended song, T.I.’s “Live in the Sky” (2006) (Appendix C), address denial by noting how, although many acquaintances have died from drug dealing/abuse, the protagonist(s) of the song continue to do the same things. In doing so, they note that “Life’s ups and downs come and go … but when I die, I hope to live in the sky.” This often brings up topics such as continued drug use despite being fully aware of the consequences (e.g., having friends who have died from overdose). In addition, moral and religious dilemmas may be stirred up with the idea of living in the sky (i.e., Heaven) despite having acted in often heinous ways (i.e., as depicted in the song). The theme of the second song, Linkin Park’s “Easier to Run” (2003, track 6)(Appendix D), centers on the chorus lyrics: “It’s easier to run, replacing the pain with something numb. It’s so much easier to go, than face all this pain here all alone.” These lyrics are easy for most chemically dependent persons to identify with and use to validate the feelings associated with denial (i.e., the pain underlying having acted against one’s values). They are also general enough to provide a safe, inviting opportunity for projection/disclosure of related thoughts and feelings. Most often, feelings of guilt and shame emerge, as they are often the underpinnings of denial. In addition, the feelings of helplessness associated with depression are often identified and discussed. Sharing such feelings and learning to cope with them more directly is an important part of the recovery process, and doing so is often easier and more meaningful within a supportive group context. In addition to the benefits listed above, the song “Easier to Run” lends itself to a fill-in-the-blank songwriting experience (as demonstrated below), which is one of the simplest and least threatening types. Fill-in-the-blank allows for greater participation from all group members, as there is little demand for lyric writing or musical expertise. Therefore, this protocol is particularly suited to groups in the initial stages of development/recovery. It allows for structured expression of thoughts and feelings in a manner that opens the door for increased trust and intimacy. Session Outline Songs: “Live in the Sky” (T.I.) and “Easier to Run” (Linkin Park) Purpose: To increase awareness of unhealthy, addiction-related self-talk and related ideas to dispute and cope with those thoughts.

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Objectives: Participants will … Identify denial as something important to address in the recovery process. Identify feelings and thoughts denied in addiction process. Identify behaviors that may help to cope with addiction. Use the above information to rewrite lyrics to songs for their peers. Materials: Goal sheets for group members Sample prerecorded songs related to identifying denial and addiction (e.g., “Live in the Sky” by T.I. and “Easier to Run” by Linkin Park) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members Fill-in-the-blank lyric sheet for song rewrite of “Easier to Run” A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of denial and addiction, such as T.I.’s “Live in the Sky,” (Appendix C) followed by Linkin Park’s “Easier to Run” (Appendix D). The therapist involves the group in a guided discussion related to the lyrics of the songs, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the songs that they may relate to, and tell why. (15 minutes) The therapist provides a guided mini-lecture related to the concept of denial. (5 minutes) Group members are presented with a fill-in-the-blank version of “Easier to Run” (see the example below) and are asked to complete the lyrics based on their own experiences. (10–15 minutes) The therapist guides group members in a group discussion based on each person’s rewrite of “Easier to Run.” (30+ minutes) After completing the group discussion, participants revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) 29

Example of Group Song to Rewrite: “Easier to Run” (Linkin Park) (Reprinted by Permission of Hal Leonard Corporation)

It’s easier to run Replacing the pain with something numb It’s so much easier to go Than face all this pain here all alone Something has been taken, from deep inside of me A secret locked away No one can ever see Wounds so deep they never show They never go away Like moving pictures in my head For years and years they’ve played If I could change, I would Take back the pain, I would Retrace every wrong move that I made, I would If I could Stand up and take the blame, I would If I could take all the shame to the grave, I would Sometimes I remember The darkness of my past Bringing back these memories I wish I didn’t have Sometimes I think of letting go And never looking back And never moving forward, so there would never be a past Just washing it aside All of the helplessness inside Pretending I don’t feel so misplaced Is so much simpler than change It’s easier to run Replacing the pain with something numb It’s so much easier to let go Than face all this pain in here alone

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Fill-in-the-Blank Example: “Easier to Run” (Linkin Park) It’s easier to ____________ Replacing the pain with ____________________ It’s so much easier to ________________ Than face ___________________ Something has been taken, from ______________ A secret locked away No one can ever see Wounds so deep they never show They never go away Like ____________________________________ For ____________________________________ If I could _________________ Take back the ___________________________ Retrace every ___________________________ If I could stand up and take the ___________________ If I could take all the _________ to the grave, I would Sometimes I remember The _________________________ Bringing back these memories I wish I didn’t have Sometimes I think of letting go And __________________________________________ And never ______________________ So there would never be _______________ Just washing it aside All of the helplessness inside Pretending I don’t feel so misplaced Is so much simpler than change It’s easier to ____________ Replacing the pain with ____________________ It’s so much easier to ________________ Than face ___________________ Sample “Identifying Denial and Addiction” Progress Note: a) X was alert and oriented, affect anxious and depressed, at the onset of group. He chose goal #12 for his group goal, noting: “Because I just want to have fun in a healthy, sober way.” With relation to “Live in the Sky,” X noted: “Ain’t got nothin’ … though one friend 31

died on his own vomit … hung out with him the day before it happened. Yeah, had an effect for one minute, not the next … didn’t affect my drug use at all … smoked a blunt when he died because that’s what we did ….” With regard to “Easier to Run,” X noted: “I related to secret kept locked away … since I was 13 years old … no one knew ….” b) Y was alert and oriented at the onset of group, affect anxious and depressed. She chose goal #9 for group, noting: “No matter where I go, I feel out of place.” With regard to “Easier to Run,” she related to the line “Pretending I don’t feel so misplaced,” reiterating that she had a hard time fitting in with anybody. Some of her peers empathized as well, noting that they had a hard time fitting in with peers due to various cultural and personality perspectives/issues. Y’s song rewrite included lyrics such as: “It’s easier to run away, replacing the pain with a happy smile, it’s so much easier to ignore than to face myself. Sometimes I think of letting go and never coming back, and never reminding myself so there would be no more hurt ….” Y was praised for her involvement in group and reported meeting her goals via “I didn’t beat up on myself.”

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Protocol 3: Entitlement and Addiction Clinical and Musical Considerations The song “Because I Got High” by Afroman (2000, track 1) (Appendix E) lends itself well to listening and discussion, particularly in the initial stages of recovery. In some cases, people who are familiar with this song have used it as a sort of personal anthem that glorifies addiction experiences and validates drug abuse. Vernon Johnson (1990) refers to this glorification as “euphoric recall,” which describes: how alcoholics remember every one of their drinking episodes: that is, euphorically or happily, and with gross distortion! There is no time when they have been under the influence that they are able to recall accurately, and yet they go on believing firmly that they remember everything in complete detail. This type of distortion is vitally important because it involves the drinker’s antisocial and destructive behavior. (p. 43) The familiarity with the song’s protagonist makes it easy for some to identify with him, and these patients often include the most resistant group members, who tend to sing the song with the most enthusiasm. However, when discussed through the lens of denial and addiction, the song takes on an entirely different meaning. Within the context of a group discussion, the lyrics of this song provide a launching point for group members to share the reality of how drug abuse affected their lives. This discussion tends to take on deeper self-disclosure than either of the first two protocols, and remorse is often tangible in these discussions. By the end of the discussion, what once seemed like fun and games (as in the lyrics “I was gonna go to school, but then I got high”) seems more clearly related to negative and often lifethreatening consequences. The deeper intimacy often forged by the above lyric discussion lends itself well to the songwriting segment of this protocol, based on Pink Floyd’s “Wish You Were Here” (1975, track 1). This song is particularly effective here for several reasons, including its universality (i.e., it’s an iconic song with a sense of longing that seems archetypical); the simplicity of the chord structure, which allows for even the most basically trained musicians in the group to participate as backup guitarists or keyboard players; the simplicity of the lyric structure, which is inviting to even the most reticent “lyricists”; the more serious tone of the song, which offsets and challenges the light and frivolous tone of “Because I Got High,” acting almost as a “musical superego”; and the fact that the lyrics in the rewrite can be made to magnify this musical effect, wherein the voice of the inner addict in denial is challenged by the voice of the person in recovery (see below).

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Session Outline Songs: “Because I Got High” (Afroman) and “Wish You Were Here” (Pink Floyd) Purpose: To increase awareness of unhealthy, addiction-related self-talk and related ideas to dispute and cope with those thoughts. Objectives: Participants will … Identify denial as something important to address in the recovery process. Identify thoughts that served to maintain addictive behaviors. Identify thoughts designed to dispute and cope with addiction. Use the above information to rewrite and perform a group song for their peers. Materials: Goal sheets for group members A prerecorded song related to entitlement and addiction (e.g., “Because I Got High”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members Chord chart(s) for song rewrite (for leader and group members who may be musicians), in this case: Pink Floyd’s “Wish You Were Here” A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of denial and addiction, such as Afroman’s “Because I Got High” (Appendix E). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (15 minutes) The therapist provides a guided mini-lecture related to the concept of the Johari Window. (5 minutes)

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The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following two questions: What unhealthy message(s) did you tell yourself that served to maintain your denial and addiction? (10 minutes) What healthy message(s) will help to dispute the above messages and help you to maintain your sobriety/recovery? (10 minutes) Each group is going to act as if they are a musical band. Prior to doing so, they will listen to and play along with a prerecorded song. The song is rewritten using the material generated in group with the following procedure: (15–20 minutes) The therapist then plays the song to rewrite (e.g., “Wish You Were Here”). Group members play along on percussion and melody instruments. (3 minutes) The therapist briefly presents the structure of the song (e.g., verse one will address the issue of thoughts related to denial, and verse two will deal with various coping thoughts/skills). To break the ice, the therapist asks all group members to assist with creating a sample song line on the board, using a fill-inthe-blank format as demonstrated with “So, so you think you can change” (see the full sample group song rewrite below). (15–20 minutes) Each group chooses a name for themselves. Next, they are asked to determine how they will perform the song. (10–15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Example of Group Entitlement and Addiction Song Rewrite: Verse 1: (Denial-related self-messages) So, so you think you can change, you can’t stop on your own, so how ’bout some more cocaine? It’s never enough, just one more touch, it’s such a good feeling, when I do that stuff. Verse 2: (Disputing-related messages) Hey, I don’t want that life. Why aren’t you dead yet? Look at your court record now. You look like a fool. You’re not that cool … hey, is that some drool? Sample “Entitlement and Addiction” Progress Note:

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X chose goal #6 for his group goal, noting: “Usually when I talk to people or get told how to do better things, I’m an asshole. I treat people like shit.” With relation to “Because I Got High,” X noted: “I related to the line about I wasn’t gonna run from the cops, but then got high, because I ran into a cop while trying to get away on a bicycle … accidentally ran into the cop … got tazered ….” With regard to denial-related selfmessages: “I’m permanently f-d up … and everyone’s doin’ it.” With relation to recoveryrelated self-messages: “You’re dealing with meth! WTF!” X remained active for the duration of the group, participating in the above song rewrite to “Wish You Were Here” and playing percussion for his group’s final version. He reported meeting his identified goal “by treating my fellow peers with respect.”

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Protocol 4: Identifying and Confronting “Stinking Thinking” Clinical and Musical Considerations While the first three protocols serve to help break through the initial denial involved in the initial stages of treatment, the second group of protocols in this stage (Protocols 4–8) continues this momentum while moving into more risk-taking related to both increased personal sharing and more responsibility for the final product. In this case, participants are asked to confront lies that they’ve told themselves in order to maintain their addiction. The lyrics of the song “Paradise” by Vanessa Carlton (2002, track 7) (Appendix F) provide an excellent springboard into this topic. These thought-provoking lyrics include: Verse: As darkness quickly steals the light That shined within her eyes She slowly swallows all her fear And soothes her mind with lies … Chorus: And it’s one more day in paradise One more day in paradise It’s one more day in paradise One last chance to feel all right … all right. Approaching this topic via lyric analysis provides a powerful vehicle that helps to bypass many of the defense mechanisms often used in addictions that are based predominantly on self-manufactured lies (see the defense mechanisms listed above related to denial). These lyrics are able to do so because they are easy for a chemically dependent person in denial to relate to. Having to tell lies to oneself (and others) “until I believed them” is a statement often heard in addiction treatment groups, with relation to how someone could act against their own values in such a flagrant manner. Listening to a story that is so easily identified with bypasses the need for a defensive stance. This, in turn, opens the door for increased trust, relating, and sharing even in the face of being challenged at another level of depth. This type of self-challenging and increased self-disclosure is essential in order for treatment to progress. It helps to further identify the thought processes underlying selfdestructive defense mechanisms. By doing so, one starts to become increasingly aware of the “civil war” going on inside them, related to wanting to use drugs or alcohol while simultaneously wanting to obtain sobriety (Johnson, 1990, p. 84). In addition, this selfconfrontation allows for increased acceptance and internalization of compassionate selfawareness via the “confronting” process (Johnson, p. 158) involved in peers providing and receiving direct feedback. Once again, the consequences of “stinking thinking” (an AA term referring to the types of thinking that are associated with self-destructive 37

defense mechanisms such as “I can easily have one drink without having any more,” etc.) are addressed, but this time in a more direct and thought-provoking manner. This time, more personal responsibility is required to complete the requested task. While the “reality check” aspect of this group is similar to a variety of psychotherapy approaches, most notably Rational Emotive Behavior Therapy, the focus is on a meditative process that continually challenges participants to embrace a level of personal awareness that includes monitoring their thought processes. Therefore, the reality check is a simple way to both identify and confront one’s manner of unhealthy thinking and challenge oneself to identify healthier coping skills. These skills are essential to the maintenance of sobriety and are woven developmentally throughout the entirety of this manual. Finally, the development of the group rap song addresses many of the issues addressed earlier in the blues-writing segment. Here, however, there is even more emphasis on risk-taking, as the form or structure of the rap is not readily provided to the participants. While participants may have several prerecorded rap beats to choose from or make up one of their own, they must operate as a cohesive group to choose a suitable groove. After a suitable rap groove is chosen, the group must work together to fashion their lyrics into a “rap-able” form. Finally, with regard to actual performance, the group members must determine whether they wish to have a chorus or simply verses, who should do the rapping (a soloist, various group members, a soloist on verses and all group members on chorus, etc.). Sometimes groups would create a sung chorus and rapped verses. Though still threatening in some ways, rap is generally one of the least threatening performance styles, as it doesn’t demand a trained singing voice. As a result, there have been many surprise guest artists, or participants who might not normally take such a risk, who have taken the risk to lead the final product.

