If any clinicians run group therapy sessions and would like to try out something fun, here's a group to try (along with an evidence-based summary and references):

TITLE:
​Thought Experiment: Spontaneous Vulnerability
This group therapy session combines elements of philosophical counseling and techniques from narrative therapy to help clients rehearse an imagined moment of vulnerability. The clinician explained the principle of Gedankenexperiment [thought experiment], the “term used by German-born physicist Albert Einstein to describe his unique approach of using conceptual rather than actual experiments in creating the theory of relativity” (Brittanica). He then provided the following thought experiment.

• Imagine you are on a date
• You are sitting across from the person. You’ve just met in person for the first time.
• You find the courage to ask, “Would you be willing to let me look through your phone for 10 minutes?”

Clients then responded to the following questions:

• What feelings come up as you imagine this experience?
• If the person says yes, how likely are you to hand your phone over as a matter of courtesy and reciprocity?
• When you’re holding the other person’s phone, what do you look for, and why do you think you choose those things?
  

The discussion up to that point prepared clients to answer the main question: What story does your phone tell about you, and is that story aligned with the story you like to tell others about yourself?
Theoretical Foundations & Therapeutic Alignment

1. Narrative Therapy Principles
   Narrative therapy posits that individuals make meaning through the stories they tell about themselves and others. This group leverages this by asking clients to examine the implicit narrative contained within the contents of their phone (photos, texts, history), thus helping them explore discrepancies between:
   
   
   • Their lived identity (as tracked digitally),
     
     
   • Their performed identity (how they wish to be seen),
     
     
   • Their recovery identity (how they hope to evolve).
     
     
2. White & Epston (1990) emphasize that externalizing conversations and exploring subjugated narratives can disrupt self-stigmatizing and substance-linked identity stories.
   
   
3. Philosophical Counseling & Thought Experiments
   Thought experiments have been used in philosophical counseling to challenge assumptions and encourage clients to rehearse moral and emotional dilemmas. The vulnerability posed by the imagined phone exchange models existential risk and intimacy.
   
   Lahav (2006) supports the use of philosophical techniques in therapy to cultivate ethical self-reflection and identity exploration, especially effective in group settings where peer perspectives deepen the inquiry.
   
   
4. Self-Concealment and Shame in Addiction
   Individuals with substance use disorders often experience elevated levels of shame and self-concealment (Luoma et al., 2007). Asking clients to imagine handing over their phone invites them into a symbolic moment of radical honesty, where their digital footprint becomes a metaphor for internal experience. This supports exposure to vulnerability in a contained and reflective way.
   
   Luoma, J. B., et al. (2007). Self-stigma in substance abuse: Development of a new measure. Journal of Psychopathology and Behavioral Assessment.
   
   
5. Digital Identity as a Tool for Reflective Practice
   Modern therapeutic approaches increasingly acknowledge that individuals maintain significant emotional and narrative content in digital devices. Asking clients to consider “what story their phone tells” uses contemporary, relatable metaphors to elicit profound reflection.
   
   Ward, C. (2018). Digital storytelling in therapy: Narrative, identity, and ethics. Clinical Social Work Journal.
   
   

Psychotherapeutic Goals of the Group— Foster insight into incongruity between private and public selves
— Increase tolerance for vulnerability in a safe, imaginative frame
— Promote group cohesion through shared discomfort and emotional risk-taking
— Challenge shame-based thinking by recognizing common themes in others’ responses
— Support authenticity in constructing new recovery-oriented narratives

Clinical Utility in Substance Use Settings

• Clients with addiction histories often feel disconnected from their “authentic self” and suffer from fragmented identities. This group encourages:
  
  
  • Cognitive dissonance exploration (Festinger, 1957)
    
    
  • Ego-integrity restoration (Erikson’s stages; McAdams’ narrative identity model)
    
    
  • Pre-relapse cognitive awareness of shame, secrecy, or avoidance
    
    
• By embedding this activity in a thought experiment, clients are spared the real-world exposure of actual phone sharing, but benefit from the emotional simulation of a highly vulnerable moment—functionally similar to imaginal exposure in trauma treatment (Foa et al., 2006).
  

REFERENCES

• https://www.britannica.com/science/Gedankenexperiment
  
• White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. Norton.
• Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2007). Self-stigma in substance abuse: Development of a new measure. Journal of Psychopathology and Behavioral Assessment, 29(4), 231–244.
• Lahav, R. (2006). Philosophical practice and self-transformation. Practical Philosophy, 9(2), 12–19.
• Ward, C. (2018). Digital storytelling in therapy: Narrative, identity, and ethics. Clinical Social Work Journal, 46, 321–330.
• Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2006). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. Oxford University Press.

Voodoo Dolls have a rich and often misunderstood multifaceted history that branches off into different cultures. Rarely does this history intersect with western therapeutic strategies. This group sought to change that.

