Nick Jaworski; Essential Elements for Effective Group Therapy

Montare Media presents Season 2, episode 15 of the Discover U Podcast with JD Kalmenson: Essential Elements for Effective Group Therapy with Nick Jaworski

JD Kalmenson interviews Nick Jaworski, an expert in behavioral health strategy, to learn about where most group therapy goes awry, and what both providers and patients can do to improve their experiences. Nick draws on his years as an educator to discuss techniques to promote greater engagement, motivation, and skill building during therapy. Learn what factors make the most difference in successful outcomes.  

Nick is an internationally recognized executive in the field of behavioral health with experience building organizations across four continents. As the owner of the Institute for the Advancement of Group Therapy and Circle Social Incorporated, he has helped behavioral health organizations ranging in revenue from 10 million to 1 billion a year, perform turnarounds, accelerate growth, and improve patient outcomes. He's a recipient of the prestigious Jefferson award for his work in mental health, and is an advisor to the board for the behavioral health association of providers. He also holds a certificate in Rational Emotive Behavioral Therapy, R E B T. And when he is not online, he can be found spending time with his favorite person in the whole world. His daughter. 

Host Kalmenson is the CEO/Founder of Renewal Health Group, a family of addiction treatment centers, and Montare Behavioral Health, a comprehensive brand of mental health treatment facilities in Southern California. Kalmenson is a Yale Chabad Scholar, a skilled facilitator, teacher, counselor, and speaker, who has provided chaplain services to prisons, local groups and remote villages throughout the world. His diverse experience as a rabbi, chaplain, and CEO has inspired his passion and deep understanding of the necessity for effective mental health treatment and long-term sobriety.

Follow JD at JDKalmenson.com

Transcript

JD Kalmenson:

 Welcome to another episode of Discover U, our podcast exploring innovative and effective solutions to issues in mental and behavioral health. I'm JD Kalmenson, CEO, of Montare Behavioral Health, a family of dynamic and comprehensive mental health treatment centers in Southern California. I'm very excited to introduce you today to our wonderful guest, Nick Jaworski. 

Nick is an internationally recognized executive in the field of behavioral health with experience building organizations across four continents. As the owner of the Institute for the Advancement of Group Therapy and Circle Social Incorporated, he has helped behavioral health organizations ranging in revenue from 10 million to 1 billion a year, perform turnarounds, accelerate growth, and improve patient outcomes. He's a recipient to the prestigious Jefferson award for his work in mental health, and is an advisor to the board for the behavioral health association of providers. He also holds a certificate in Rational Emotive Behavioral Therapy, R E B T. And when he is not online, he can be found spending time with his favorite person in the whole world. His daughter. Welcome Nick. I am so glad that you took the time to discuss something so important. Helping patients and families identify what good mental health therapy looks like, what authentic and quality care ought to look like. So jumping right in, can you tell us a little bit about yourself and the Institute that you run and how you sort of, know so much about this critical issue? 

Nick Jaworski:  So I'd probably start going back to the education component, which is a lot of my experience within the group therapy setting in particular. So as a young man, I went through therapy myself for addiction treatment. I went through an I IOP, or intensive outpatient level of care, like the age of 18 or so. It was a pretty negative experience for me, mainly because of the low quality of the counseling. So I was in there for a DUI. It was mandatory to go, into counseling after that as well was about half the group was in there for the same reason, but there was another half that had voluntarily chosen to come and were really looking to get better. They were looking for help struggling with their alcoholism, their drug use, and I just saw how little help that they got. And so that stuck with me a long, long time. 

JD Kalmenson: When you were going through that experience, what did you find that was so absent that was so lacking and what made the experience negative? Was it a lack of a curriculum? Was it a lack of sophistication or compassion or empathy? What specifically would you, would you look back at that experience and say, you know, this is what really contributed to being contributed it to being negative and ineffective? 