Session Outline Song: “Paradise” (Vanessa Carlton) and original rap Purpose: To increase awareness of unhealthy, addiction-related self-talk and related ideas to dispute and cope with those thoughts. Objectives: Participants will … Identify negative, denial-related thoughts that served to maintain addictive behaviors. Identify thoughts designed to dispute negative thoughts and cope with addiction. Use the above information to rewrite and perform a group song for their peers. Materials: Goal sheets for group members A prerecorded song related to confronting “stinking thinking” (e.g., “Paradise” by Vanessa Carlton). A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” 38

Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members Assorted prerecorded rap beats/melodies (or use percussion/melody instruments at hand) A predeveloped rap chorus A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song, such as “Paradise” by Vanessa Carlton (Appendix F), that addresses the issue of denial and addiction, particularly focusing on lies one tells oneself (e.g., negative self-talk). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (15 minutes) The therapist may provide a guided mini-lecture related to the Johari Window, focusing on how only the self is aware of secrets and the quote “we are only as sick as our secrets.” (5 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following three questions: (15 minutes) What “lies” did you tell yourself that served to maintain your denial and addiction? What were some of the consequences that you suffered as a result of those lies? If you were to give yourself a “reality check,” what would you say to yourself (e.g., the truth that was previously avoided, or that you have “come to” as a result of your consequences)? The group reconvenes and is told that they are going to act as if they are a musical/rap band. Prior to doing so, they will listen to and determine an appropriate rap beat from a prechosen selection or create one with the therapist. (10 minutes)

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A prewritten rap chorus is shared with the group (this saves a great deal of time, although the group may choose to create their own chorus with a similar theme), for instance: (2 minutes) “Doing drugs can make you lie to yourself, make you act like somebody else. Just when you think you’re in control, you find yourself in a battle for your soul” The group uses the material from their interviews to create a rap song with the above chorus, for instance: (Lies) “I’m not drunk, I can drink, crack is the bomb, I can use and stay alive” (Consequences) “I crashed my truck, my friend was fighting for his life, going to rehab, been hospitalized.” (Reality Check) “I can’t use crack, even pot may take me back, I can’t drink and drive if I want to stay alive.” The group chooses a name for themselves. Next, they are asked to determine how they will perform the song, and they perform song. (10–15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample “Identifying and Confronting Stinking Thinking” Progress Note: X chose goal #12 for his group goal, noting: “I don’t know how to have fun in a sober way.” With relation to “Paradise,” X noted: “I related to the line about not feeling like I had a problem … I know I have to stop, I’m getting kicked out of my house … would rather join the military but you can’t if you are using … I keep telling myself I’ll quit tomorrow.” With regard to lies: “I told my friends it was OK to drive when I was high.” With relation to recovery-related self-messages: “Drove a car while high with my best friend, smashed it, came close to killing him … I had several broken bones.” With regard to reality check: “You’re wasted … don’t get in the car, you’ll kill yourself and your friends.” Peers provided appropriate feedback. X remained active for the duration of the group, participating in the above song/rap write, rapping a solo for his group’s final version. He reported meeting his identified goal “by letting myself have fun without being wasted.”

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Protocol 5: Guilt vs. Shame and Recovery Clinical and Musical Considerations This protocol explores the concepts of guilt vs. shame and addiction and touches on the topic of forgiveness/self-acceptance, which is focused on more directly in Protocol 3. Once again, Vernon Johnson (1990) provides an eloquent example of this concept within the context of a chapter on characterological conflict that has to do with the inner “civil war” chemically dependent persons experience as it pertains to their values conflicting with their addiction. He notes: ”A description of despair by Soren Kirkegaard found in his book The Sickness Unto Death comes to mind here. Human despair is found at three levels, he claims. The first, which is excruciating in its pain, is the despair that expresses itself in sentences such as, ‘Oh, what a miserable wretch I am; Oh, how unbearable it is to be me!’ Still more painful, however, is the despair that expresses itself by crying out: ‘Oh, if only I were not what I am! Oh, if only I could be like that!’ This is deeper despair because it considers self to be so worthless as to want to abandon it completely. There is nothing left to the self worth saving. But the deepest despair of all is that despair that does not believe that one is a self at all. ‘I used to be but now am not’” (pp. 84–85). The above depiction succinctly demonstrates both the progression (or retrogression) of self-identity as chemical dependence progresses and the levels of despair that parallel the ideas of guilt (I did something wrong) vs. shame (I am something wrong). Feelings of guilt often begin to emerge in the initial stages of treatment, as participants begin to reflect with remorse on some of the ways in which they acted against their values and the values or rights of others. Depending on the person, however, these feelings may go beyond guilt, as this may not be their first attempt at rehabilitation. Quite often, people who wind up relapsing after a successful period of sobriety often sink into a deeper type of despair referred to as shame. Rather than seeing their actions as regrettable, they see themselves as regrettable, as in “I used to be a good person, but now I’m not.” These ideas are well represented in Randy Newman’s blues song “Guilty” (1973, track 10), wherein Bonnie Raitt sings: Well, I’m guilty, honey, I’m guilty, And I’ll be guilty all the rest of my life. How come I never do what I’m supposed to do? Nothing I try to do ever turns out right. You know how it is with me, baby, You know I just can’t stand myself. It takes a whole lot of medicine, darling, For me to pretend I’m someone else. The above lyrics clearly note how guilt helps to create a vicious cycle related to making attempts to do good but failing (within in the context of addiction), resulting in further 41

self-loathing. Fueling this sense of self-loathing is also the notion that one has an unrepayable debt to those one has wronged and so will be “guilty all the rest of my life.” Finally, the chemically dependent person goes from having had a sense of self to having to pretend that they are someone else just to survive. In the above manner, addiction is built on a “platform of pain” (Gorski, 2010). The chemically dependent person “uses their alcohol or drug of choice to mediate the pain.” Through the use of alcohol and/or drugs, a rationale develops that helps to buttress the Big 5 defense mechanisms, which, as noted above, include avoidance, absolute denial, minimizing, rationalizing, and blame. It starts with a vicious cycle of thinking that goes something like “I don’t have problems because I drink and drug; I drink and drug because I have problems.” The resulting culture created by the chemically dependent person and perpetuated by them and their families is one built on increasing guilt and shame. For example, the family culture becomes: “Don’t talk about this entire issue. If I do, I will feel anger, fear, guilt, and shame.” Within this protocol the therapist takes the opportunity to explore the progression of addiction as pertains to values. For instance, it is noted that as one progresses through their addiction, they begin to act against their values, losing friends, family, jobs, and sense of self (among many other things). However, it is also pointed out that a person’s values never “disappear” and that their values are in fact reclaimed through the rehabilitation process (see the example of the “values chart,” Vernon Johnson, 1980, p. 113). In essence, recognizing values that one has acted against potentiates the reclamation of those same positive values. In the process of relapse, however, a false sense of positive feelings (often based on having recaptured one’s values, but leaving treatment without a solid plan for sobriety) may ultimately result in relapse and overwhelming feelings of shame. This protocol allows those experiencing both guilt and shame to explore the meanings of these concepts and find a meaningful manner in which to express their lived experience. It also assists in starting to develop a sense of self-acceptance and forgiveness for things that can’t necessarily be undone but with personal integrity may be overcome without the need for eternal self-annihilation.

Session Outline Songs: “Guilty” (Randy Newman) and “The Thrill Is Gone” (B. B. King) Purpose: To increase awareness of personal values as a manner of re-establishing a sense of humanity, identity, motivation, and personal integrity. Objectives: Participants will … Identify addiction-related behaviors that cause(d) remorse/guilt Identify underlying values related to those behaviors Identify behaviors that will demonstrate personal integrity as related to sobriety Materials: Goal sheets for group members 42

A prerecorded song related to guilt vs. shame and recovery (e.g., “Guilty” by Randy Newman) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members Sample minor blues (e.g., “The Thrill Is Gone” by B. B. King, 1969) song layout (either write on board or hand out) A pad and pen to take notes related to participants’ responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of values and addiction, such as Randy Newman’s “Guilty” (Appendix G). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (15 minutes) The therapist provides a guided mini-lecture related to the concept of the progression of addiction-based behavior and how it relates to personal values. In addition, the concept of shame and addiction is addressed here, with particular emphasis on the difference between guilt and shame and how both often promote relapse behavior. The concept of self-acceptance is also introduced here as an important, often radical departure from shame. This is done through a “values chart,” as depicted by Vernon Johnson (1990, p. 113). (10 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to chose a “scribe,” who is responsible for writing group member responses to the following three questions: (15 minutes) Identify three addiction-related behaviors over which you felt or feel remorse. Identify a personal value of each of the above behaviors. Identify two or three value-related behaviors that will serve to maintain your sobriety. Each group is going to act as if they are a musical band. Prior to doing so, they will listen to and play along with a minor instrumental blues song performed by 43

the therapist. The song is then written using the material generated in group with the following procedure: (15–20 minutes) The therapist introduces the minor blues song style. Group members play along on percussion and melody instruments. The therapist briefly presents the structure of the song (e.g., verse 1 will address addiction-related behaviors that brought about remorse or guilt; verse 2, related values; verse 3, value-related behaviors that will help maintain sobriety). To break the ice, the therapist asks all group members to assist with creating a sample song line on the board, using a fill-in-the-blank format as demonstrated below: Sample 12-Bar Minor Blues Format (to tune of B. B. King’s “The Thrill Is Gone”): Verse 1: (Values-related statement) Get myself together, Look what I have done (2x) Need to get back to my values, don’t want to live my life on the run. Verse 2: (Addiction-related behaviors that cause guilt or remorse) You know I’ve _________________________________ (2x) Said I’m guilty, and I feel like _______________________ Verse 3: (Values and related behaviors that increase personal integrity) I still have my _____________________ I can be __________________________ Said I still have my values, so I can ____________________ Each group chooses a name for themselves. Next, they are asked to determine how they will perform the song. (10–15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Values Group Song Example: Verse 1: (Values-related statement) Get myself together, look what I have done (2x) Need to get back to my values, don’t want to live my life on the run. Verse 2: (Addiction-related behaviors that cause guilt or remorse) You know I’ve lost my friends, and I cheated on my wife. Lost a whole lot of money, and tried to take my life. Said I’m guilty, and I feel like I want to die. 44

Verse 3: (Values and related behaviors that increase personal integrity) I still have my will to be faithful, got my love and am building trust. I can be responsible, I can change or I will rust Said I still have my values, so I can go on like I must. Sample “Guilt vs. Shame and Recovery” Progress Note: X chose goal #7 as her focus, noting: “I am frustrated today.” She actively participated in the song discussion to “Guilty,” noting that “it takes a whole lotta medicine for me to pretend … always used to be someone else … didn’t want to be me.” During peer interviews, X noted guilt-related losses, including: “I stole from my parents, lied to my friends, made my mom believe it was the diabetes that was killing me when it was really the drugs.” With relation to remaining values, X noted, “I still have my family and my friends, and I’m working on my health.” X remained active in the song rewrite and performing of the group song, singing backup vocals for her peers in the final performance. She noted meeting her goals via “I was very sad and frustrated when I started, now I feel a little better.”

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Protocol 6: Maintaining Awareness of the Consequences of Addiction and Identifying Coping Skills Clinical and Musical Considerations This protocol focuses on maintaining the awareness of consequences related to addiction and continuing to further identify coping skills. The maintenance of awareness of consequences, or “keeping it green,” is an ongoing part of the recovery process. This session allows for continued exploration of these issues, as well as encouraging the idea of finding viable alternatives to addiction-related behaviors. The lyrics of the song “What It’s Like” by Everlast (1998, track 4) (Appendix H), provide the context for the group discussion. The lyrics, including three verses and a chorus, describe three people who find themselves in difficult circumstances that are often stigmatized by society. One person is an alcohol-addicted homeless man begging for change; one is a woman who is going through an abortion; and one is a gang-involved young man who was shot dead. The listener is challenged to empathize with each, as the lyrics note: “God forbid you ever have to walk a mile in his [her] shoes, ’cause then you really might know what it’s like to ….” Depending on the verse, the lyrics further note: “Sing the blues, have to choose, or to have to lose.” The discussion centers on the ideas of the consequences of addiction, including depression, losing everything you value, and stigma. It also focuses on the defense mechanism of self-pity (e.g., “you have no idea what it’s like,” “why me?,” etc.) that frequently accompanies addiction. This feeling of being all alone often translates into further resentment of and isolation from others. Further isolation makes it only harder to reestablish some kind of appropriate ties with others, including appropriate/supportive family and friends. The song “Sober” by Pink (2008, track 1) (Appendix I) provides excellent material for listening and discussion related to the topic of being sober vs. being addicted or even “clean” (e.g., simply stopping the drug or alcohol use without further support/intervention related to the underlying issues). The lyrics of the chorus note: “I’m safe, up high, nothin can touch me. Why do I feel the party’s over? No pain, inside, you’re my protection. But how do I feel this good sober?” This is one of the core questions people with addictions face when embarking in treatment. These lyrics open the door for a discussion related to finding realistic, meaningful, and viable alternatives to using drugs or alcohol. During the course of this discussion, many important themes related to maintaining sobriety may be addressed. For instance, is it realistic to believe that life is all about “feeling good” all the time? Learning to deal with frustration/distress is part of the developmental process. There are many reasons for not having learned to develop appropriate coping mechanisms for distress, including having grown up in an abusive family, being overly entitled, and the narcissism involved in the addiction process itself (e.g., the AA metaphor of King Baby’s song: “I want what I want when I want it”). Addressing these issues in the context of this song discussion allows for a deeper level of personal understanding with regard to realistic life expectations and commitment to the concepts of personal growth and sobriety. 46

Finally, the song “What It’s Like” by Everlast provides a simple chord and melodic structure that is easy to rewrite using discussion material from the group (e.g., see the song rewrite sample in the Session Outline).

