People, Places & Things
The slippery criteria that define substance abuse are notoriously difficult to distinguish in a client’s behavior. Sometimes the signs are obvious. But often, therapy clients hesitate to report the full extent of their usage. Practicing therapists must ask the right questions, usually more than once. I was trained to begin therapy asking several background inquiries including questions about substance use. Some typical questions include:
“Do you drink alcohol and, if so, approximately how many drinks a week?”
“Do you smoke cigarettes? If so, how many cigarettes a day?”
“Do you use any other substances? If so, which ones and how often?”
Depending on the answers, clinicians are trained to refer therapy clients to substance abuse programs. But clinicians cannot expect immediately honest answers to questions about substance abuse. There’s a general consensus in the therapy field that clients admit to about half of the number of drinks per week that they actually consume. Clients tend to be even less truthful about cigarette smoking and the usage of other substances.
Duncan Macmillan’s bold play People, Places & Things shines a bright, unflattering light on the complex dynamics of substance abuse and the grueling journey that treatment involves. Emma is an addict who uses with abandon: pills, booze, cigarettes and a healthy regular dose of denial. She activates her gifts as a professional stage actor to lie to others with authority and ease. She manipulates anyone who gets close to her, and manages to make herself the ongoing center of attention.
Despite Emma’s classic attempts to resist, group therapy breaks through her defiance. The play scripts an honest reflection of the humbling and powerful group therapy process. Irish acting powerhouse Denise Gough gives a soul-stirring rendition and becomes an addict her audience will remember. Performed in the chic, minimalist St. Anne’s Warehouse Theater in Brooklyn, following a sold-out and critically acclaimed run in the United Kingdom, audience members face one another in well-lit seating areas, creating a greater mirror to the group process. Early in the first act, the audience is surprised to discover a sudden spotlight shining on fellow audience members across the stage. This structural twist incorporates viewers into the set, metaphorically morphing each audience member into a larger group.
Most therapy clients do not seek professional help with the intention of joining a group. In my practice, I feel honored when a client trusts our work enough to try a group. I don’t run groups to suit the comfort zone of therapy clients; I run groups because they are effective. Group process speeds up the rate of clinical change. The group itself structures a laboratory where members can practice new behaviors and forms of communication.
Emma’s resolute resistance to group work is not surprising. She rejects and mocks her group and its methodical honesty. She makes fun of members who celebrate their days of sobriety. She makes up stories to mock their process of sharing. Nevertheless, the group triumphs.
Why is group therapy so effective? Think of group as a room of mirrors and windows. Mirrors into the parts of one’s self that are painful to face but much more visible and surprisingly more palatable when reflected through the words and honesty of another group member. Group is also a room of windows into the perspectives of our loved ones whose viewpoints are tough to swallow, but become more accessible when viewed through the words of another. Group members have a manufactured degree of emotional distance from one another, and this necessary psychological space sets the clinical stage for change.
One of the most interesting facets of the play’s dialogue involves a comparison between acting and group therapy. Is the group a performance? Is it real? Emma admits that acting gives her the same therapeutic boost as therapy. She magically explores the way theater and therapy compliment and collide.
If you or a loved one have struggled with addiction, this magnificent play and Gough’s electric performance are well worth the trip to Dumbo (Down Under the Manhattan Bridge) to experience this memorable and meaningful artistic work.