Nick Jaworski: Oh, all of that JD.  There was no real plan or structure in place, you know, one day we might come in and watch a movie for two hours. Other times it was just tell me about what's going on. Let's talk about it.  it was also very inauthentic. Right? So the assumption was that if you were in this program, you were never going to drink again, that you were committed to sobriety, which was just not the case for half the people in the room, but if you didn't, basically state the case that you were in there for those reasons, then you wouldn't pass through therapy, right. And then you wouldn't meet your qualifications for, for the DUI criteria. So ironically I was under 21 at the time, but half the half the group would actually go out to the bar after the IOP sessions, you know, so everyone's in there talking about everything and making all this stuff up, but it was not real. That was really bothersome to me. And then the empathy part was a big one, right? So the counselor was very, very new unskilled untrained. She had a year of sobriety under her belt and one comment sticks out with me really consistently during that time was, there's a woman named Tammy and she was in there voluntarily with major drinking drug problems. And, she was relaying a story to us about going home and she decided to stop by the liquor store down to fifth of vodka before she drove home. Well, one of the reasons for her drinking was she had a very abusive spouse, and so she starts going into how, you know, she had just been the victim of, domestic violence the night before. She was extremely apprehensive about this, and the counselor goes, “Tammy.” She goes, “we're not here to talk about your relationship. We're here to talk about your addiction.” 

JD Kalmenson: Wow. You 

Nick Jaworski: Need to focus on alcoholism, you know, and that, that moment just really stood out to me that complete disconnect, no empathy. And then the lack of understanding and that as if addiction's completely disconnected from what 

JD Kalmenson: Your life, from everything else. Wow. And I I'd say we've come a long way since…

Nick Jaworski: Sometimes, it definitely depends on the group I'm in. I do still see that, especially if I'm talking to medical directors. Medical directors a little bit more than clinical directors. Dual diagnosis has become a norm. So this understanding that there's kind of more, underlying issues going on. Trauma has become a big thing in the space. People recognize it more, but it's still, they're almost seen as separate entities. Addictions over here, mental health is over here, trauma’s over here, which just isn't the reality. 

JD Kalmenson: Yeah. No, most definitely. And uh, we we'll jump more into that in greater depth in detail, but I interrupted, you were middle of saying how that sort of was a starting point. And then you ended up being involved as a leader in education for quite a long time. 

Nick Jaworski: so we talked a little bit about the fact that I went through treatment myself, you know, as 18, 20 years ago, that stuck with me, I then spent a decade abroad. So I was a trainer, a teacher. Then I was a trainer. Then I was a school administrator all over the world. So, uh, Czech Republic, Turkey, Vietnam, China, the us. And so from there, when I came back to the US. I ended up moving into the marketing consulting space for behavioral health, partly because of my experience with treatment myself and some of the gaps I found there. And then over time after building Circle Social for the marketing operations part, I just was in all these programs, I was in over a hundred programs and saw these gaps in treatment. And I realized that the gaps that were happening in the group therapy sessions were the same gaps I had in my classroom that I used to run. And I used to train my teachers on. So I said, well, actually I can actually help here. We can build this. And so we launched the Institute for the advancement of group therapy, specifically to train teachers, which are the therapists, right in the behavioral health setting. I'm sure we'll get into the, the difference there, how to maximize patient engagement. So everyone's involved and how to maximize skill building, not just knowledge transfer. 

JD Kalmenson: I love what you're saying on two fronts, first of all, when we, and we've spoken about this on another occasion, customized treatment is not just about taking the same modality, CBT, DBT. And just applying it to the client's specific circumstances and life story. But rather a custom treatment is more like a custom suit where it's not just the size that's custom, but the material, the look, and the feel and how it resonates with your character and personality. And when you take that into treatment because human beings, we're a composite of so many intricate nuanced details, and we're so unique and special. It's just going to follow that effective treatment will vary greatly not just about how it applies, but as far as the intervention and how the intervention ought to be done. 

So, you know, the fascinating thing between education and therapy is that I think some people superficially might say, well, Nick, education's very different than therapy because education is just a teacher conveying information. Whereas therapy is about dealing with an individual and creating a certain subjective injection to the cure so that it's effective so that it actually resonates. But I, I happen to think, and I, I, I wonder what your take is. I have to think that education also has to really be tailored to the individual students skillset way of thinking level of interest and what excites them for it to, you know, for them, for the student to be successful.