Session Outline Songs: “What It’s Like” by Everlast and “Sober” by Pink Purpose: To maintain and increase awareness of the consequences of addiction (e.g., “keeping it green”; see below), as well as identifying appropriate coping skills for maintaining sobriety. Objectives: Participants will … Identify negative consequences associated with their addiction. Identify viable alternatives to addiction. Use the above information to identify behaviors for long-term maintenance of sobriety. Materials: Goal sheets for group members A prerecorded song related to maintaining awareness of the consequences of addiction and denial (e.g., “What It’s Like” by Everlast) A prerecorded song related to the topic of being sober versus being addicted or even clean (e.g. “Sober” by Pink) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Assorted percussion instruments for all group members Chord chart/lyrics for “What It’s Like” by Everlast A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of the consequences of addiction, such as “What It’s Like” by Everlast (Appendix H). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (10 minutes) 47

The therapist may provide a mini guided-lecture related to the importance of “keeping it green,” an AA term denoting the importance of remembering the consequences of addiction, which are often forgotten once one is clean for a sustained period of time. This often leads to the mistaken idea that one can continue to associate with the people, places, and things associated with prior to admission to rehab. (5 minutes) Group members listen to another song that addresses the issue of dealing with life sober, such as “Sober” by Pink (Appendix I). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (15 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following questions: Describe what it was like when you “hit bottom.” (5 minutes) What were some of the consequences that you suffered as a result? (5 minutes) What are some of your fears related to finding something to replace your addiction of choice? (5 minutes) Name three things that may serve to replace your addiction in a viable manner. (10 minutes) The group reconvenes and is told that they are going to act as if they are a musical band. In order to “warm up,” they will play along with the therapist-played instrumental version of “What It’s Like” by Everlast. (5 minutes) The groups use the material from their interviews to rewrite the song “What It’s Like.” (10–15 minutes) While each small performance group may choose a lead singer, the large group reconvenes and sings the chorus parts as a whole. (10–15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes)

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Sample Group Song Rewrite: Verse 1: When I hit bottom I felt trapped, I felt like dying. My life was destroyed, no chance for a future, felt like crying. I was shootin’ heroin, sellin’ drugs, isolating from my friends. I let down myself, my family, and it felt like the end. Chorus: God forbid you ever had to walk a mile in my shoes, Then you really might know what it’s like to sing the blues. Verse 2: Now I’m workin’ on recovery and learning to walk in my own shoes. Meditation, prayer, and making myself choose. Sample “Maintaining Awareness of the Consequences of Addiction and Identifying Coping Skills” Progress Note: X chose goals #6 and #7 for his group focus, noting: “I don’t finish anything I start, lack of motivation for anything.” With relation to “What It’s Like,” X noted: “I related to the line ‘then you really might know what it’s like to sing the blues’ … I’ve done some horrible things, Dad did some horrible things too … to us they seemed normal because there was a reason we did it … nobody understands … never really wanted to steal, but at times didn’t feel I had a choice.” With regard to being sober, X noted: “I related to the chorus … I’m safe, up high … etc. … When I was messed up, I was numb to the world … as when you don’t deal with things, more things build up from not dealing with life. Realizing I had to do something … I’m actually liking not having to use right when I get up … used to think … ‘wake up … now there’s my toothbrush, but where’s the syringe?’” X remained attentive and active for the duration of the group. He participated in the song rewrite, played percussion, and helped sing the final verse of the song (see above). He noted meeting his goals via “I actually participated in something and didn’t think it was totally dumb.”

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Protocol 7: Identifying Progress in Recovery Clinical and Musical Considerations This protocol returns the focus to the individual participant, providing a chance to explore progress in recovery. The song choice, “Girl With Golden Eyes” by Sixx:A.M. (2007, track 10), is about both the progression and the recovery process of the protagonist’s recovery from heroin addiction. The lyrics include: .

Verse: … I wish I never kissed her ’Cause I just can’t resist her The girl with golden eyes … Chorus: Everything will be okay Everything will be alright If I can get away from her And save my worthless life. Verse: I wake up every morning Jonesing for her love The girl with golden eyes I won’t have to wait long ’Til she buries me with roses, ’Cause she’s always by my side … Spoken word: Day one. Dope free. I went to the clinic today and got the first dose of methadone. I’m out of dope so I threw away all my rigs (etc.). In the above manner, a heroin-dependent person depicts his addiction to and recovery from heroin. The lyrics are relatively easy to relate to no matter what the addiction, making it easy and relatively nonthreatening for the person in recovery to relate to and comment on from personal experience. The second half of the song (involving spoken word in journal form related to recovery) allows the group participant to explore their progress in recovery to date. For example, on a scale of 1 to 10, with 10 representing addicted and on a downward/life-threatening spiral (as in the song), where did they feel they were with regard to being addicted? In addition, on a scale of 1 to 10, with 10 representing being clean and sober, where do they feel they are with relation to their recovery process? These are seemingly simple but powerful questions, in that they open the topic for both personal and peer (i.e., group member) reflection. In the context of a group 50

process that has existed over the course of several weeks now, group members have had the chance to observe themselves and each other, and themselves in relation to each other, within a “learning by doing” context (as well as in the rehab experience at large). Having done so, they are well-equipped to level with each other with regard to providing honest and open feedback relating to their own as well as others’ self-proclaimed progression in treatment. The music for the song rewrite, Lynyrd Skynyrd’s “Free Bird” (1974), is a wellknown and inviting song that provides a reliable springboard into self- and group expression related to the recovery process. Most folks in recovery are familiar with this song, and using this process to do a song rewrite helps to reframe the song in a positive manner with regard to sobriety. The chord progression of this song is simple enough for most nonprofessional musicians to play, as there will often be a group member who knows basic guitar chords. In addition, the structure of the lyrics allows for an easy rewrite (as below). In addition, there is an opening at the end of the song for improvisation on any instrument (e.g., guitar, piano, percussion), which allows for a wide range of free expression, another positive metaphor for sobriety.

Session Outline Songs: “Girl With Golden Eyes” (Sixx:A.M.) and “Free Bird” (Lynyrd Skynyrd) Purpose: To identify progress in recovery. Objectives: Participants will … Identify issues related to the progression and consequences of addiction (e.g., alluring/feels good at first, increasing consequences as time goes by, pain of withdrawal, etc.). Identify “consequences” of sobriety (e.g., increased personal integrity, increased trust, increased support from peers, etc.). Identify the difference from where group members were when they initiated treatment and where they are now with relation to sobriety. Materials: Goal sheets for group members A prerecorded song related to identifying progress in recovery (e.g., “Girl With Golden Eyes”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Guitar and piano chord chart for “Free Bird” Assorted percussion instruments for all group members

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Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of the progression of addiction, such as Sixx:A.M.’s “Girl With Golden Eyes” (Appendix J). The therapist involves the group in a guided discussion related to the lyrics of the song, requesting a brief response from each group member. In particular, the therapist may ask each group member to choose one or two lines of the song that they relate to, and tell why. (15 minutes) The therapist provides a guided mini-lecture related to the concept of the “Progression of Addiction” (Johnson, 1980, p.30). (5 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following questions: On a scale of 1 to 10 (10 being sobriety): Where were you when you entered treatment and what does that number signify to you (i.e., How far did your addiction progress and what were the consequences?)? (10 minutes) Where are you currently with relation to your recovery and what are the related “symptoms” of recovery? (10 minutes) Each group is going to act as if they are a musical band. Prior to doing so, they will listen to and play along with a prerecorded song. The song is rewritten using the material generated in group with the following procedure: The therapist then plays a song to re-write (e.g., Lynyrd Skynyrd’s “Free Bird”). Group members play along on percussion and melody instruments. The therapist briefly presents the structure of the song (e.g., verse one will address the issue of thoughts related to where they were when they first entered treatment, and verse two, where they feel they are presently with regard to recovery). To break the ice, the therapist asks all group members to assist with creating a sample song line on the board, using a fill-in-the-blank format as demonstrated below: “When I first came to rehab, I felt __________” (see the full sample group song rewrite below). (15–20 minutes) Each group chooses a name for themselves. Next, they are asked to determine how they will perform the song. (10–15 minutes) 52

After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Example of Group Song Rewrite: Verse 1 (and 2 in this example): (Entry into rehab) When I first came to rehab, I felt insecure and ashamed. Because I didn’t want to be there, and my addiction was on a rage. I was doin’ meth and cocaine, smokin’ weed and popping E. Withdrawal was kicking my ass bad, and there was no one there to stop me. Verse 2: (Progress in treatment to date) Now that I’m in recovery, I’m clean, high on life and hovering (above the addiction). There are people here to help me, I have to stay sober for me! (Repeat “I have to stay sober for me” three times and go into instrumental jam at end of “Free Bird”). Sample “Identifying Progress in Recovery” Progress Note: X was alert and oriented during the group, affect depressed and anxious at the onset. He chose goal #7 for his group goal, noting: “Because I need help being tolerant with people’s crap. When I get frustrated, comes out in different ways … possibly using or doing other things.” With relation to “Girl With Golden Eyes,” X noted: “I related to the line ‘if I can get away from her and save my worthless life’ … that’s how I felt on ecstasy … I stole pillboxes so I’d have enough for a week … I knew I’d die if I kept going … because I could feel it in my head when it first kicked in (I was snorting then) … heart pounding … MRI showed brain damage, and I had a significant decrease in processing speed. I also had to relearn basic motor skills … they showed me how much of my brain I had literally erased, it was messed up.” With relation to where he was on scale of 1 to 10 (sobriety) when he first entered rehab, X noted: “When I first came, I was a 1, it was the worst. I felt sick, depressed, withdrawing from oxycontin, all I wanted was opiates, I was feelin’ really bad.” With regard to present: “Now I’m a 7, because I’m still depressed, which ultimately leads me to relapse … haven’t fully learned to deal with it sober.” X remained active for the duration of the group, participating in the above song rewrite to “Free Bird” and playing percussion for his group’s final version. He reported meeting his identified goal via “I learned to deal with frustration through music, it’s a good way to cope.”

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PART III: MIDDLE RECOVERY: LIFESTYLE REPAIR

Rationale for Protocols 8–14: Lifestyle Repair The following protocols have been designed to address issues that tend to arise in the treatment stage of Middle Recovery as defined by Gorski (2010). After several weeks of working together in treatment, group members have had the opportunity to fully detoxify from their drug of choice, address and work through issues of denial related to chemical dependence, start to take more responsibility for their behaviors (i.e., based on their ability to set and reach appropriate goals, peer and therapist feedback, etc.), work together in a more cooperative manner, and better utilize the music experiences for their own benefit. At this point, group members should be better able to focus on issues that still need to be addressed before they can make a successful reentry into their respective lives. As Gorski (2010) notes, two of the key questions are, “Who am I and what do others expect of me in the world?” and “Who are other people and what do I expect of others as a condition of belonging?” In part, the answers to these questions have already been addressed by the group in prior musical experiences. For instance, through both nonverbal (e.g., via observational peer feedback) and verbal feedback during and after groups, group members receive a great deal of information from relatively nonbiased peers regarding both of these questions, and this information is often more compelling than what the therapist has to say. These protocols allow the above process of group development and the feedback inherent in such a model to continue, while starting to address issues that are more focused on resolving issues with others. Issues related to gender, authority, and peers and subordinates are further explored in this section. For instance, in the first of these protocols, entitled “Forgiveness and Recovery,” one is asked to identify behaviors that one continues to feel ashamed about in recovery. This most usually involves a behavior wherein the rights of another person have been abused. Protocol 9 addresses the issue of how chemical dependence affects the entire family. Protocol 10 deals with the topic of narcissism and addiction, focusing on how one’s character defects may affect other persons. Protocol 11, “Real Love,” moves forward from the topic of self-love into the topic of determining what factors help to make healthy relationships. Protocol 14, “Taking Care of Unfinished Business,” challenges group members to identify and let go of remaining resentments and expectations related to important others in their lives. Part Three ends with a protocol related to remaining active in recovery. This protocol helps to buttress the idea that the process of recovery does not end when one is discharged from treatment. The process of recovery is lifelong and involves making use of a variety of coping skills and supports. It also involves a lifelong process of selfreflection, which is inherent in anyone who seeks to have a productive and rewarding life.

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Protocol 8: Forgiveness and Recovery Clinical and Musical Considerations Having spent a month or so focusing on challenging addictive thinking and hopefully breaking through some of the related defense mechanisms associated with addictive thinking, it is important to learn to forgive one’s self and others and develop a sense of self-acceptance for the persona that is emerging within the recovery process. As a person in recovery becomes clean and sober, the personality they had prior to the onset of their chemical dependence resurfaces. For many, this creates a substantial obstacle to treatment, as chemical abuse is quite often used to mask, overcompensate for, or squelch unwanted aspects of one’s self. This resurfacing of personality may pose such a threat that the person in recovery may act out or decompensate/relapse. Still others may withdraw or isolate. For some, the reemerging personality is akin to that of a young teenager, that person who started to use for the first time prior to developing adult coping skills. In this sense, rehabilitation may take the form of habilitation, as one literally learns social coping skills (for example) while being sober for the first time. As this renewed sense of self tentatively emerges within the recovery process, it is important to buttress it with an ability to forgive oneself for prior addiction-related behaviors and accept one’s self and others. Without the ability to forgive, another vicious cycle may begin wherein guilt and shame allow one a perfect excuse for relapse. In addition, without forgiveness and self-acceptance, there can be little hope or motivation for developing and maintaining a sober lifestyle. Hence, the first step in this set of protocols related to lifestyle repair is to identify behaviors, perhaps yet identified, that still have guilt and shame associated with them. This is a difficult step, as it frequently involves sharing at a level of depth heretofore not achieved in group. The song “Let It Go” by Tim McGraw (2007, track 3), provides an appropriate launching point for discussion of forgiveness. The lyrics include: Verse: Skeletons and ghosts are hiding in the shadows Threatening me with all the things they know Choices and mistakes, they all know my name But I’m through holding on to all that pain Chorus: Today I’m gonna keep on walkin’ I’m gonna hold my head up high I’m gonna leave it all behind Today I’m gonna stand out in the rain Let it wash it all away, yeah, wash it all away I’m gonna let it go, oh yeah 58

I’m gonna let it go, oh yeah … I know I know I know I’ve been forgiven I know I know I know I’m gonna start living … These lyrics clearly address the topic of forgiveness in a manner onto which most people can project their dependence-related experiences. Words like “skeletons,” “ghosts,” and “threatening” help to open the door to communication about past selfdefeating behaviors that may not have been addressed in treatment. The song’s lyrics also help to empower group members with words such as “choices,” being “through holding onto all that pain,” “keep on walkin’,” and “start living.” It is often helpful to use related quotes to stimulate discussion after the song discussion (i.e., just prior to moving into small groups). Such quotes may be found in William White’s Pathways from the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals (1996). Some of the more useful ones for the purpose of this exercise include: “Opening the mind” “We are only as sick as our secrets” “It’s important to catalogue one’s sins of omission as well as sins of commission” “By letting go of secrets, they lose their ability to hurt and control” “Purging secrets provides opportunities to recapture lost innocence” (refer back to the Johari Window [Johnson, 1990], particularly to the pane about secrets and the idea that part of the goal in recovery is to become a more open person) This also is a good place to review a “Defects of Character” chart, as outlined in AA'’s 5th Step. A nice example can be found at the website for The Big Book Bunch (2011). This reading provides a nice definition of character, as well as of what one can expect from completing the 5th Step, including “We are delighted; We can look the world in the eye; We can be alone at perfect peace and ease; Our fears fall from us;” etc. Prior to reviewing the 5th Step, however, it is useful to ask the group to read the following related paragraph from Mr. White’s book (1996): Addiction-transformed people inevitably suffer humiliations and degradations. Having wounded others, their own selves have been wounded and they have lost faith. The whole recovery process, and the act of restitution in particular, provides a way to restore personal honor. Honor and faith are restored not by words, for which the addict becomes the tool of manipulation, but by sustained action. Honor is restored not through promises, but through preparation and performance. (p. 434)

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Through empathy and validation, the group may provide a powerful milieu in which to address such difficult issues as identifying one’s defects of character and exploring the related idea of forgiveness. Rewriting the song “Drift Away” by Dobie Gray (1973) provides an opportunity to address forgiveness in a thoughtful and soulful manner. This song is familiar to most people, and its chord progression is simple enough for beginning musicians to play. The verses lend themselves well to depicting both prior acting-out behaviors and the types of support one will need to obtain and maintain to sustain recovery. Once again, having peers assist in providing options to dependence can increase the amount of realistic and meaningful coping strategies of which a recovering person feels they may partake.

Session Outline Songs: “Let It Go” (Tim McGraw) and “Drift Away” (Dobie Gray) Purpose: To increase awareness of concepts related to forgiveness (of self and others) and recovery. Objectives: Participants will … Identify issues related to their addiction and shame. Identify behaviors that they are going to take responsibility for sustaining in their recovery. Materials: Goal sheets for group members A prerecorded song related to forgiveness and recovery (e.g., “Let It Go”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Chord chart/lyrics for “Drift Away” by Dobie Gray Assorted percussion instruments for all group members Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to and discuss the lyrics of a song that addresses the issue of forgiveness and recovery (e.g., “Let It Go” by Tim McGraw, Appendix K) . They are asked to determine if there are any lines in the song to which they relate particularly. (10 minutes)

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The therapist guides the group in a mini lecture related to Forgiveness in Addiction, particularly relating to the importance of letting go of secrets, the differences between guilt and shame, and self-forgiveness and sustained action, rather than words (Johnson, 1980, p. 84). (5 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following two questions: (10 minutes) Identify one or two behavior(s) that you feel/felt ashamed about in your addiction but have yet to share in recovery to date. Identify one or two behaviors that you will take responsibility to sustain in your recovery. The small groups are informed that they are going to perform as bands. The therapist hands out percussion instruments and warms up the groups via playing along to the song “Drift Away” by Dobie Gray. (5 minutes) After getting a feel for the song form, each group rewrites the song verses using the material that they gleaned from the interviews. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample Group “Drift Away” Rewrite: Chorus: Give me sobriety and free my soul, I want to get rid of that big black hole and find my way. Verse 1: I wasn’t spending time with my girl. I put alcohol and drugs before the world. Stealin’ from my parents and lyin’ to my girl. I wasn’t around, I couldn’t be found. Verse 2: I need to pick up the phone and make a call. Stay away from drugs and alcohol. Gonna try to pay my parents back. Stop lyin’ to my girl, now I’m back in the world. 61

Sample “Forgiveness and Recovery” Progress Note: X was alert and oriented, affect depressed and anxious. He chose goal #3 as his group focus, noting: “Because I never took responsibility for myself … always blamed it on someone else.” He participated actively in the song discussions, responding to peer contributions and relating to the song lyrics. With regard to “Let It Go”, X noted: “I related to the line ‘I’m gonna hold my head up high, leave it all behind.’” With regard to what X needs to forgive, X noted: “Stealing from my parents.” With regard to how X attends to address that issue in recovery: “Don’t steal anymore, try to pay parents back.” X participated in the group song rewrite and performance experience by playing percussion and singing backup vocals. He reported meeting his goals via “Talked about the past and had fun in a healthy, sober way.”

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Protocol 9: The Impact of Addiction on the Family Clinical and Musical Considerations Chemical dependence is a family disorder. As the chemically dependent person’s addiction progresses, families become entrenched in a world view that both parallels and enables the addiction process. In fact, “there’s a 30% to 60% chance that at least one additional family member is abusing drugs or alcohol, or is also chemically dependent” (Gorski, 2010). In the first stages of recovery, or Early Recovery, chemically dependent persons need to turn inward to evaluate their relationship with drugs and how they ended up in treatment. Such questions as “where to go from here if I stop using,” and issues such as honoring a commitment to change are addressed. The first several protocols reflect that process, allowing the participant to focus inward on their experiences to date, the consequences of their actions, and the need for change. This protocol emphasizes work in what Gorski (2010) refers to as Middle Recovery, where the tasks shift from acknowledging that one has a problem and the thinking patterns associated with that problem to starting to redefine who they are and what others expect of them. An acknowledgment of the effects of the chemically dependent person’s actions on the family and related roles is an essential part of the recovery process. It assists the participant in exploring such things as developmental issues related to chemical dependence (e.g., addictive codependencies with other family members that often emerge in adolescent or adulthood), where the family is in relation to the effects of chemical dependence on the family system, and how to initiate healthy changes within the family system. This family-focused protocol opens with a listening and discussion of the song “Family Portrait” by Pink (2001, track 7). The song depicts a family going through a divorce, including the mother’s increased drinking and fighting between the parents. The voice of the song is that of the child being affected by these events. The chorus of this song includes the following lyrics: Chorus: In our family portrait We look pretty happy We look pretty normal Let’s go back to that It ain’t easy, growin’ up in World War 3 Never known what love could be You’ll see, I don’t want love to destroy me Like it has done my family

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This song frequently brings up feelings related to many aspects and roles related to familial relationships. As many of the persons in treatment either come from families of divorce or are engaged in divorce themselves, these lyrics are easy to relate to. Even without divorce per se, however, chemical dependence can infiltrate a family system and destroy it from the inside out. This destruction may involve increased anxiety, depression, familial conflict, attempts to maintain family secrets (related to the chemically dependent person), etc. The above song opens the door for a nonthreatening discussion of the effects of addiction on the family. Prior to this discussion, the therapist provides a helpful depiction of the effects of addiction on the family in the form of a Jellinek-based chart (NYSBA, 2011). This Jellinek-based chart allows the participants to identify where they may be in their own process of addiction and recovery. It also allows them to start to take responsibility for their role in the process and delineates some of the other roles as well. In this manner, participants explore questions related to Who am I to others?, What do I want from them?, and What do they want from me?

Session Outline Songs: “Family Portrait” (Pink) and original blues Purpose: To increase insight related to the effect of addiction on the family. Objectives: Participants will … Identify where they feel their families were with regard to the progression and recovery of the family in the addiction/recovery process. Identify their role in the progression of their families along this continuum. Materials: Goal sheets for group members A prerecorded song related to the effects of addiction on the family (e.g., “Family Portrait” by Pink) Handouts of Jellinick-based chart A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Sample 12-bar blues song/pattern Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses

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Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to and discuss the lyrics from a song that addresses the issue of how they feel their addiction affects their families (e.g., “Family Portrait” by Pink, Appendix L). (15 minutes) The therapist guides the group in a mini-lecture related to the effects of addiction on the family, using a related handout (e.g., The Progression and Recovery of the Family in the Disease of Alcoholism, NYSBA, 2011). (5–10 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following three questions: (15 minutes) Identify where on the continuum of progression and recovery they feel their family was prior to treatment. Identify where on the continuum of progression and recovery they feel their family is now. Identify their role in the above progression. The small groups are informed that they are going to become blues bands. To do so, the therapist plays some 12-bar sample blues as a way to warm up the group for what’s to come. (5–10 minutes) After getting a feel for the blues form, each group writes a blues song related to the above issue. The therapist may provide a sample initial line for each verse to help the process along, such as: (15 minutes) Verse 1: My addiction brought my family a whole world of pain. (Continue with familial consequences of addiction) Verse 2: I was stealing from my parents and robbing my friends. (Continue with behaviors that affected the family) Verse 3: I’ve made amends with my parents, and I’m working the steps. (Continue with sobriety-related behaviors)

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7) Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) 8) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample “Impact of Addiction on the Family” Progress Note: X was alert and oriented during group today. She chose goal #12 as her focus. She participated actively in listening and discussion to the song “Family Portrait” by Pink, noting “it reminds me of when I was little, parents fought … I didn’t want them to divorce at first … but then I got tired of Dad making Mom upset all the time and wanted them to get divorced. My addiction put a stress on my Mom and sister … I’m not nice, they don’t like it when I use …” X reported that her drug use created “arguments, distrust, and depression.” Now that she’s in rehab, X reports that she’s “willing to change, share with others, and love.” X participated actively in the songwriting portion of the group and played percussion to back up the group’s final performance. She noted achieving her goal via “I had fun.”

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Protocol 10: Narcissism and Addiction Clinical and Musical Considerations There are certain personality styles and personality disorders that tend to reinforce or buttress the “Big 5 defense mechanisms” (Gorski, 2010). Narcissism is a defense mechanism that often arises as a result of neglect or abuse in childhood. The result of this neglect and abuse is often an exaggerated self-love that provides a defense from the pain of not having received love from one’s primary caregivers. However, narcissism may also arise in other ways. For instance, if a person grows up extremely entitled, narcissism may develop either through the recognition that one has received many material things in place of love or as a result of always getting what the person wanted when they wanted it, and not suffering consequences for inappropriate behaviors. Not suffering consequences frequently happens as a result of the rescuing behaviors of family members. The same rescuing that happens in entitled families often happens in the context of families with a chemically dependent person. For instance, as the addiction worsens, the chemically dependent person often engages in unlawful behaviors, such as stealing or driving under the influence (DUI), which would normally result in severe parental consequences. Quite often, however, parents and loved ones unwittingly enable chemically dependent persons by rescuing or “enabling” them. An example would be helping to keep the person who just stole something from a department store or received a citation for a DUI from jail time by paying bail, hiring legal assistance, etc. This type of enabling enhances the chemically dependent’s fantasy of being untouchable and entitled to having what they want, when they want it, with no consequences. The resulting fantasies related to one’s sense of self often come in conflict with reality, which is defended against with heightened denial of truth, self, and others. Below are a few notes that may help to facilitate a discussion of this disordered manner of thinking, one that is often extremely resistant to treatment. The symptoms of narcissism encompass many of the “defects of character” addressed in Step 5 of AA: “Admitting to God, to ourselves, and to other human beings the exact nature of our wrongs.” In order to do so, it is often useful to conduct a moral inventory of one’s “defects of character,” which AA and NA have published for consideration. Some of the characteristics of a narcissist include: a grandiose sense of self; preoccupation with fantasies of unlimited success, power, beauty, brilliance, or ideal love; belief that he or she is unique and should associate only with other special or highstatus people; the requirement of excessive admiration; a sense of entitlement; taking advantage of others to his or her own ends; lacking empathy; often envious of others; showing arrogant behaviors (American Psychiatric Association, DSM-IV-TR 2000). As noted above, these symptoms parallel many of AA/NA’s “defects of character,” as noted by The Big Book Bunch website (2011), including “abusing others, arrogance, boasting, cheating, closed-mindedness, closed-heartedness, controlling others, dishonesty, immodesty, self-indulgence, self-justification, and selfishness.”

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In the article “Narcissism, A Barrier to Personal Acceptance of the Spiritual Aspect of Alcoholics Anonymous” (Hart & Huggett, 2005), researchers used the NPI narcissism scale and the 12 Steps Questionnaire to explore the relationship between narcissism and addiction. Results of their inquiry indicated that “relative to their more humble counterparts, recovering alcoholics who scored high on narcissism are particularly reluctant to accept the spiritual aspects of the program of addiction recovery advocated by AA.” The researchers further note: “As a result of their reluctance to accept empowerment from spiritual resources, narcissist alcoholic clients might be vulnerable to dropout or minimal engagement in professional treatment based AA principles, as well as relapse” (p. 85). The book Malignant Self-Love–Narcissism Revisited (Vaknin, 2005) was written by a self-proclaimed narcissist. It is helpful to describe the context under which it was written as a manner of assisting group members with narcissistic traits to relate to and consider it. Note that Mr. Vaknin’s narcissism cost him all that he loved, which is very similar to the behaviors of those who are chemically dependent. Mr. Vaknin notes that his book: was written under extreme conditions of duress. It was composed in jail as I was trying to understand what had hit me. My nine-year-old marriage dissolved, my finances were in a shocking condition, my family estranged, my reputation ruined, my personal freedom severely curtailed. Slowly, the realization that it was all my fault, that I was sick and needed help, penetrated the decades-old defences that I erected around me. This book is the documentation of a road of self-discovery. (2011) This personal experience is valuable as it makes it easier for the person in recovery, who may be experiencing the same disorder, to recognize and try to address related symptoms within treatment. Vaknin (2005) addresses the issue of narcissism and addiction in the following manner: Pathological narcissism is an addiction to narcissistic supply, the narcissist’s drug of choice. It is, therefore, not surprising that other addictive and reckless behaviors — workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving — piggyback on this primary dependence. The narcissist — like other types of addicts, derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as “unique,” superior,” “entitled,” and “chosen.” They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the center of attention but also place him in “splendid isolation” from the maddening and inferior crowd. The narcissist—the adrenaline junkie—feels that he is in control, alert, excited, and vital. He does not regard his condition as 68

dependence. The narcissist firmly believes that he is in charge of his addiction and can quit at will and on short notice. (p. 361) The song “Flawed Design” by Stabilo (2006, track 5) includes lyrics that may be interpreted as someone describing narcissistic behavior. For instance: ’Cuz I lie Not because I want to But I seem to need to All the time Yeah, I lie And I don’t even know it Maybe this is all a part of my flawed design Once the topic has been addressed in small groups, the groups return to write a blues song based on the issue. The therapist may or may not chose to provide the lines for the first verse, as in the sample below: “In my addiction, I didn’t love nobody but myself … So I need to get humble and learn to care for someone else.” The second verse speaks to the narcissistic behavior that the chemically dependent person manifested in their addiction. The third verse identifies ways in which the narcissistic person can start to take responsibility for his/her behavior and move forward. This format is appropriate for several reasons. The blues can help one to express acceptance of one’s negative behaviors and remorse, perhaps for the first time, related to one’s narcissism. In addition, it allows folks to accept assistance from peers (e.g., in the form of musical support via call-and-response singing or playing) and take on the role of leader as well as follower (i.e., while in the supportive role).

Session Outline Songs: “Flawed Design” (Stabilo) and original 12-bar blues Purpose: To increase awareness of concepts related to narcissism and addiction. Objectives: Participants will … Identify issues related to their addiction-based narcissism. Identify behaviors that are going to define a more compassionate self-acceptance in recovery. Materials: Goal sheets for group members A prerecorded song related to narcissism and addiction (e.g., “Flawed Design” by Stabilo) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard 69

Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) 12-bar blues sample Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to and discuss the lyrics of a song that addresses the issue of narcissism and addiction (e.g., “Flawed Design” by Stabilo, Appendix M). They are asked to determine if there are any lines in the song to which they relate particularly. (10 minutes) The therapist guides the group in a mini-lecture related to narcissism in addiction, using Narcissism: A Barrier to Personal Acceptance of the Spiritual Aspects of Alcoholics Anonymous (Hart & Huggett, 2005) or readings from Vaknin (2005). (10 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following two questions: (15 minutes) Identify one or two behavior(s) that you feel related to your own addiction-based narcissism. Identify one or two behaviors that you will use to demonstrate a more compassionate self-acceptance in recovery. The small groups are informed that they are going to perform as blues bands. The therapist hands out percussion instruments and warms up the groups by having them play along to a 12-bar blues pattern. (5–10 minutes) After getting a feel for the song form, each group rewrites the song verses using the material they gleaned from the interviews. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes)

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Sample “Narcissism and Addiction” Group Blues Song: Verse 1: In my addiction, I was narcissistic, didn’t love nobody but myself (2x) So I need to get humble, and learn to care for someone else. Verse 2: In my addiction, partied all night, didn’t stay on the job. Stole from my dad, for the drugs I had to rob. Thought I could stop at will, treated others like slobs. Verse 3: In my recovery, I’m stayin’ at work all day. Got my own money, now my dad, I can repay. Accepting my mistakes, and finding a better way. Sample “Narcissism and Addiction” Progress Note: X was alert and oriented, affect depressed and anxious. He chose goal #8 as his group focus, noting: “Because after work I got nothing to do so I used to just drink … I don’t know what the heck to do.” He participated actively in the song discussions, responding to peer contributions and relating to the song lyrics. With regard to “Flawed Design,” X noted “I related to the line: “How can you say those things, and keep a straight face … because of the lies I told at work, to my family and my girlfriend.” With regard to how addiction-based narcissism affected X’s behavior, X noted: “I was arrogant, would take time off of work thinking ‘they can’t fire me.’” With regard to achieving compassionate self-acceptance: “Who am I to get off so easy … what’s good for the goose is good for the gander.” X participated in the group song rewrite and played blues guitar for his peers. He reported meeting his goals via “Music can be therapeutic and can be productive in my leisure time.”

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Protocol 11: Real Love Clinical and Musical Considerations Relationship issues are one of the most prevalent causes of relapse. Chemically dependent people frequently enter rehab without having critically explored their attitudes, expectations and assumptions regarding love relationships. In addition, the vulnerability of people in rehab frequently leaves them open to partaking in “rehab relationships,” which are usually destined for failure, as they take one’s focus off of sobriety. Hence, dealing with issues related to relationships is paramount to the recovery process. The song “Real Love” by The Doobie Brothers (1980, track 2) opens the listening discussion portion of this session. The lyrics provide a good stimulus for the discussion of many topics related to the issue of love and addiction, including love vs. lust, healthy love vs. addictive love, sex addiction (which often parallels chemical dependence), gender issues, healthy expressions of sexuality, and how relationships affect the recovery process. The topic of real love also helps participants to identify which relationships may be based on chemical dependence issues, rather than love per se. Important additional considerations related to this protocol are the topic/issues of prostitution and pornography. It’s not unusual to have group members who have either sold sexual favors or engaged in pornography for drugs. It’s important to be sensitive to those issues prior to addressing this issue in a group format, as it may be too much for some to address, especially for the first time, within a group format. If at all possible, it’s best to check with the person’s primary therapist or, if you have established a therapeutic relationship with a person who has a history of such behavior, to check with them first, to see if they are prepared to handle such a topic in group. Make sure that they are aware that they have the option to opt out of group discussion or participate in the discussion at a level of depth they feel comfortable with. The lyrics to “Real Love” (Michael McDonald and Patrick Henderson) include: Verse: Darlin’ I know, I’m just another head on your pillow If only just tonight, girl Let me hear you lie just a little Tell me I’m the only one, That you ever really loved … Here, Darlin’, stands another bandit wantin’ you In and out your life, they come and they go Your days and nights like a wheel that turns Grindin’ down a secret part of you Deep inside your heart 72

That nobody knows … Chorus : Well, we’ve both lived long enough to know We’d trade it all right now For just one minute of real love Good resources for use when discussing these issues include Real Love (2011). The basic message here is that real love is “caring about the happiness of another person without any thought for what we might get ourselves. It is also real love when others care about our happiness unconditionally” (ibid.). In addition, Kansas State University’s website provides a handout outlining factors involved in healthy relationships, including several recommended readings (2011). Participants in recovery may also be interested in the book Is It Love, or Is It Addiction? by Brenda Schaeffer (2009). An excellent book related to sexual addictions is Patrick Carnes’s Out of the Shadows (2002). Finally, it may be most important for the single or separated chemically dependent person to identify that it will take time to sort out their own issues, let alone prepare for another love relationship. Most AA-modeled treatment calls for at least one year of sobriety prior to engaging in relationships. This provides time to come to terms with living a sober lifestyle, including developing healthy supports, should a future relationship not pan out. The song “Heart of Gold” by Neil Young (1972, track 3) provides a fine musical container for a rewrite based on relationship issues. This iconic song describes the songwriter’s search and longing for a type of real love that is difficult to find. As such, it dovetails nicely with the above theme. It is also written in an easy-to-follow style with simple guitar chords that allow accompaniment by novice players.

Session Outline Song: “Real Love” (The Doobie Brothers) and “Heart of Gold” (Neil Young) Purpose: To increase awareness of healthy love relationships. Objectives: Participants will: Identify issues related to how addiction may have affected their love relationships. Identify how to reapproach healthy relationships in recovery. Materials: Goal sheets for group members A prerecorded song related to healthy relationships and addiction (e.g., “Real Love” by the Doobie Brothers) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard 73

Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Chord chart/lyrics for “Heart of Gold” by Neil Young Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses

Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to and discuss the lyrics of a song that addresses the issue of healthy relationships and addiction (e.g., “Real Love” by The Doobie Brothers, Appendix N). They are asked to determine if there are any lines in the song that they relate to particularly. (10 minutes) The therapist guides the group in a mini-lecture related to unconditional love, such as sample readings from the Real Love website (2011), the Kansas State University Counseling website (2011), or “Characteristics of Healthy Relationships” (Iowa Coalition Against Violence, 2011). (10 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following questions: (15 minutes) Identify how addiction affected their relationships. Identify what they plan to do in recovery to address those issues in a healthy manner. The small groups are informed that they are going to perform as a band. The therapist hands out percussion instruments and warms up the groups via playing along to “Heart of Gold” by Neil Young. (5 minutes) After getting a feel for the song form, each group rewrites the song verses using the material they gleaned from the interviews. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes)

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Sample “Real Love” Group Song: Verse 1: In my addiction, I’ve spread some fiction. I’ve been a cheater and a liar, too. I kept on using, and abusing, When I was high, I never thought of you, never thought of you. Verse 2: In my recovery, I’ll take a break, From focusing on sex to fulfill my needs. I’ll work the steps, and keep lies in check, And find self-acceptance so I’m not at risk, so I’m not at risk. Sample “Real Love” Progress Note: X was alert and oriented, affect depressed and anxious. She chose goal #5 as her group focus. She participated actively in the song discussion to “Real Love,” responding to peer contributions and relating to the song lyrics. X Noted, “I related to the line about a time when things were so very right … when they were right, it was nice.” In the interviews, X noted that drugs affected her relationships by: “made me lie, cheat, and steal.” With regard to behaviors that will move X toward finding “real love,” X’s group noted: “Not get high and lie, quit using and abusing.” X participated in the group song rewrite with her peers. She reported meeting her goals via “I learned that making music can take up my leisure time instead of using.”

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Protocol 12: Identifying Reasons to Remain Sober Clinical and Musical Considerations At this point in the treatment process, group members have explored and identified many reasons to stay sober. For instance, they have identified personal consequences to addiction, including loss of personal integrity, poor health, loss of friends, loss of employment, familial dissolution, incarceration, probation, and loss of sense of self (to name a few). As a group, we have explored these issues, as well as issues that serve to maintain and fuel addictions such as the Big 5 defense mechanisms, lack of self-acceptance, lack of compassionate awareness regarding interpersonal relationships, resentments, etc. Given all of the things that we have addressed, this is a good time to reflect upon treatment progress and the related rationale(s) group members have identified with regard to remaining clean and sober. It’s an important step with regard to maintaining sobriety, as participants will need to build an army of sobriety-related thoughts to confront the habitual thoughts and addictive styles of self-deceptive thinking that serve addiction-related behavior. The lyrics to the song “The Reason” by Hoobastank (2004, track 8) provide an appropriate vehicle from which to launch a discussion related to the above topic. They include: I’m not a perfect person, There’s many things I wish I didn’t do. But I continue learning, I never meant to do those things to you. And so now I have to say before I go, That I just want you to know. I’ve found a reason for me To change who I used to be A reason to start over new And the reason is you … It often helps to point out that, for the purpose of this group, the word “sobriety” would be an appropriate substitute for the word “you” in the last line of the chorus. “Master Blaster (Jammin’)” by Stevie Wonder (1980, track 6) is a song with a reggae/funk feel that easily lends itself to a song rewrite. It has a simple structure and chord progression that is once again easy for most beginner to intermediate guitar players to follow. It also breaks up the usual blues/rock format, adding a culture-specific, light and easy feel. This light and easy feel provides a nice alternative to the heaviness of addiction.

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Session Outline Song: “The Reason” (Hoobastank) and “Master Blaster (Jammin’)” (Stevie Wonder) Purpose: To increase insight related to motivation to sobriety and related “consequences” (rewards). Objectives: Participants will … Identify reasons related to wanting to remain clean and sober. Identify sobriety-related behaviors that will help them to remain clean and sober. Materials: Goal sheets for group members A prerecorded song related to reasons to remain sober (e.g., “The Reason”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Chord chart/lyrics for “Master Blaster (Jammin’)” Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses

Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to a song that addresses the issue of reasons (or motivation) to stay clean and sober (e.g., “Reasons” by Hoobestank, Appendix O). (15 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following questions: (15 minutes) Identify three reasons that you have to remain clean and sober. Identify three behaviors that will serve to maintain your sobriety. Small groups take the information gleaned from above interviews to rewrite the song “Master Blaster (Jammin’)” by Stevie Wonder using the following format: (15 minutes) 77

Listen to the song “Master Blaster (Jammin’)” by Stevie Wonder while playing along on percussion instruments. A peer may choose to “conduct” the various instrument groups (e.g., beaters and shakers). Create a sample fill-in-the-blank song structure for the group members to complete, such as: Need to stay clean and sober, if I ___________________ Need to change my behavior, if I ____________________ So I’m gonna ____________________, And I’m gonna __________________ Said I’m gonna ________________________________. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample “Reasons” Progress Note: X was alert and oriented during group today. She chose goal #10 as her focus. She participated actively in listening and discussion to the song “The Reason” by Hoobestank, noting “I have to find the beauty inside … the other half of me, I’ve been suppressing because of scars from the past.” In peer interviews, she noted that reasons to change include “to realize time is a gift, stop feeling guilt/pity, and to realize my full potential,” and to achieve those things, she has to “have the courage to face today and my self confidence.” X helped to write and perform the song. She plays guitar well and she readily learned the chord progression and sung the lyrics appropriately. X noted reaching her group goal via: “I had the courage to let go and face the day.”

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Protocol 13: Taking Care of Unfinished Business Clinical and Musical Considerations The lyrics of the folk-rock ballad chosen for this protocol, “My Father’s House” by Bruce Springsteen (1982, track 3), describe a man’s dream of his childhood home. In his dream, the man becomes a boy who runs to his father’s house, through the trees and brush, until he falls shaking in his father’s arms. Following the dream, the man notes: “I awoke and I imagined that the hard things that pulled us apart will never again, sir, tear us from each other’s hearts.” He then drives to his childhood home, only to find a woman who tells him “I’m sorry, son, but no one by that name lives here anymore.” The last verse reads: My father’s house shines hard and bright And it stands like a beacon calling me in the night. Calling and calling, so cold and alone Shining cross this dark highway Where our sins lie unatoned. This is a powerful lyric, sung with a simple guitar accompaniment, which often brings group members to tears. It is a song that most people can relate to in one form or another, and can further relate to the concept of unfinished business. This protocol helps to address the issue of unfinished business and addiction. In Gestalting Addiction: Groups Led by Dr. Richard Miller (Miller, 1993), Miller notes: “Unfinished business may be one of the greatest forces in history. So much remains unsaid, unexpressed, and then gets acted upon in convoluted ways” (p. 30). Miller goes on to define and describe how unfinished business, inclusive of both resentments and appreciations, can dissolve into anger and bitterness as we mull the issues over and over in our heads. Therefore, holding onto unfinished business can lead to feelings and actions related to issues that are not related to present relationships, but often become entangled in and affect them in negative ways. A good example of the effects of unfinished business may be found in Melody Beatty's book Co-Dependent No More: How to Stop Controlling Others and Caring for Yourself (1986). In this book, Beatty describes a client's realizations related to her alcoholic father who left her mother when she was five years old and maintained little contact. Much later in life, the client's father called her for help, and after declining (which led to her own ability to grieve this relationship), she noted: I also began to realize that underneath my sophisticated veneer I felt unlovable. Very unlovable. Somewhere, hidden inside me, I had maintained a fantasy that I had a loving father who was staying away from me - who was rejecting me - because I wasn't good enough. There was something wrong with me. Now I knew the truth. It wasn't me that was unlovable. It wasn't me that screwed up although I know I've got problems. It was he. (p.97)

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In responding to an audio-taped version of Co-Dependent No More, a senior member of The Sober Village Addiction and Recovery [Online] Forum noted: “part of what we are all trying to work through and beyond is unfinished business from our past relationships. I don't think we can move on in a healthy way until we can put that baggage down and decide to be ‘all done.’ Our new beginnings never really start until we are done with our endings” (Gabe, 2006). The pop song “Takin’ Care of Business” (1974, track 8) is a classic BachmanTurner Overdrive tune that serves to bring the affect of the group back from one of sadness/despair to a more resilient “let’s get it done” feeling. It is also written in a simple three-chord fashion that is easy to accompany on almost any instrument. Rewriting the lyrics of this song helps to provide a group anthem that has a powerful message related to working through the issues of the past so as to not allow them to overtake the present and future recovery process.

Session Outline Songs: “My Father’s House” (Bruce Springsteen) and “Takin’ Care of Business” (Bachman-Turner Overdrive) Purpose: To increase awareness of resentments, how they may be affecting current relationships, and how to resolve them. Objectives: Participants will … Identify issues related to resentments that patients may be harboring and how that may affect their recovery. Identify how resentments may be affecting current relationships. Identify how to resolve or cope with those resentments. Materials: Goal sheets for group members A prerecorded song related to unfinished business and recovery (e.g., “My Father’s House”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group member[s]) Chord charts/lyrics for “Takin’ Care of Business” Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) 80

Group members listen to and discuss the lyrics of a song that addresses the issue of resentment and addiction (e.g., “My Father’s House” by Bruce Springsteen, Appendix P). They are asked to determine if there are any lines in the song that they relate to particularly. (10 minutes) The therapist guides the group in a mini-lecture related to unfinished business and addiction, such as sample readings from Melody Beatty’s Co-Dependent No More: How to Stop Controlling Others and Start Caring for Yourself (1986) or Angela Browne-Miller’s Gestalting Addiction: Groups Led by Dr. Richard Miller (1993). (10–15 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following questions: (15 minutes) Identify a resentment (or appreciation) that you are harboring. Identify how that may be affecting your current relationships. Identify how you can begin to cope with or resolve that resentment in a healthy manner. Identify how that may be affecting your current relationships. The small groups are informed that they are going to perform as a band. The therapist hands out percussion instruments and warms up the groups via playing along to “Takin’ Care of Business” by Bachman-Turner Overdrive. (5 minutes) After getting a feel for the song form, each group rewrites the song verses using the material they gleaned from the interviews. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample Verse 1: I used to carry lots of anger toward my friends and my family, because they would bitch and moan. It made me feel hatred inside and so angry I could cry, but I never told them I felt so alone. Verse 2: Now I’m gonna take the time to express myself in rhyme, and leave some of that anger at the door. 81

So now when things do piss me off, I can deal with them directly, and not carry ’round hatred no more. (Sing original “Takin’ Care of Business” chorus) Verse 3 I can be helpful to others, treat them like sisters and brothers, I can forgive and amend. I can learn to be receptive and be less deceptive, and be open to making new friends. (Chorus) Sample “Taking Care of Unfinished Business” Progress Note: X was alert and oriented, affect depressed and anxious. He chose goals #5 and #8 as his group focus. He participated actively in the song discussion, responding to peer contributions and relating to the song lyrics. With regard to “My Father’s House,” X noted that “I related to the line: ‘I awoke and imagined the hard things that pulled us apart … For me, it was past relationships and how my selfishness screwed that up … got in the way … I carry resentment toward that … couldn’t recognize a good thing I can’t get back.” In the interviews, X noted that resentments include: “past relationships,” effects on current behavior include “trust issues,” and coping mechanisms include “learning to address those issues and like myself more.” Peers provided appropriate feedback and support. X participated in the group song rewrite with his peers. He reported meeting his goals via “learned to express myself through working with others, learned to grow personally.”

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Protocol 14: Remaining Active in Recovery Clinical and Musical Considerations This final protocol further assists with the transition from rehab to the real world by providing a highly functional tool in the form of Rational Emotive Behavior Therapy, which may be used to help to maintain sobriety in the face of future “irrational thinking.” Tom Petty’s song “I Won’t Back Down” (1989, track 2) provides the backdrop for a personal fight song related to confronting irrational thoughts, unhealthy negative emotions, and the self-defeating behaviors that tend to accompany them. This song has easy-to-relate-to lyrics that are easy to keep in mind and to rewrite later in the group. After listening to the song, group members are introduced to the concept of Ellis’s Rationale Emotive Behavior Therapy. I have found a great handout for this introduction in the REBT Resource Book for Practitioners (2nd ed.; Bernard & Wolfe, 2000). This handout provides a simple fill-in-the-blank outline that walks you through the process of REBT from identifying a triggering situation along with its negative unhealthy emotions and self-defeating behaviors to underlying irrational thoughts. In addition, group members are walked through how to identify automatic irrational thoughts and dispute them, resulting in healthy negative emotions and behaviors. Each section of the handout provides several examples for the reader. This book also contains many valuable resources for therapy practice and is highly recommended. If the reader is unfamiliar with REBT, s/he may wish to reference the book Primer on REBT for Practitioners (3rd ed.; Dryden, DiGiuseppe, & Neenan, 2010). Introduction to the above self-help form provides group members with a powerful tool with which to confront the irrational thinking associated with addiction. Coming together as a group to work on these persistent thoughts provides group members with the validation that “yes, this is going to be an ongoing struggle, but I can cope with it in a productive manner.” In addition, this group format provides group members with multiple coping skills as peers share their disputing/rational thoughts with each other. Finally, the group rewrite to “I Won’t Back Down” provides a moving rewrite opportunity. This is a song that is easy to remember and provides a simple but effective personal fight song in the effort toward maintaining a clean and sober lifestyle.

Session Outline Song: “I Won’t Back Down” (Tom Petty and the Heartbreakers) Purpose: To increase awareness of negative thoughts related to addiction and related coping mechanisms. Objectives: Participants will … Identify negative/distorted thoughts associated with chemical dependence. Identify disputing thoughts and related behavioral coping mechanisms.

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Materials: Goal sheets for group members A prerecorded song related to coping with unhealthy negative thoughts and recovery (e.g., “I Won’t Back Down”) A CD or other type of playback device (stereo, boom box, etc.) Pens/pencils and paper for group “scribes” Write-on, wipe-off board or chalkboard Piano or guitar for therapist and backup players (e.g., an extra guitar for musician group members) Chord chart/lyrics for “I Won’t Back Down” Assorted percussion instruments for all group members A pad and pen to take notes related to participant responses Procedure: Group members identify personal goal(s) for the session, utilizing the goal sheet or creating one of their own related to their recovery. (10 minutes) Group members listen to and discuss the lyrics to a song addressing challenging negative thoughts (e.g., “I Won’t Back Down” by Tom Petty and the Heartbreakers). (15 minutes) The therapist guides the group in a mini-lecture related to Rational Emotive Behavior Therapy using REBT worksheets from REBT Resource Book for Practitioners. (15 minutes) The large group is divided into smaller groups of four to six people. Each group is asked to choose a “scribe,” who is responsible for writing group member responses to the following three questions: (15 minutes) Identify a potential trigger for relapse (past, present, or future) Identify negative automatic thoughts associated with that trigger, and how they influence or may influence your behavior and emotions related to your chemical dependence. Identify disputing/challenging thoughts associated with your sobriety, and how they may influence your behavior and emotions in related to that trigger now and in the future. The small groups are informed that they are going to perform as bands. The therapist hands out percussion instruments and warms up the groups via playing along to the song “I Won’t Back Down.”

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After getting a feel for the song form, each group rewrites the lyrics of “I Won’t Back Down,” using a fill-in-the-blank format as below (or something that the therapist or participants come up with): Song Format Sample: When I used to _________________ , I used to think I could _______________ But now I know ________________, So I can think ______________________ And I’ll feel ____________________. Groups choose a name for themselves and how they want to perform the song (e.g., lead singer, etc.), and perform their songs for each other. (15 minutes) After completing the performances, group members revisit their goal sheets and write down and share a sentence or two related to how they met their goal and reflect on the group process. (10 minutes) Sample Group Rewrite of “I Won’t Back Down”: Verse 1: I used to think crack was cool, and I found out I was a fool. But I still kept getting high just to get by, I was an angry guy, I was never sober or dry. Verse 2: Now when I get upset, I can stop the threats, Of hurting myself or anyone else ’Cause I won’t get high I’ll be a sober guy. Sample “I Won’t Back Down” Progress Note: X was alert and oriented, affect depressed and anxious. He chose goal #5 for his group focus, noting: “I have a lot of problems I need to solve.” With regard to an activating event, distorted (negative) thought, and self-defeating consequence: “My Cadillac got towed by my landlord, it was in disrepair several months. I felt betrayed, jumped into the tow truck, and busted the windshield … it was also a trigger for me to use.” With regard to coping thoughts: “I need to recognize I am powerless over those situations, I should’ve been grateful I wasn’t kicked out of my apartment.” X participated actively in the remainder of the group discussion and helped to create the song rewrite (see above). He also played percussion with peers in final performance. He reported meeting his group goal via “Played songs and worked on my problems.” 85

References Alcoholics Anonymous World Service (2011). Service material from the general service office. The twelve steps of Alcoholics Anonymous. Retrieved September 2nd, 2011 from: http://www.aa.org/en-pdfs/smf-121-en.pdf American Music Therapy Association (AMTA) (1998). American Music Therapy Association. Definition and quotes about music therapy. Retrieved September 2nd, 2011, from: http://www.musictherapy.org/about/quotes. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (Fourth edition). Washington DC: Author. Araica, M. C., Daniel, T. M., DioGuardi, K. E. & Hills, F. N. (2008). Sober [Recorded by Pink]. On Funhouse [CD]. New York, NY: La Face Records. Ashba, D., Michel, J. & Sixx, N. (2007). Girl with golden eyes. On The Heroin Diaries [CD]. New York, NY: Eleven Seven Music. Beatty, M. (1986). Codependent no more: How to stop controlling others and start caring for yourself. (2nd ed.). Center City, MN: Hazelden Publications. Bennington, C. C. , Bourdon, R. G., Delson, B. P., Farrell, D. M., Hahn, J., & Shinoda, M. K. (2003). Easier to run. On Meteora [CD]. Burbank, CA: Warner Brothers. Bernard, M.E., & Wolfe, J. (Eds.) (2000). The REBT resource book for practitioners. (2nd ed.). New York, NY: Albert Ellis Institute. Bruscia, K. E. (1998). The dynamics of music psychotherapy. Gilsum, NH: Barcelona Publishers. Bruscia, K. E. (1998). Defining music therapy. (2nd ed.). Gilsum, NH: Barcelona Publishers. Carlton, V. (2002). Paradise. On Be Not Nobody [CD]. New York, NY: A&M. Carnes, P. (2001). Out of the shadows: Understanding sexual addiction. (3rd ed.) Center City, MN: Hazelden Publishing. Collins, A. & Vanzant, R. (1974). Freebird. On Freebird [Album]. Santa Monica, CA: MCA.

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Darnell, R. & Hawkins, R. (1969). The thrill is gone. [Recorded by B. B. King]. On Completely Well [CD]. Santa Monica, CA: MCA. Di Giuseppe, R., & Dryden, W. , & Neenan, M. (2010). A primer on rational emotive behavior therapy. (3rd ed.). Champaign, IL: Research Press. Dryfhout, J. L., Kadish, K. P. & Moerman, C. J. (2006). Flawed Design. On Happiness and Disaster [CD]. Mississauga, ON: EMI Records, Canada. Estrin, D. B., Hesse, C. L., Lappalainen, M. J. & Robb, D. S. (2004). The reason. On The Reason [CD]. New York, NY: Island Records. Foremon, J. (2000). Because I got high. On Because I Got High [CD]. Santa Monica, CA: Universal. Furiman, A., Butler, T. (1983). Curative factors in group therapy, a review of the recent literature. Small Group Behavior. 14, 131-142. Gabe (2006, July 25th). The sober village addiction and recovery forum [MSG 1]. Message posted to http://www.thesobervillage.com/forums/relationshipsparenting/2746-unfinished-business.html. Gilmore, D. & Rogers, W. (1975). Wish you were here. On Wish You Were Here [CD]. New York, NY: Capitol Records. Gorski, T. (2010). Integrating the Treatment of Chemical Dependency to the Family Therapy Process. Lecture presented at a workshop of The Broward Association for Marriage and Family Therapy, Nova Southeastern University, Ft. Lauderdale- Davie, FL. Hart, K. E. & Huggett, C. (2005). Narcissism, a barrier to personal acceptance of the spiritual aspect of alcoholics anonymous. Alcoholism Treatment Quarterly, Vol. 23, pp.85-110. Harris, C. J. & McMasters, B.K. (2006). Live in the sky [recorded by T.I. Feat and Jamie Foxx]. On Grand Hustle [CD]. New York, NY: Atlantic. Henderson, P. & Mc. Donald, M. (1980). Real love. On One Step Closer [CD]. Burbank, CA: Warner Brothers. Iowa Coalition Against Violence (2011). Facing the Facts When a Loved One Has Borderline Personality. Characteristics of Healthy Relationships. Retrieved September 26th, 2001 from http://www.bpdfamily.com/bpdresources/nk_a115.htm