​Németh (2018) reports that "The earliest extant reference to magic dolls is made in the foundation oath of the settlers of Cyrene [Libya]" (179). These dolls, in fact, show up in fragments of text throughout the classical Greco-Roman world. But these dolls, while similar in purpose and effect, at least on first glance, to the "Voodoo Doll" of African and Afro-Caribbean figures, are in fact quite different. When we approach the topic of magic dolls and the Voodoo religious practices, we run into difficult territory. David Frankfurter (2020) explores these difficulties at length. He argues that term often applied to hand-sized, human-like dolls made of fabric or straw, and used for the purposes of inflicting harm on a human identified by the miniature effigy, is "fundamentally misleading in its history of applications and especially egregious in the current debate over the openness of classics to people of color."

His argument is worth citing in some detail because the primary points of contention are all valid. First, he shows how "the term Voodoo Doll implies that it is the law of sympathy (“like affects like”) that is the prevailing assumption of the artifact’s users. But these laws of sympathy belong not to the various worlds in which people have used ritual figurines and curse-poppets but rather to the “armchair” synthetic theories of Frazer’s Golden Bough, which strove to comprehend primitive religion in a general, if uninformed, way" (53–54). Second, citing the work of Joan Dyan (1995), he acknowledges how “anything diabolical, irrational, or superstitious became materialized [starting in the 18th century] as the spirit of blackness" (cit. 54). Ultimately, Frankfurter's claim is clear and simple understand: "The term Voodoo Doll should be abandoned, as many more precise ones have long been available to scholars" (54).

​I don't disagree, but I also chose to use the oft-misused, sometimes offensive word for the title of this group. I had two primary reasons for this choice. First, the milieu of group therapy in substance use treatment facilities is populated by many types of people. The effort to find a "common language" while also teaching and doing valid therapeutic work is substantial. I gravitate toward scholarly sources such as Frankfurter's essay, but I have learned through thousands of hours of experience that most of my clients do not. Since I am well-trained in the art of teaching and have the ability to translate scholarly concepts into different modes of discourse, I frequently lead groups on heady and challenging topics. But, I always pepper those groups with copious pop culture terms and references in order to speak to as many people as possible all at once. In the case of this group, "Voodoo Doll" is accessible as a concept, and so I used its accessibility as a rhetorical gambit to entice clients (aged 19–61) into the hard emotional work that I'll explain below. 

Second, if and when matters of race, gender, sexuality, stigma, offensiveness, political discord, religious trauma, etc., come up, which they do quite frequently, then whatever gets initially branded as "offensive," regardless of who says it, becomes an invitation to a therapeutic discussion about the emotions that arise around the particular brand of offense one experiences. Nothing occurs in the treatment environment that is devoid of therapeutic value. All problems, especially racism and similarly charged -isms, have the power to reveal something that was previously invisible to one or more clients, even to the clinician(s). So, having hazarded the use of "Voodoo Doll," I was prepared to drop my plan for the group and pivot to a processing group on racism and cultural appropriation. As it turned out, that need did not arise.

Clients were at first hesitant about the prompt to construct Voodoo Dolls, but the hesitance dropped away as I provided the set-up and rationale for the group. I began by talking about the difference between self-defeat and self-destruction. Clients were quick to point out the main difference. Self-defeat is a thought-based, self-talk problem. Self-destruction is a behavior that causes harm. For example, self-defeating thoughts take the form of core beliefs such as "I'm not worthy of love." One self-destructive behavior that could follow from that belief is the self-imposed prohibition on making any attempt to connect meaningfully with other people. The harm caused by this behavior is the harm of isolation. Without meaningful connection, the self fails to grow. Another self-destructive behavior, however, could be much more severe. To prove to oneself that one is not worthy of love, a person could inject fentanyl into their neck with the hope of numbing the pain caused the lack of meaningful interpersonal love. In either case, the self-destruction hurts. What's more, self-defeat and self-destruction work together like tag-team wrestling partners. The behavior often doubles as proof that the core belief is correct, when in actuality the "proof" is made for the purpose of reifying the belief. My plan was to use Voodoo Dolls to address this problem, a problem with which all clients were very familiar.

I proposed that anger is the primary emotion that accompanies self-defeat and self-destruction. The problem with anger, in this case, is often that it gets directed toward the self instead of directed towards the actual instigating object. With this possibility in play, I asked clients to make a Voodoo Doll that represented a person or a specific situation toward which they had unresolved anger and rage. Once they made the doll, the clients were to use thumb-tacks, scissors, and markers to make surgical wounds on the dolls. Each mark or stab had to relate to a specific instance of anger. I asked clients not to hold back. And they didn't. A few minutes into the creation process and the clients were expressing their anger.