You know, when you sterilize an environment, especially at a younger age where there's no feeling, there's no emotion, there's no connection and attachment in the educational process. It's just a dry, cold transmission of data and information. You know, it it's, it's not that that creates monsters. It's just that, that might, you know, have the lack of that attachment might lead somebody who is already feeling very, alone in this world to do something a little bit crazy. So I, I think that education can actually learn from therapy in a way.

Nick Jaworski: So I, I wanna go back to something you said about education, and where education is didactic, right, where it's just a transfer of information and that's actually really poor education. That's one of the main things that I had to combat when I was teacher training and running school systems.  I would create all of our learning processes and training systems for the schools that I ran. And, a lot of teachers are didactic, right? And so that's one of your parallels between teaching and therapy is it's when you get a degree program, whether it's a BA or a master's, it's very, very book heavy. It's very, very theory, heavy, right? There's not a lot of applicable processes. So people don't learn how to engage learners and, and focus on what they're actually learning and how to measure that and improve that. 

And in the therapy session, it's the same. So what you wanna do, whether it's effective learning or therapy, and there is a large component of therapy that's learning, right? What do we want patients to get out of a particular group therapy session? Well, we want them to be able to restructure negative thoughts. We want them to be able to use I statements. We want them to be able to do incremental goal setting. We want them to be able to communicate better, to create a resume that helps them get a job, to emotionally regulate. Right? All of these things are teachable skills and skills is the exact keyword there whenever we're talking about learning. So the mistake that most programs make, both in the educational setting and the therapy setting is that they're just relaying information. And this is one of the reasons why you see people come back into treatment again, and again, and again. I mean, I'll be sitting in a group therapy program, and you've got other therapists as patients in that program. 

so the example that we use all the time is I can't learn to swim by reading a book about swimming. Right. I can't learn another language by just watching videos about that language. I have to use it live in action because there's different learning systems in the brain. And one of them is an unconscious automated process. And so you have to have that conscious element, which is the didactic element. And that happens the first 10 to 15 minutes of an hour-long session. But the remaining time in the group to be used really effectively is focused on skill building and maximizing repetition. So the more practice that they get, right, the more time I have in the water, the better I'm gonna learn to swim. The more time I have riding a bike, the better I'm gonna be on that bike. I can't listen to a teacher. Talk about it on a chalkboard or read about it from a book I've gotta get on the bike and do it. And recovery skills are exactly the same. So what we're really doing is taking active adult learning theory, right. And student-centered teaching practices and saying, Hey, how do you make sure that when your patients leave here, they have the skills to go out there and be successful in recovery. And we don't just want them to know those skills intellectually, right? We want them to have practice to such a degree that has at least started to become an unconscious automated process. So when they have someone walk up to them, maybe that they do in their past life and they say, Hey man, do you wanna go out for a drink? They don't have to think through their, you know, the practice that they did. Cause that's often not gonna work. They just go, Nope. They jump right to and say, I really appreciate it. It's not really what I do anymore, you know, but do you wanna go out for a bike ride next? I'd love to do that. So to do it without thinking, and that's the key. 

JD Kalmenson: I love that. I, it stimulated a lot of thoughts as you were speaking. And you know, one of the things that we believe very strongly at Montare and Renewal, our addiction treatment program, is that inspiration and empathy are two things that in other areas of healthcare, traditional medical healthcare, are non-factors. But when it comes to behavioral health, empathy is not a luxury, it's a necessity. And when you talk about a group that you were in over 20 years ago and half the group wasn't motivated, I think what people have to realize when you enter the treatment space is you will encounter invariably tons of clients who are there, but are not incredibly motivated. So one of the ways that we assess the efficacy of our group facilitators, and we do this with our surveys is we ask them to grade the group on a scale of one to 10, in three separate categories: How educational was the group, how engaging was the group, and how inspiring was the group. And they're really three separate things. You can have a group that was highly educational, engaging, but doesn't leave me walking away feeling like I want a part of that. I want that lifestyle, whatever the group facilitator was talking about, it just made my heart feel warm and fuzzy. And I wanna pursue that. And likewise, you could have a group that's very inspiring, but not very educational. It doesn't leave you with practical tips and coping skills that I can implement and integrate into my life. So they're really three separate categories. And, you know, the line that sticks out to me is even in the educational arena, you find that the very best teachers are not the brilliant, analytical geniuses. It's people don't care how much, you know, they wanna know people. I think the line was, people don't care how much, you know, they wanna know how much you care. 

Nick Jaworski: Sure. 

JD Kalmenson: And 

Nick Jaworski: That's, I think exactly right. 

JD Kalmenson: And that's where the inspirational piece comes in. It's, you know, this person cares about me and that inspires me to give my life a second chance if they see something in me. And that's the type of sentiment that we hear a lot in, in behavioral health. So yeah, I mean, on the educational front and the therapeutic front, these components really drive the success and the efficacy. They're not, they're, you know, they're not secondary, luxury enhancements. 

There's something that, uh, I've, I've been discussing recently with our team, which is an example I use is you take the, the deer who goes to the Riverbed every day and chooses the same path. And the path becomes well-trodden. And that's the familiar path for the deer. And one day a tree stump falls over the path and now there's an obstacle and there's some splinters on the path that can really hurt the deer's feet. And the deer can definitely take an alternative path, but without even realizing, it takes that path that it's to its own peril and danger, because it just knows that path. And when you look at somebody who was very inspired in treatment and really did well, and then they find themselves relapsing six months later, nine months later, and they look back and they say, Hey, it must have all been fake. None of this was sincere. How did, how did I lose it all? And what our response to them is, no, you have to really pause and say what happened here was not that I conscientiously chose alcoholism or drug abuse over sobriety and dignity. It's that in a moment of reactionary, impulsivity, I resorted to what's familiar to me and allowed that to trump what's better for me. So like, you know, it's just, where our minds naturally go. If we can make the natural default sobriety, then you're sort of out of the woods, you're in the clear.

Nick Jaworski: That's exactly right. So from a neurological learning standpoint, right, you've got different memory types. Some of the primary types are your short term, where you tell me a phone number or use it to call, and I forget it right away. Right. Then you've got working memory, which is, if I'm trying to do a math problem, I have to keep a couple different factors in my head as I'm doing it. And I'm carrying the one in my head as I'm remembering the numbers, that's working memory. And then if I use that consistently, I can move it from working memory to long term memory. And so that has to happen before you remember it. So what a lot of teachers and clinicians do, that's not effective is they'll say something, and they'll have someone repeat it back. Well, that person repeats it back and they're like, oh, they got it. No, they don't. Right. They had it in short term memory or working memory, but it wasn't enough repetition. They weren't firing it enough to wire it down, and you have to give time and pauses. So like, let's say, I want them to remember, you know, different cognitive distortions, and so I say, okay, list them on the board. I ask, them what they are. They remember them okay, done. Wrong. Right. You wanna come back to that five minutes later, 10 minutes later, 20 minutes later. And so memory is really about recall. So the more that you recall as an activity within a learning setting, the more likely it is to be committed to long-term memory. And then over time it'll become this automated process. Another really important factor is sleep actually. So during REM sleep, your brain actually recategorizes everything. And then actually runs the, the patterns and the pathways to find the optimal pathways. So it gets rid of the stuff it doesn't need, and then creates that pathway, that neural network that you're talking about and says, this is what you need to do. So if you look at like athletes, for example, say they're practicing a martial arts routine or gymnastics routine, and they do it all day and they're just having trouble with it while they'll wake up the next morning and then they'll just be able to do it. And that's actually what sleep is doing. And so this is why you have this trouble with mental health and addiction issues because sleep is a big problem. Yes, people won't get enough sleep, they have insomnia. And so they're not hitting their REM cycles and then alcohol and marijuana and some other drugs also pre prevent REM sleep. And so even though it might help you fall asleep, it prevents that Reem sleep. And so you're not getting that consolidation aspect of the sleep behavior. So you're in effect actually not effectively learning. It's pretty fascinating all around.

JD Kalmenson: That's an amazing, it's an amazing observation. You’re lacking the optimization that really is, is available to you by simply not giving your body a chance to regulate itself and to, and to optimize its neuro pathways. Having been in the field for a number of years, we see firsthand the, the, the parallels between addiction and insomnia and how so many of them fundamentally struggle with sleep is a massive issue. They don't know what it means to get a good night's sleep. And it's a, it's, it's an enduring ongoing struggle. And seeing the link between that issue and the other issue again, it creates a much more holistic and comprehensive treatment approach as opposed to looking at things in a vacuum or in a, you know, in isolation. You know, we've been talking about therapy for a few minutes now and I, I would love to get your take just on a very elementary, fundamental, basic level. What you've observed over a hundred therapy sessions. What does a session look like? What should it look like? What's the framework, the structure? I know a lot of television shows right now are showing different parts of, of what therapy looks like starting from the Sopranos, you know, with Tony seeing his shrink and there's so many shows since then, but for those who haven't been to therapy or who feel like they might not be doing it right, what does a typical session look like? 

Nick Jaworski: Yeah. So I'll focus on the group therapy aspect, cuz that's what I'm involved in. I don't do the private therapy sessions and I think that might be a little bit touchy for patients anyway. Sure. But the group therapy session we're used to having people coming in and out. So it's very easy for us to go in and that's where the max or the most of the patient engagement's happening. Right. so the majority of sessions, I mean really I can frankly say every session I've ever been in, without qualification, I've never been in a session that didn't have this structure to it. The therapy therapist walks in, and they just go around the room and they say, JD, tell me how you're doing today, Nick, how are you doing today, Suzanne? How are you doing today? and that's usually a check in, right. And that's the, the first kind of hour, and then the second hour they might do a topic, right? They might do DBT or something, but then they'll do the same thing. They'll have a question about emotions. And so they'll go around the room. Well, if I've got 12 people in that room, which is pretty standard for a group therapy session, I've only got really 50 minutes cuz you do 50 minutes and then you do a 10-minute break for smoking or coffee or bathrooms or whatever. So if I've got 10 people in the room and they each speak for five minutes, they only get five minutes of time, that's it. Five minutes of time per group session. And so if I've got six group sessions per day, right, six times five is 30, I'm getting 30 minutes of practice or talking time to discuss my issues in that therapy setting. And so that is one of the biggest problems that we see. And so what we do at the Institute is we train people how to maximize patient engagement within the therapeutic process. So at every single point in the therapy session, everyone should be engaged all the time. And so I'll give you two simple ways to do this, right? So let's say like, I like to use balls and, and little, aids, within the group therapy session. And so we'll take a ball, and we'll ask everyone, we'll ask the group a question, right?  So we'll say something like somebody, you know, tell me about a time that you had a cognitive distortion, and you were making mountains out of mole hills.  Sell, so what I'm not doing is throwing that ball to someone and then asking a question because if I do that, what happens?   Everyone else shuts down, right? They're like, oh, JD's got the ball, he's answering the question. I'm off, off the hook. I'm done, right. Whereas if I hold onto that ball and I say, okay, well tell me about that time you made a mountain out of mole hill. Now everyone's thinking, right. Cause they don’t know who the ball's gonna come to. And so you've done a little tiny tactic or technique, within the therapy session to maximize everyone's engagement. Another really big example is like we see readings, readings are, are reading out loud is, is probably one of the most ineffective techniques that I see within both traditional teaching settings and therapy sessions. 

JD Kalmenson: Well it's effective, might be effective in putting the others to sleep, which is something they need. Right. The REM…

Nick Jaworski: That's right. That's right. Maybe get some sleep, sleep, uh, tactics out of it. So they'll go around the room and everyone will read from it. Right. Well, if I'm reading my paragraph, whatever, what is everyone else doing? They're either reading it on their own or just not paying attention until it comes to them. Right? So again, another really ineffective process. So what we teach is a lot of focus tasks. So we'll say, okay, well there's lots of different things we can do. There's, there's a million different activities that we teach. But if you just wanna take the read aloud thing, only one person gets the sheet of paper. No one else has it. And then as that one person is reading their paragraph. You say everyone else, I need you to come up with a question that you have about that paragraph, that you're gonna ask someone else in the group, you know, after they're done with it. So again, what have I done? I've created a situation where every single person in that group therapy session has to be paying attention and they're learning something and getting something out of it. The, the next big step, something that we work really hard with clinicians on is pair work and small group work. 

So it's not my job to relay the information that they can look up on Google. It's my job to teach the skills and then provide them with the opportunities and the context to maximize practice as much as possible. And then I'm there as a support I'm walking around, I'm listening, I'm helping, okay, they're not doing this, right. They're not getting something. I'll bring everyone back and talk to 'em about it. And like we'll retry, or I've got one or two people that are really struggling with this particular, like they can't make I statements. They're having a really hard time converting a blaming statement into an I statement, you know? So then I'll sit there, I'll work with that group a little bit and say, okay, let's try this again. I'll model it for you. You do it. So you're absolutely active in facilitating, helping, and supporting, but you're also at the same time maximizing practice. And so in a really, really good therapy session, if you get to like the last half to quarter of the session, you should be able to run activities and skill set building, be able to walk outta that room, come back, and everyone is still on task, practicing these skills that we're working on, throughout the, the whole hour. 

JD Kalmenson: That's amazing. And that really resonates with me as I told you earlier, I I'm, I'm hearing all three categories being very strongly focused on in your, in, you know, in the trainings and in some of the ideas and exercises that you're having them do. I mean, obviously there's the educational piece, but I'm hearing that the engagement becomes a very high priority that the group facilitators ought to be focused on and ensuring that everybody is engaged, which is a challenge when you're dealing with multiple people, but using thoughtful, you know, insight and in how to, uh, implement that, that, you know, you you're, you're making that possible. And then last but not least inspiring them to go ahead and actually experience these exercises. Uh, you know, that’s the first step to making that a part of their habits and their lifestyle later on. So that's, that's amazing. I, I wanna pivot to something that those who haven't necessarily been to therapy or those who might hear stereotypes about folks who go to therapy might think about, and I'll tell  it to you by way of a story. 

A fellow, walks into a bar and he orders a drink, downs the glass of beer, picks up the glass and throws it across the bar and it smashes into pieces. The bartender grabs him and says, what, what the heck was that for? And he says, I'm so embarrassed, I'm ashamed, but I'm telling you, I've got anger problems. He says, you gotta be a lot better at that in the future. Sure enough, the next week, same thing happens. And after the fourth or fifth time, the bartenders had it, he grabs him by the shirt throws him out of the bar. And he tells him, you are not welcome until you go to therapy for half a year. Half a year comes, passes by. And the fellow shows up again. And the bartender is really happy that this individual, you know, he took his advice to heart, gets him a glass of beer, and sure enough, after he downs the glass, picks it up, throws it across him and smashes it into pieces. The bartender is yelling at him, and he says, “what about the therapy?”  He says, I went to therapy. I'm no longer ashamed. You know? And that's, and that's like a misconception out there that therapy makes us feel a lot better about ourselves. Right. And it helps us not judge ourselves. And there's definitely a lot of that that's very important, to combat feelings shame. But it, you know, to the layman who wants to know Nick, what are the goals of therapy? Is it to make us feel better or to change behavior? Is it to provide us with coping skills to deal with the world and all of its adversarial manifestations? Or is it to boost our self-esteem and to co us in a sense 

Nick Jaworski: That is an excellent question and what I've not been asked before. So from our standpoint, or from my standpoint, I would say it's skill building, right? So if I wanna feel better about myself, and that is a root of many people's mental health problems or addiction, you know, they grew up in an environment where they were told they were, they were always a loser, right. They couldn't do anything right. And just like we talked about, they internalized that by constantly hearing it in their environment. So it became kind of an unconscious thought pattern that just repeats and repeats and repeats, you know? And they didn't try to learn that they didn't wanna learn that, but because you hear so much repetition, it becomes that voice in your head, right? So the way that we think about it is, well, now you have to restructure those negative thoughts. Right. And you have to recognize it. So first you have to train yourself to recognize it 

So we wanna teach them the skills that's identify and recognize that emotion or that thought, and then restructure it and say, well, I'm not a loser and that's not good enough. Right. As you know, as in the therapeutic setting, we're not just gonna counter that statement. We wanted to think of a specific real-world actions and past events to counter it. So well, you know, actually I was really successful in fourth grade, or I ran a marathon last year, or I, I wanted to reduce my drinking from every night to three nights a week. And I did that. And so great. Now you've identified an actual success to combat that narrative. And so you're restructuring that negative thought pattern. So for us, it's about that. You're going to feel better about yourself through these processes, but it's about building the skills to help you feel better, not just some kind of superficial thing, like, well, tell yourself, you know, you're, you're not a loser, right? Or tell yourself you want a better life. That's not enough. You actually have to give them the skills to do that on a regular basis. 

JD Kalmenson: But I love that answer because you're basically saying that the two options don't have to be mutually exclusive. When you change your behavior, when you become a better person, you will feel better. That will elevate your self-esteem that will make you feel less shameful. That will help combat all those feelings of insecurity. So that's a, that's an awesome response. You know, they say that, how many chiropractors does it take to change a light bulb? And I know the answer is one, but 25 times. So, they get this bad rep about, you know, repeat clients. And I think that's something else that a lot of folks struggle with. Like what does a therapeutic intervention really look like? What's the beginning, what's the middle and what's the end, or is it something that is an ongoing sort of relationship that is indefinitely maintained? 

Nick Jaworski: As you know, it's different for everyone, right? It depends on the severity of your addiction and where in your life depends on support or lack of support that you have. Right. If I'm going back to a home environment where, or my entire family's using all the time, that's a lot, lot more difficult than if I've got a family that doesn't use.  or, you know, if everyone I know has a college degree and can kind of help me get jobs, and I, I know how that works versus I don't know anyone that's ever completed high school. I don't know what, uh, anyone around me that's ever held a job that was more than part-time at like fast food or hospitality, you know? So it really is, uh, there's a strong factor of 

JD Kalmenson: Circumstantial. 

Nick Jaworski: Yeah. Right. 

That’s not gonna happen for everyone is that they're gonna go into a therapeutic session and, and just be better. Right. I think that's one of the big mistakes. A lot of people make. It's possible. It does happen. But you know, the average, especially if we're looking at residential, you know, there's usually three to four treatment episodes seems to be what the research says on an average over like an eight-year period. Before a lot of people find kind of long-lasting recovery, but that's on a very severe end of things. Right. Another 80% of people will just walk away from addiction without any therapy, without any professional support whatsoever. They'll just, you know, they'll have a child they'll get older, they'll start to have a career. 

JD Kalmenson: Is that how high the number is? 80%. 

Nick Jaworski: Yeah. According to the research that I'm familiar with, it's 80% in terms of what people call natural recovery for people that just walk away, right

JD Kalmenson: So 80% will never need treatment. That's an amazing. I'm just curious. Yeah, is…

Nick Jaworski: We skewed because we deal with the severe cases that really struggle. Right, but like, if you look at, so just look at like the SAMSA data, they track all of the addiction rates for different age groups and cohorts for a long, long time. And so if you look at between the ages of 25 and 26, so you're 18- to 25-year-olds are always the highest rate of addiction out of any age group. And then suddenly at 26, that number drops by half. So half of all people will leave addiction between 25 and 26. Why is that? I mean, you know, I don't have a, a concrete answer, but we can make a pretty strong educated guess that they're getting outta college. They're getting serious about life. They're having families getting married, having kids starting to have careers, it's just not conducive to a lifestyle of drugs and partying all the time. But yeah, that's pretty consistent, you know? And so even if you look at like really hardcore drugs or what people might call a hardcore drug, like cocaine or heroin, people actually leave those behind sooner. So the average length of a cocaine addiction is about four years. The average length of an alcohol addiction is 20 years plus. So why, why, if we consider cocaine to be a hard drug, do people leave it so much more quickly than alcohol? Well, alcohol is socially condoned. It's very easy to get access to we have less legal troubles with it, less social stigma against it. It's also cheaper, right? Whereas cocaine's super expensive. It's hard to get lot of legal repercussions, lot of social repercussions. So I'm, I'm strongly encouraged to leave my cocaine addiction behind, whereas I'm not so encouraged to leave my alcohol addiction behind a lot of the time, so all these factors kind of go into where people are 

JD Kalmenson: So, so interesting. So what, in your opinion are the most important elements that make therapy effective? Like if you had to pinpoint and you were guiding a mom, you know what to look for in therapy for a child or a loved one, what would you, what would you advise?  

Nick Jaworski: When it comes down to the wire, it's really about how is the therapeutic Alliance between the therapist and the person in treatment. And so what I tell people is, you know, look for a good program, cuz they're more likely to have good therapists or, or larger programs also have a number of therapists, but you need to find someone that clicks with you, or clicks with your loved one or whoever it is.  I used to tell, parents the same thing when they were looking for schools and said, you know, I don't care if you're doing Walford, or Montessori or kind of traditional teaching. Not a lot of it matters. What really matters is, is there a bond between the teachers and the students and, and can the therapist or the teacher help facilitate those bonds? So that's number one. Number two is related to the motivation, the engagement aspect. So if someone's just going around in a circle and you get five minutes of talk time, I'm completely disengaged. And so I'm not going to have a positive recovery experience most of the time. So it's all probabilities, right? We're just trying to maximize the probability of success. Nothing is full proof, but if we engage everyone in a therapeutic session, they're much more likely to have a positive response. And then the third piece is the recovery skill building. Right so we've got their engagement, right? I've built the empathy. I've built the relationship. I've got everyone engaged through all these tactics that we train on. And then finally, am I giving them the skills. So when they walk out the door again, it's, it's at least as automated as possible so that they just default to it, versus having to consciously think about it, which is too slow. It takes too much energy in the brain and it's less likely to be successful than, than if it's really been practiced and drilled into people through the treatment process. 

JD Kalmenson: Would you say that if you have strong engagement, strong motivation, strong connection, and strong exercise building, it's less important, which modality, or would you say that that's also a critical component into this overall success and you know, effectiveness? 

Nick Jaworski: Yeah. A hundred percent. The modality really doesn't matter. it doesn't matter. And that's been really shown in the research consistently. That's a therapeutic alliance that matters. So even if you have someone that comes in, that's an atheist and the therapist is teaching 12 step facilitation, they will still do really well in that program if they really bond with the therapist. 

JD Kalmenson: And it makes sense because you know, one of, so our three company core values are empathy, authenticity, and purpose, but jumping into the authenticity piece for a second, it's like if I am gonna put on airs and I'm going to present myself in treatment as a certain way and not really allow myself to be authentic and vulnerable, then I'm essentially just closing myself up from allowing all the incredible insight and skills and skillset building to really penetrate into the real me. So if somebody's coming and that, and they don't have that alliance, then what's really happening here is the real them, as it were, is not going to walk away changed because that real them has been closed and sheltered from having a voice and having a representation in this therapeutic process here, you know. It needs to be represented so that it could really, it could really open itself up and allow change to happen. 

JD Kalmenson:   If our listeners would like to contact you, what's the best way for them to get in touch? 

Nick Jaworski: Oh, sure, so LinkedIn is actually one of the best places to make a personal connection with me so if you just find me Nick , J a w O R S K, I, uh, I actually get my name cause I have such an early adopter of LinkedIn <laugh>, but I don't weird numbers or anything after it. , otherwise you can email me directly. , so the Institute for the Advancement of Group Therapy has a general address, so if you wanna reach me personally, I would use my circle social address, which is Nick at circle, social Inc nc.com. , and then as always you can check out our website. So Institute is under group therapy, certification.com and then circle social is circle social impact.com 

JD Kalmenson: That's amazing. And really the primary consultancy for the, for the, for the, uh, trainings of the therapist is for companies who are organizations who are looking to improve the quality of their care, their outcome measures and their efficacy. And that's where the trainings would really be helpful in really giving it a, a structured sort of trajectory of success. And that's, that's awesome. We, we need a lot of that right now. So thank you for doing that. And, uh, thank you for taking the time, ensuring a lot of incredible insight and depth of knowledge and about our space  and thank you audience for joining us too. 

I hope you enjoy today's episode of Discover U. At Montare we want you to know that you're not alone on your journey, and to find out more about our treatment programs, you can always find us@montarebh.com, or monteerbehavioralhealth.com. And you can listen to our Discover U podcast on iTunes, Spotify, or wherever you get your podcasts, wishing all of you, wonderful health in a safe and peaceful day. See you next time.