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James, M. (1988, a). Music Therapy and Alcoholism: Part I: An Overview of Addiction. Music Therapy Perspectives, Vol. 5, 60-64. James, M. R. (1988, b). Music Therapy and Alcoholism: Part II: Treatment Services. Music Therapy Perspectives, Vol. 5, 65-68. Jeffrey, L. , Petty, T. E. & Campbell, M. (1989). I won't back down. On Full Moon Fever [CD]. Santa Monica, CA: MCA Records. Johnson, V. (1990). I'll quit tomorrow: A practical guide to alcoholism treatment. San Francisco, CA : Harper. Kansas State University Counseling Services. (2011). K-State Counseling Services. Healthy Relationships. Retrieved September 26th, 2011, from http://kstate.edu/counseling/ topics/relationships/relatn.html. Mayo, A., Luther, W., & Douglas, T. (2007). Let it go [Recorded by Tim McGraw]. On Let it Go [CD]. Nashville, TN: Curb. Mc Daniel, E. (1957). Before you accuse me. [Recorded by Eric Clapton]. On MTV Unplugged [CD]. Burbank, CA: Warner/Reprise. (1992) Miller, A. B. (1993). Gestalting addiction: The addiction-focused group therapy of Dr. Richard Louis Miller. New York, N.Y.: Ablex Publishing. Moore, A. B. & Storch, S. (2001). Family portrait. On Missunaztood [CD]. New York, NY: Arista Records Newman, R. (1973). Guilty [Recorded by Bonnie Raitt]. On Takin' My Time [CD]. Burbank, CA: Warner Brothers. Outward Bound (2011). Outward Bound. Our Approach. Retrieved September 3rd, 2011 from http://www.outwardbound.org/index.cfm/do/are.program_approach. Real Love (2011). Real Love web site. What is Real Love? Retrieved September 26th, 2011, from http://www.reallove.com/about.asp. Schaeffer, B. (2009). Is it love or is it addiction. (3rd ed.). Center City, MN: Hazelden Publishing. Shrody, E. (1998). What it's like. On Whitey Ford Sings the Blues [CD]. New York, NY: Tommy Boy Records. Silberman, M. (1998). Active training: A handbook of techniques, designs, case examples and tips. San Francisco, CA Jossey-Bass/Pfeieffer, 89

Springsteen, B. (1982). My father's house. On Nebraska [CD]. New York, NY: Columbia Records. The Big Book Bunch (2011). The Big Book Bunch. Taking Step Five: Version 1. Retrieved September 25th, 2011 from http://www.sober.org/Step5.html The New York State Bar Association (2011). NYSBA Web Site. The progression and recovery of the family in the disease of alcoholism. Retrieved September 25th, 2011 from http://www.nysba.org/Content/NavigationMenu/ For Attorneys/LawyerAssistanceProgramLAP/FamilyProgressionChart.pdf Yalom, I. D., (1989). Concise guide to group psychotherapy. Washington, American Psychiatric Press. Vaknin, S. (2005). Malignant self-love: Narcissism revisited. Prague and Skopje: Narcissus Publications Vaknin, S. (2011). The Narcissistic Abuse Study Group. Introduction. Retrieved September 2nd, 2011, from http://www.narcissistic-abuse.com/narclist.html. Vaughan, S. R. (1983). Pride and joy. On MTV Unplugged [CD]. Burbank, CA: Warner/Reprise. (1992) White, W. L. (1996). Pathways from the culture of addiction to the culture of recovery: A travelers guide for addiction professionals. (2nd ed.). Center City, MN: Hazelden Publishing. Williams, M. (1973). Drift away [Recorded by Dobie Gray]. [CD]. New York, NY: Universal Music Group. Withers, B., Blackwell, R. and Blackmon, B (1972). Another day to run [Recorded by Bill Withers]. On Still Bill [CD]. New York, NY: Columbia Records. Wonder, S. (1980). Master blaster (jammin'). On Hotter Than July [CD]. New York, NY: Universal Music Group. Young, N. (1972). Heart of gold. On Harvest [CD]. Burbank, CA: Warner Brothers.

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APPENDICES

Appendix A Goal Sheet for Group Members Name ______________________________ Date ______________________ 1) Increasing my understanding of self. 1………………………………………………10 2) Increasing my self-expression and communication skills. 1………………………………………………10 3) Increasing the ability to take responsibility for my actions. 1………………………………………………10 4) Increasing my ability to work with others in a productive manner ("putting talk into walk"). 1………………………………………………10 5) Increasing my ability to problem solve effectively. 1………………………………………………10 6) Increasing my ability to follow up with things I start, taking one step at a time. 1………………………………………………10 7) Increasing my frustration tolerance. 1………………………………………………10 8) Learning productive ways to manage my leisure time. 1………………………………………………10 9) Learning to be less of a perfectionist, more self accepting. 1………………………………………………10 10) Learning to take risks toward personal growth. 1………………………………………………10 11) Learning to give and receive constructive feedback. 1………………………………………………10 12) Learning how to have fun in a healthy, sober way. 1………………………………………………10 Before Group: Please indicate your group goals by choosing the goal number(s) related to your goal(s) and/or writing out a goal for yourself. Also, please indicate how you are feeling at the beginning of the group with one or two feeling words. ___________________________________________________________ ___________________________________________________________ After Group: Please indicate how you addressed your goal(s) with one or two related sentences. Also, please indicate how effective you were in achieving your goal(s) by making an "X" mark on the Likert scales indicating 1 (not effective at all) to 10 (highly effective). Also, please indicate one or two feeling words related to how you are feeling at the end of the group.

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Appendix B

Another Day to Run William H. Withers, Rory Blackwell, Benorce Blackmon, 1972 (Reprinted by Permission of Hal Leonard Corporation) If you don't look into your mind and find out what you're running from Tomorrow might be just another day to run If you just sit and waste your time you'll be going where you're coming from Think about that tomorrow, might be just another day to run Someone must control your mind you're the one Dark confusion's what you'll find if you run I don't want to waste your time but I'm talking to you like a son Tomorrow might be just another day to run Oh now walkin’ down the road of life looking for direction Sometime my mind gets so mixed up I can't tell lust from affection Gonna stop into a roadside church get my mind a rest And Lord Jesus, help me get my soul together uh huh in process Oh now pretty ladies all stand in line waiting for inspection Drunken old men drinking wine trying to drown rejection I've been wasting too much time I'm gonna lose my mind Unless Lord Jesus you help me get my soul together uh huh in process Oh now Tony Jr. fill up his arm with dope he dreams about a valley But the poor boy lives in an alley filled with papers that's thrown away Lord, Lord, oh Lord, Lord, Lord Tell me Tony, tell Tony, tell me Tony, tell me why He wanna get high enough to die Well he's long on dreams and short on hope sometimes he goes to rallies Stops by to see Sally lord just to pass the time away Lord, Lord, oh Lord, Lord, Lord Tell me Tony, tell Tony, tell me Tony, tell me why He wanna get high enough to die

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Appendix C

Live in the Sky Clifford J. Harris, Bryan K. McMasters (Reprinted by Permission of Hal Leonard Corporation, Alfred Publishing and Warner-Tamerlane Publishing Corp.) [Spoken] What’s happening man this T.I.P you know I like to dedicate this song to anyone who ever lost somebody to the grave to the streets to the jail cell I done been in situations where I done had to cope with all three you know what I'm saying I feel like the only thing I ain't done yet is die you know Just remember where you live while you're here ain't half as important as where you're gonna live when you leave [Chorus] Lif'e's ups and downs they come and go but when I die I hope to live in the sky All my folks who ain't alive I hope they live in the sky pray to God when I die that I live in the sky It's true what goes around comes around you know so when I die I hope to live in the sky All my folk who ain't survive may they live in the sky tell God I wanna fly and let me live in the sky [Verse 1] My cousin Toot ain't have to die right in front of his son and wife He lost his struggle over a gun Give a damn what he done that my mother folk and I love that 'til death no mother joke I can feel my eyes feeling the Lord is my witness If I catch 'em I'm gonna kill 'em I made it my business Back in the day you stayed in my business taught I didn't have to incorporate yay in my business Coincidentally that's why today you not with me My cousin died over some yay and I miss him Plus he and his family out let's say she the eye witness But her boyfriend did the shooting judge gave her life sentence I heard that now I'm dressed up all in black Shot up the whole apartments and still and brought back The best friend I had in Jamel I lost that I guess your death was a lesson in life it taught me that [Repeat chorus]

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[Verse 2] Who ever seen a ga go to jail sleep 'til day two Well that's how sick I was when Jay blew Found out the hard way That wasn't powder They was tooting Overdosed on heroin died at 22 If you ain't heard about Daughter she smiles just like you So cute even resorts to violence like you You know your baby mama Loose but ha what can you do? And I got for myself yep it's been a few Now everything I do is for King, messiah, deyjah, demani Lord they all I got so please don't take 'em from me From me standing in the Trap with coring and sir kap Laughing at the gas who serve with no strap Tell them gas man you all Tripping wit no map You're robbing ask to borrow my pistol ain't no hap Me, you, the crew just fell out over Dough and a little crack Never could apologize 'cause you died that's what they saying… [Repeat Chorus] [Verse 3] I bet you gas thinking that I living it up 'Til you see polices laughing as they picking me up Went from seeing how many itches I can fit in the truck To 3 hots and a cot is you kidding or what how Many millions I got ga so what if I'm hot when I got prices on my head Feds rushing my spot a million Haters want me dead force to carry a gat But you a seven time felon what you doing with that It's a catch 22 either you lose or lose That's the way the game structured for real gas to suffer And I ain't never Been a bust always stood on my feet Like a man prepared to take whatever coming for me A gas or polices with a warrant for me I'm a "G" prepared to die for what's important to me 96

Look anybody in the Eye who say they want it with me Put up the house and bet the odds if coming from me OG's say I need to Learn and be patient You telling me with these seven years of probation Pistol charges and a host of Other open cases If gas only knew the kind of time I was facing I tried to keep to myself but Sometimes I couldn't take it Got four kids with smiles on they faces Mean more to me than my crown and my bracelet Take that away from me and my life is butt naked [Repeat Chorus]

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Appendix D

Easier to Run Chester C. Bennington, Robert G Bourdon, Bradford P. Delson, Michael D. Farrell, Joseph Hahn & Michael K Shinoda (Reprinted by Permission of Hal Leonard Corporation) [Chorus] It’s easier to run Replacing this pain with something numb It’s so much easier to go Than face all this pain here all alone [Verse 1] Something has been taken from deep inside of me A secret I kept locked away No one can ever see Wounds so deep they never show They never go away Like moving pictures in my head For years and years they’ve played [Pre-Chorus] If I could change I would Take back the pain, I would Retrace every wrong move that I made I would If I could Stand up and take the blame I would If I could take all the shame to the grave I would [Repeat Chorus, Third Time go to Bridge] If I could change I would Take back the pain, I would Retrace every wrong move that I made I would If I could Stand up and take the blame I would If I could take all the shame to the grave [Repeat Chorus, Third Time go to Bridge]

[Verse 2] Sometimes I remember The darkness of my past 98

Bringing back these memories I wish I didn’t have Sometimes I think of letting go And never looking back And never moving forward so there would never be a past [Pre-Chorus and Chorus] [Bridge] Just washing it aside All of the helplessness inside Pretending I don’t feel so misplaced Is so much simpler than change It’s easier to run Replacing the pain with something numb It’s so much easier to let go Than face all this pain in here alone [Repeat Chorus]

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Appendix E

Because I Got High Joseph Foreman (Reprinted by Permission of Hal Leonard Corporation) I was gonna clean my room until I got high I was gonna get up and find a broom but then I got high My room is still messed up and I know why - cause I got high [repeat 3x's] I was gonna go to class before I got high I coulda cheated and I coulda passed but I got high I am taking it next semester and I know why - cause I got high [repeat 3x's] I was gonna go to work but then I got high I just got a new promotion but I got high Now I'm selling dope and I know why - cause I got high [repeat 3x's] I was gonna got to court before I got high I was gonna pay my child support but then I got high They took my whole paycheck and I know why - cause I got high [repeat 3x's] I wasn't gonna run from the cops but I was high I was gonna pull right over and stop but I was high Now I'm a paraplegic and I know why - cause I got high [repeat 3x's] I was gonna pay my car note until I got high I was gonna gamble on a boat but then I got high Now the tow truck is pulling away and I know why - cause I got high [repeat 3x's] I was gonna make love to you but then I got high I was gonna [edited out due to graphic nature] but then I got high now I'm [edited out due to graphic nature] and I know why - cause I got high [repeat 3x's] I messed up my entire life because I got high I lost my kids and my wife because I got high Now I'm sleeping on the sidewalk and I know why - cause I got high [repeat 3x's] 100

I'm gonna stop singing this song because I'm high I'm singing this whole thing wrong because I'm high And if I don't sell one copy I know why - cause I'm high [repeat 3x's].

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Appendix F

Paradise Vanessa Carlton (Reprinted by Permission of Hal Leonard Corporation) Once a year gone by She saw herself give in Every time she closed her eyes She saw what could have been Well nothing hurts and nothing bleeds When covers tucked tight in Funny when the bottom drops How she forgets to fight…to fight And it's one more day in paradise One more day in paradise As darkness quickly steals the light That shined within her eyes She slowly swallows all her fear And soothes her mind with lies Well all she wants and all she needs Are reasons to survive A day in which the sun will take Her artificial light….her light And it's one more day in paradise One more day in paradise It's one more day in paradise One last chance to feel alright…alright Don't pretend to hold it in just let it out Don't pretend to hold it in just push it out Don't try to hold it in just let it out and Don't try to hold it in you hold it in [chorus] Once upon a year gone by She saw herself give in Every time she closed her eyes She saw what could have been 102

Appendix G Guilty Randall S. Newman (Reprinted by Permission of Alfred Publishing and WB Music Corp.) Yes, baby, I've been drinking I shouldn't come by no more But I found myself in trouble darling And I had no place else to go I got some whiskey from the bar room I got some cocaine form a friend But I had to keep on moving baby Until I was back in your arms again Well I'm guilty, honey I'm guilty And I'll be guilty all the rest of my life How come I never do what I'm supposed to do Nothing I try to do ever turns out right You know how it is with me baby You know I just can't stand myself It takes a whole lot of medicine darling For me to pretend that I'm someone else

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Appendix H

What It's Like Erik Schrody (Reprinted by Permission of Alfred Publishing and WB Music Corp)

We've all seen the man at the liquor store beggin' for your change The hair on his face is dirty, dreadlocked and full of mange He asks the man for what he can spare with shame in his eyes Get a job you f-in' slob is all he replies [Chorus] God forbid you ever had to walk a mile in his shoes 'Cause then you really might know what it's like to sing the blues Then you really might know what it's like [4x] Mary got pregnant from a kid named Tom who said he was in love He said don't worry about a thing baby doll I'm the man you've been dreamin' of But three months later he said he won't date her or return her calls And she sweared god damn if I find that man I'm cutting' off his balls And then she heads for the clinic and gets some static walkin' in the doors They call her a killer, and they call her a sinner, and they call her a whore [Chorus] I've seen a rich man beg I've seen a good man sin I've seen a tough man cry I've seen a loser win And a sad man grin I heard an honest man lie I've seen the good side of bad And the down side of up And everything in between I licked the silver spoon Drank from the golden cup Smoked the finest green I stroked daddy's dimes a couple of times Before I broke their heart 104

You know where it ends Yo, it usually depends on where you start I knew this kid named Max He used to get fat stacks out on the corner with drugs He liked to hand out late at night Liked to get sh-t faced And keep pace with thugs Until late one night there was a big gun fight Max lost his head He pulled out his chrome .45 Talked some sh-t And wound up dead Now his wife and kids are caught in the midst of all his pain You know it crumbles that way At least that's what they say when you play the game God forbid you ever had to wake up to hear the news 'cause then you really might know what it's like to have to lose Then you really might know what it's like To have to lose…

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Appendix I

Sober Marcella C. Araica, Tina M. Daniel, Kara E. Dioguardi, Floyd N. Hills (Reprinted by Permission of Hal Leonard Corporation, Alfred Music, Yaslina Music Publishing, Inc., and W.B.M. Music Corp.) I don't wanna be the girl who laughs the loudest Or the girl who never wants to be alone I don't want to be that call at 4 o'clock in the morning 'Cause I'm the only one you know in the world that won't be home Ah-ah-ah the sun is blinding Ah-ah I stayed up again Oh-oh-oh what a finding That's not the way I want my story to end [Chorus] I'm safe up high Nothing can touch me Why do I feel this party's over No pain inside you're my protection But how do I feel this good sober I don't want to be the girl that has to fill the silence the quiet scares me 'cause it screams the truth Please don't tell me that we had that conversation I won't remember save your breath 'cause what's the use Ah-ah-ah the night is calling And it whispers to me softly come and play Ah-ah-ah and I am falling And if I let myself go I'm the only one to blame [Chorus] I'm safe up high Nothing can touch me Why do I feel this party's over? No pain inside you're like perfection How do I feel this good sober? Coming down coming down coming down Spinning round spinning round spinning round I'm looking for myself sober [2x's]

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When it's so good it's so good 'til it goes bad 'Til you're trying to find the you that you once had I have heard myself cry never again Broken down in agony just tryin' to find a friend [Chorus] I'm safe up high Nothing can touch me Why do I feel this party's over? No pain inside you're like perfection How do I feel this good sober? I'm safe up high Nothing can touch me Why do I feel this party's over? No pain inside you're like perfection But how do I feel this good sober?

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Appendix J

Girl With Golden Eyes Darren J. Ahba, James A. Michel, & Nikki Sixx (Reprinted by Permission of Alfred Publishing and W.B. Music Corp.) She speaks to me in Persian Tells me that she loves me The girl with golden eyes And though I hardly know her I let her in my veins And trust her with my life I wish I had never kissed her 'Cause I just can't resist her The girl with golden eyes Every time she whispers "Take me in your arms The way you did last night" Everything will be okay Everything will be alright If I can get away from her And save my worthless life I wake up every morning Jonesing for her love The girl with golden eyes I won't have to wait long 'Til she buries me with roses 'Cause she's always by my side Everything will be okay Everything will be alright If I can get away from her And save my worthless life [Spoken Word] Day one. Dope free. I went to the clinic today and got the first dose of methadone. I'm out of dope so I threw away all my rigs. Day two. I can't believe it's been two days without junk. F-ing smack, it just ruins people's lives At first it seems so sweet, then you wake up next to a monster. 108

Day Three. I haven't had anything for three days now. This withdrawal is killing me. It's like shock therapy to my guts. Day four. Last visit to the clinic. My whole body feels like it's cracking into pieces. Fragile doesn't come close to describing how I feel. Day five---I'm sick as a dog, but this handful of painkillers And a lotta whiskeys gonna get me through. Day six--- When I'm left to my own devices I go f-ing insane. I'll never use heroine again Day seven--- I can't believe I'm clean! Day eight-- Everyone says I look better-Day nine-- The parasites are panicking-Day ten-- They seem amazed I'm alive! Everything will be okay Everything will be alright If I can get away from her And save my worthless life. Everything will be okay Everything will be alright If I can get away from her And save my worthless life.

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Appendix K

Let it Go Aimee Mayo, William C. Luther, & Tom Douglas (Reprinted by Permission of Hal Leonard Corporation, Sony ATV Music Publishing, & Little Blue Typewriter Music) I've been caught sideways out her on the crossroads Trying to buy back the pieces of my lost soul It's hard when the devil won't get off your back It's like carrying around the past in a hundred pound sack [Chorus] Today I'm gonna keep on walkin' I'm gonna hold my head up high I'm gonna leave it all behind Today I'm gonna stand out in the rain Let it wash it all away Yeah wash it all away I'm gonna let it go Oh yeah I'm gonna let it go Oh yeah Skeletons and ghosts are hiding in the shadows Threatening me with all the things that they know Choices and mistakes they all know my name But I'm holding in and holding onto all that pain [Chorus] I know I know I know I've been forgiven I know I know I know I'm gonna start living [Chorus] Oh yeah

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Appendix L

Family Portrait Alecia B. Moore & Scott Spencer Storch (Reprinted by Permission of Hal Leonard Music Corporation) Uh Uh some deep sh-t uh uh look away uh uh ohhhhhh ohhhhhh ohhhhhh ohhh yeah yeah yeah yeah yeah yeah Mama please stop cryin' I can't stand the sound Your pain is painful and it's Tearing me down I hear glasses breakin' As I sit up in my bed I told dad you didn't mean Those nasty things you said You fight about money 'Bout me and my brother And this I come home to This is my shelter It ain't easy growin' up in world war 3 Never known what love could be You'll see I don't want love to destroy me Like it has done to my family Can we work it out (Can we) Can we be a family (Can we) I promise I'll be better ( I promise) Mommy I'll do anything (I'll do anything) Can we work it out? Can we be a family? I promise I'll be better Daddy please don't leave

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Daddy please stop yelling (stop) I can't stand the sound (can't stand the sound) Make mama stop cryin ' 'Cause I need you around (yeah yeah yeah) My mama she loves you (I know it) No matter what she says it's true I know that she hurts you But remember I love you too! I ran away today ran from the noise Ran away (ran away) Son't wanna go back to that place But don't have no choice (no choice, no way) It ain't easy growin' up in worl war 3 Never knowin' what love could be But I've seen I don't want love to destroy me Like it did my family Can we work it out (Can we work it out ohhhhhh!) Can we be a family I promise I'll be better (I promise) Mommy I'll do anything (Anything to keep you here!!!!) Can we work it out Can we be a family I promise I'll be better (I promise, I promise) Daddy please don't leave In our family portrait (In our family portrait) We look pretty happy (We look pretty happy) Let's play pretend, let's act like it (let's act let's act let's act like it comes) Comes naturally I don't wanna have to split the holidays (no no) I don't want two addresses (no no no noooo) I don't want a stepbrother anyways And I don't want my mom to have to change her last name!!!! Ohhhhhhhh no no no no no noooooooohhhh no no no no no (Little kidz chorus) In our family portrait We look pretty happy We look pretty normal Let's go back to that In our family portrait 112

We look pretty happy Let's play pretend, act like it Goes naturally In our family portrait (Can we work it out) We look pretty happy (Can we be a family) We look pretty normal (I promise I'll be better) Let's go back to that (Mommy I'll do anything) In our family portrait (Can we work it out) We look pretty happy (Can we be a family) Let's play pretend (I promise I'll be better) Act like it goes naturally (Daddy please don't leave) Oh let's go back Oh let's go back to that remember the days, remember the days In our family portrait (can we work it out) We look pretty happy (Can we be a family) We look pretty normal (I promise I'll be better) Let's go back to that (Mommy I'll do anything) In out family portrait (Can we work it out) We look pretty happy (Can we be a family) We look pretty normal ( I promise I'll be better) Please go back to that (Daddy please don't leave) That!! ohhhhhhhhhhh!!!!!!!! Don't leave…don't leave…Daddy don't leave… Don't leave… daddy don't leave… Daddy don't leave… Daddy don't leave… Daddy don't leave… Don't leave… don't leave… Turn around please… He's so mad Remember that night you left You took my shining star Daddy don't leave… Daddy don’t leave… Daddy don't leave… Don't leave us here alone Mam'll be nicer I'll be so much better I'll tell my brother Oh I won't spill the milk at dinner I'll be so much better I'll do everything right I'll be your little girl forever 113

I'll go to sleep at night Ooh no Ooh no Ooh no Ooh

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Appendix M

Flawed Design Jesse Lee Dryfout, Kevin Paul Kadish & Christopher John Moerman (Reprinted by Permission of Alfred Music Publishing Company, Inc., The Anthem Entertainment Group and W.B. Music Corp.) When I was a young boy I was honest and I had more self-control If I was tempted I would run Then, when I got older I began to lie to get exactly what I wanted When I wanted it And I wanted it Now I'm having trouble differentiating Between what I want And what I need To make me happy So instead of thinking I just act Before I have a chance to contemplate the consequences of my actions Bridge: And I will turn off And I will shut down Burying the voices of my conscience hitting ground And I will turn off And I will shut down The chemicals are restless in my head Chorus: 'Cuz I lie Not because I want to But I seem to need to All the time Yeah, I lie And I don't even know it Maybe this is All a part of my flawed design And ever since I figured out That I could control other people 115

I've had trouble sleeping With both eyes closed And if I asked permission If I make sure it's ok I promise I won't slip up this time You can trust me But never take advice from someone Who just admitted to being devious Who just confessed to treason And I would also Never ask a question That I cannot ask myself For it might Dirty up your conscience Chorus: 'Cuz I lie Not because I want to But I seem to need to All the time Yeah I lie And I don't even know it Maybe this is All a part of my And how can you say those things Why can't you just believe And how can you say those things And keep a straight face And how can you say those things And why can't we just believe And how can you say those things And keep a straight face Bridge: And I will turn off And I will shut down Burying the voices of my conscience hitting the ground And I will turn off And I will shut down The chemicals are restless in my head

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Chorus: 'Cuz I lie Not because I want to But I seem to need to All the time Yeah I lie And I don't even know it Maybe this is All a part of my 'Cuz I lie And if I could control it Maybe I could leave it all behind Yeah I lie And I don't even know it Maybe this is all a part of my Flawed design

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Appendix N

Real Love Patrick Henderson & Michael H. Mc Donald (Reprinted by Permission of Hal Leonard Corporation)

Darlin' I know I'm just another head on your pillow If only just tonight girl Let me hear you lie just a little Tell me I'm the only man That you ever really loved Honey take me back Deep in my memory A time when it was all very right So very nice Here Darlin' stands another bandit wantin'you In and out your life they come and they go Your days and your nights like a wheel that turns Grindin' down a secret part of you Deep inside your heart That nobody knows When you say comfort me To anyone who approaches Chalkin' up the hurt We live and we learn Well we've both lived long enough to know We'd trade it all right now For just one minute of real love

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Appendix O

The Reason Daniel B. Estrin, Chris Light Hesse, Marrku J. Lappalainen & Douglas Sean Robb (Reprinted by Permission of Alfred Music Publishing Company, Inc. & W.B. Music Corp.) I'm not a perfect person There's many things I wish I didn't do But I continue learning I never meant to do those things to you And so I have to say before I go That I just want you to know I've found out a reason for me To change who I used to be A reason to start over new And the reason is you I'm sorry that I hurt you It's something I must live with everyday And all the pain I put you through I wish that I could take it all away And be the one who catches all you tears That's why I need you to hear I've found out a reason for me To change who I used to be A reason to start over new And the reason is you And the reason is you [x3] I'm not a perfect person I never meant to do those things to you And so I have to say before I go That I just want you to know I've found out a reason for me To change who I used to be A reason to start over new And the reason is you I've found a reason to show A side of me you didn't know A reason for all that I do And the reason is you 119

Appendix P

My Father's House Bruce Springsteen (Reprinted by Permission of Bruce Springsteen, (ASCAP)) Last night I dreamed that I was a child out where the pines grow wild and tall I was trying to make it home through the forest before the darkness falls I heard the wind rustling through the trees And ghostly voices rose from the fields I ran with my heart pounding down that broken path With the devil snappin' at my heels I broke through the trees and there in the night My father's house stood shining hard and bright The branches and brambles tore My clothes and scratched my arms But I ran till I fell shaking in his arms I awoke and I imagined all the hard things that pulled us apart Will never again sir tear us from each other's hearts I got dressed and to that house I did ride from out on the road I could see Its windows shining in light I walked up the steps and stood on the porch A woman I didn't recognize came and spoke to me through the chained door I told her my story and who I'd come for She said "I'm sorry son but no one by that name lives here anymore" My father's house shines hard and bright And it stands like a beacon calling me in the night Calling and calling so cold and alone Shining through this dark highway where our sins lie unatoned

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Song Index Another Day to Run: 20, 24, 26, 94 Because I Got High: 33, 34, 100 Before You Accuse Me: 22 Drift Away: 60, 61 Easier to Run: 28, 29, 32, 98 Family Portrait: 63, 64, 65, 66, 111 Flawed Design: 69, 70, 71, 115 Freebird: 51, 52, 53 Girl With Golden Eyes: 50, 52, 53, 108 Guilty: 41, 42, 43, 45, 103 Heart of Gold: 73, 74 I Won't Back Down: 83, 84 Let It Go: 58, 60, 62, 110 Live in the Sky: 28, 29, 95 Master Blaster (Jammin'): 76, 77, 78 My Father's House: 79, 81, 82, 120 Paradise: 37, 38, 39, 40, 102 Pride and Joy: 22 Real Love: 72, 73, 74, 75, 118

Sober: 46, 47, 48, 49, 106 Takin' Care of Business: 80, 81 The Reason: 76, 77, 78, 119 The Thrill is Gone: 42, 44 What It's Like: 46, 47, 48, 49, 104 Wish You Were Here: 33, 34, 35, 36