But then I introduced a twist. I reminded them that the name of this group is "You will suffer." Offered as a fact, not a threat, the group, as the clients know by now, derives its name from Buddhist approaches to wellness and recovery. Suffering exists. It only causes more suffering to pretend that isn't the case. What would it look like to operate from the certainty that suffering will happen instead of avoiding suffering or refusing to admit that we all suffer? In accordance with Buddhist principles, however, each act of violence we direct toward others is an act of violence committed against ourselves (since there is no real self-other/subject-object divide). With that thought in mind (treating it as true), I invited clients to take another look at their dolls. I asked them to watch as the identity of the doll transforms from someone else or some outer situation and becomes a representation of themselves. I asked them to notice: You are already dinged up. Your anger has hurt you. Following from that, I asked them to add more marks to the doll. I asked them to add a new mark/cut/tear for each self-defeating belief and self-destructive behavior they’ve enacted in the past 6 months.

Each person in the room groaned and audible sighed. The weight of the idea landed in their bodies. Perhaps reluctantly, each client took up the invitation and made their marks.

Another twist. Buddhist approaches to recovery also invite us to meet suffering with compassion. We suffer more when we fail to accept that we cause harm, that we defeat ourselves, that our self-defeat leaks out onto others. As such, I instructed the clients to take a look at their dolls and slowly, with great care, attempt to return the doll to its starting shape as one (or more) plain piece of paper. I asked them to smooth out the wrinkles the best they could. I asked them to do this with the same sensitivity that you might use to wash a baby. In a metaphorical sense, that's exactly what they are doing. They are caring for their dinged-up and disheveled selves, and they are offering the care because they are deserving of it. 

Next, we observed the wrinkled paper. We imagined ourselves as the wrinkled paper. I said, take a look at that paper. It’s you. You are wrinkled and torn. And since we can never untoast the toast, so to speak, we will never return to a state of pristine paper. But the clean sheet is an illusion anyway. Nobody ever attains it (addict or otherwise). Unless we start from where we are, meaning in this wrinkled and torn state, we cannot truly accept ourselves. I then asked them to keep looking at the paper while I asked some questions. I invited them to feel what comes up when I asked: Do you think anyone wants this wrinkled piece of paper? Do you want to be the paper in this shape? What allows or prevents you from accepting that this is it?

If you'd like to see what kinds of responses arise after a session of this sort, I invite you to try out the group in your own environment. This was the second time I conducted this group, and the pleasant surprise that hit me this time came at the very end as I pondered what to do with all the paper and related material. It felt charged. I didn't want to throw it away. To preserve the memory, I gathered it all together and invited clients to think about the pile as our collective pain. When most people think of anger, they think of the color red, of punching and kicking, and of steam coming out of cartoons' ears. But nobody thinks about this tattered stack of paper. And yet, in under 60 minutes, our group had created a beautiful representation of collective suffering.

References:
Dayan, Joan. 1995. Haiti, History, and the Gods. Berkeley: University of California Press.
Frankfurter, David. "" Voodoo Doll": Implications and Offense of a Taxonomic Category." Arethusa 53.1 (2020): 43-58.
​Németh, György. "Voodoo dolls in the classical world." Violence in Prehistory and Antiquity (2018): 179-94.

Therapeutic references:
Feen-Calligan, H., McIntyre, B., & Sands-Goldstein, M. (2009). "Art therapy with substance abuse clients: Evidence-based support for a model program." Art Therapy: Journal of the American Art Therapy Association, 26(3), 104–110.
Kabat-Zinn, J. (2003). "Mindfulness-based interventions in context: Past, present, and future." Clinical Psychology: Science and Practice, 10(2), 144–156.
Malchiodi, C. A. (2005). Expressive Therapies. Guilford Press.

Client's don't often come into treatment with any knowledge of (or interest in) art history, so I try to find as many opportunities as I can to introduce them to visual art. Today's art therapy group drew inspiration from the Impressionist Berthe Morisot and the Expressionist Erich Heckel. I showed them Morisot's Psyché and Heckel's Männerbildnis because I wanted them to use Impressionist and/or Expressionist visual language to produce self-portraits. There was, however, a catch. The two self portraits had to be conceived from the perspective of two people: a stranger and someone who knows you well. This constraint, in addition to the artistic mode of expression, produced the therapeutic effect of the group; namely, creating self-portraits through others' eyes helps to make visible how we see ourselves, how we hide parts of our emotions from view, and how we yearn for others to see the parts of ourselves that we hide. 

Research supports the use of art therapy as a means of fostering emotional regulation, enhancing insight, and promoting psychological flexibility (Kimport & Robbins, 2012; Gussak, 2007; Slayton et al., 2010). The dual self-portrait exercise specifically encourages clients to explore the discrepancy between internal and external perceptions of self, which can be particularly valuable for individuals in recovery who may struggle with shame, self-stigma, and identity confusion (Mezo & Short, 2012; Kim et al., 2017).

Since most clients are highly judgmental, especially when it comes to their own perceived lack of artistic skill, I provided a few extra words of guidance:

• Use of Color: Participants should represent affective states and emotional intensity through color choice (Moon, 2010).
• Use of Line: Use lines to show your measure of self-cohesion and mindfulness regarding present-moment awareness.
• Background Setting: Let the background image or texture act as a metaphorical tool for exploring underlying values, personality traits, and environmental influences on identity.

Here are some of the results: