“Expletive Deleted” (ExD): A Group Motivational Exercise for Coping and Maintenance

Treatment

Counselor Magazine 2010/Nov-Dec

 

It all begins with one experience shared by the overwhelming majority of alcoholics and addicts who have tried to abstain—picking up the first drink/drug of relapse with an expletive of frustration and/or despair, most commonly starting with the letter “f.”

So the exercise must start with that experience, verified and replicated every time the exercise is facilitated, whatever feelings a clinician may have about such language:

“Who here has ever been abstinent, intending to remain that way, only to break down with some sort of expletive and pick up that first drink/drug?” Americans monotonously (but not exclusively) use of the “f  word” (DuWors, 2000)—this article will refer to it simply as ‘(ExD).’ Having established that most of the people in the room have had this experience, the facilitator may observe:

“These expletive words are generally meaningless and always irrelevant. You are not about to perform the action verbs used. And “it” is a pronoun with no specific antecedent.  In other words, you are about to do the most meaningful negative thing an addict/alcoholic can do about their addiction. And yet, the words of your decision are meaningless and irrelevant!”

The facilitator asks the group to let him/her join them in their moment of expletive relapse, saying something like, “Imagine I am standing there. You have just said “(ExD),” or the like and are about to pick up that first drink/drug. I am not there to judge. Far be it from me to stop you. I just want to know what you really mean by those words.”

Their personal “translations” of “(ExD)” go up on  a white board, with one modification: after each one, insert a parentheses containing a preposition, followed by a dotted line. For instance, the most common group response, almost never omitted, is “I don’t care.” This goes on the white board as,

“I don’t care (about . . .), which is usually joined by, “I give up (on . . .) “I quit (trying to . . . “F—- you? (for . . .) “It isn’t worth it (to . . .) “I’ve had it (with . . .) “What is the use (of . . .) “I’ll show you (for . . .)

Virtually all of the groups with which the author has facilitated this exercise, for over 10years now, have generated similar “translations.” (You may have to prompt for some.)

So, how do we use the translations? Basically, ask them to fill in the blanks.

Saying something like, “Your ‘translations’ seem to tell us what verb means in ‘(ExD).’ But we still have no antecedent for our pronoun. What is ‘it?’ Can the group come up with a category, a class of ‘objects’ that will complete all of the sentences in pretty much the same way? What do all of these translations have in ­common?”

The responses here are not as predictable, nor do you need them to be. Put them on the board separate from the translations. Answers will range from being a little too abstract to referring concretely to personal triggers—not general enough for practical use. In summary: “It appears that if we are going to stay clean and sober, we have to prevent or control this voice in our head that says ‘(ExD).’ And this voice dominates when some sort of real-life situation is troubling us. If we are not going to say “(ExD)”, what are we going to have to do instead?”

As counselors, you may be amazed how UNobvious this answer can be. The word “stress” may come up again —as in “stress management.” That is pretty close, as is the answer, “deal with it.” Once we are in the ballpark, we revert to semantic brainstorming again, seeking a four-letter word for “dealing with it.” If they don’t come up with it, give it to them:

C-O-P-E—The four-letter word for the only healthy alternative to the “(ExD)” relapse. In fact, the expletive-type relapse may be described as a breakdown of the willingness and/or ability to cope. The next time my mother-in-law tells my wife that alcoholics never recover, I would do better to cope than to say “(ExD)” and make her case for her. And if I am going to actually cope, I need two things: the skill to cope effectively; and the willingness to use those skills.

We have just developed a “motivational discrepancy” (Miller, W.R. & Rollnick, S., 2002)—the perception of contradiction between my self-ideal and my actual behavior  How many people want to see themselves unable to cope with adult life? “Non-hackers?” “Inadequate?” “Weak?” On the positive side, how many people will accept an addictive hell when the shared exercise makes it so clear that effective coping could prevent such a fate?

I usually proceed directly from this discrepancy to discussion of what “coping” actually is, how to learn, and how to remain abstinent while learning.  He is partial to a meta-model (DuWors, 2000) of coping based on the Serenity Prayer, but trusts that most counselors and therapists have their own approach. Once learned, 12 Step (Anonymous, 2001) and other communities offer sustaining motivation to use the coping skills.

Answering two questions might increase the reader’s readiness to facilitate some form of this exercise with your own clients:

• Can you do this exercise in individual sessions? (Yes, you may lose group sharing and identification, but you gain individualization.)
• Why spend so much time on mere words and what they mean?

Years ago, I had a rare opportunity to facilitate this exercise in a small “relapse prevention” group with the regular counselor present. When I asked for their translations of “(ExD,)” the counselor offered, “I can’t cope.” I had no time to retrieve my stolen thunder before a group member chimed in, “That’s a counselor answer!”

They were both right; and after an effective facilitation of “Expletive Deleted,” they will both see that.

References

Anonymous (2001). Alcoholics Anonymous, The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. New York, NY: Alcoholics Anonymous World Services, Inc. DuWors, G.M. (2000). White Knuckles and Wishful Thinking, Learning from the Moment of Relapse in Alcoholism and Other Addictions. Seattle, WA: Hogrefe and Huber Publishers. Miller, W.R. & Rollnick, S. (2002). Motivational Interviewing, Preparing People for Change. New York, NY: The Guilford Press.