NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction

NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction

NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction
Assignment 1: Psychotherapeutic Approaches to Group Therapy for Addiction
When selecting a psychotherapeutic approach for a client, you must consider the unique needs and characteristics of that particular client. The same is true when selecting a psychotherapeutic approach for groups. Not every approach is appropriate for every group, and the group’s unique needs and characteristics must be considered. For this Assignment, you examine psychotherapeutic approaches to group therapy for addiction.
Learning Objectives
Students will:
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• Evaluate psychotherapeutic approaches to group therapy for addiction
To prepare:
• Review this week’s Learning Resources and reflect on the insights they provide on group therapy for addiction.
• View the media, Levy Family: Sessions 1-7, and consider the psychotherapeutic approaches being used.
The Assignment
In a 2-page paper, address the following:
• Identify the psychotherapeutic approach that the group facilitator is using and explain why she might be using this approach.
• Determine whether or not you would use the same psychotherapeutic approach if you were the counselor facilitating this group and justify your decision. NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction.
• Identify an alternative approach to group therapy for addiction and explain why it is an appropriate option.
• Support your position with evidence-based literature.
• Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Psychotherapy.net (Producer). (2015). Group therapy for addictions: An interpersonal relapse prevention approach [Video file]. Mill Valley, CA: Author.
 
TIM LEIGHTON: I’m Tim Leighton, and I’m the director of professional education and research for the charity, Action on Addiction. This charity provides services for alcohol and drug users and their families. And we provide degree level education in addictions counseling in partnership with the University of Bath. I’m a registered cognitive analytic psychotherapist and have published several papers and chapters on this therapy model and on interpersonal group therapy. NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction.
In 1985, I started my career as an addictions counselor at a residential treatment center. And armed with Irvin Yalom’s book and a huge video camera– in those days, they were about the size of the cameras on Match of the Day– I set out to train myself in this group model, as I had become convinced it had enormous potential for addictions treatment. Later, I learned a lot more about it and began to teach the model in my courses. I hope you found this video resource helpful.
JAX BEATTY: My name is Jax Beatty. I’m an addictions and family counselor. I have been facilitating groups for eight years. When I was first trained in this model, I was very enthusiastic about it. I wanted to learn how to use it to the best effect, to help people to recover from addiction. I’m currently a cognitive analytic therapy practitioner and work in a range of settings with addicted people and their family members.
DEVIN ASHWOOD: My name is Devin Ashwood. I’m an addiction counselor and program leader for the honors degree in addiction counseling offered in the United Kingdom by Action on Addiction. My specialities are interpersonal group therapy, as well as Mindfulness-Based Relapse Prevention and cognitive therapy.
LEIGHTON: It is important to say that for ethical reasons, the clients in these clinical vignettes are played by actors. The scenarios were developed from the clinical and educational experience of Devin Ashwood and myself, who between us, have been practicing and teaching interpersonal group therapy in addiction settings for over 40 years.
 
The final scripts for the vignettes you will see were arrived at through a process of initially loosely scripting the characters and scenarios, which actors were then encouraged to improvise around. This had the intended effect of replicating some of the realistic, difficult, messy, and potentially confusing situations that so often characterize real life interpersonal therapy groups in these settings. It is sometimes the case that video teaching resources present their material for clarity’s sake in too neat a way to seem realistic to experienced addictions therapists. We wanted to retain an authentic feel but also help therapists understand and develop a clear model and rationale for their group therapy work.
 
Perhaps the first thing to say is that these videos are not in themselves a substitute for a training course or continuing supervision in the model. They’re intended to supplement such activities and to act as an aid to creative thinking about the model and its application in addictions treatment. Although future videos will be produced by us demonstrating more technical aspects of group facilitation, we predict that this set of scenarios will primarily illuminate the model, the process of the group, and how it helps group members, rather than teach a full set of facilitation skills. Such skills are required by practice in the company of and with the help of experienced practitioners who may act as colleagues, models, and supervisors. NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction.
This training aid was developed to help address the clear gap in education and skills evidenced in the field of substance misuse treatment. One of the main ways people suffering from addiction problems are offered support is through some form of activity in groups. However, professionals who lead these groups all too often don’t have a framework to understand how best to use groups. There was an absence of a theoretical model and a lack of understanding of what is likely to be helpful in a group. What you see presented here is influenced strongly by the work of Irvin Yalom and Philip Flores, who have both written extensively on this topic.
 
It is, of course, not the only useful way of working in groups with clients in transition or early recovery from addiction. Skills training, provision of information, motivational work, and discussion about recovery may all happen in groups. And there is some evidence supporting the effectiveness of group-based cognitive behavioral approaches. Interpersonal group therapy is by no means incompatible with such approaches. But it needs to be carefully distinguished from them in the minds of both therapists and clients. NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction.
The groups have different tasks and should be timetabled separately. As we shall see, the more clients come to understand how this type of group therapy works, the better the group is likely to go. But for us, the main rationale for using interpersonal group therapy for addictions is that we think that, among other benefits, it builds resilience to some of the best evidenced relapse precipitants, interpersonal conflict, and what Miller & Harris have described as a state of demoralization and alienation.
 
We like to think of this model of group therapy as interpersonal relapse prevention, which you will notice is the subtitle of our training package. It is the most suitable group therapy for those who are entering in developing recovery. For example, it is frequently used immediately after detoxification, although we see no reason to think it wouldn’t be beneficial to those starting their recoveries supported by a substitution pharmacotherapy. As recovery progresses, the group model remains relevant and forms a useful after care intervention for those who have completed their rehab programs.
 
There is also reason to think that this form of therapy might help people make the best use of mutual aid groups, although the form of group interaction is very different in those groups. Firstly, it’s important to point out that complex and sophisticated social relationships are a defining feature of the human species. Our place on the evolutionary tree is as the specialist in its personal relations. Our ability to form relationships may well explain our species’ survival and eventual dominance. And we now have a global social community with the ability to instantly communicate across continents. There is evidence that we are biologically set up to attach to others and have a fundamental need to be part of social groups. NURS – 6650N Psychotherapy with Groups and Families : Levy Family Case Study – Psychotherapeutic Approaches to Group Therapy for Addiction
It is also ensured that we will express distress and unhappiness when we feel outside of social groups. It’s a noted characteristic of addiction to drugs and alcohol that an obsessional relationship with substances almost always becomes harmful to human relationships. Some people begin addictive careers before ever fully developing the ability to have supportive adult relationships. But even those who become addicted later, by the time they are ready to seek treatment for their problems, years of obsessional drink or drug use is likely to have caused significant harm to any good relationships that may have developed.
 
In addition, people forget how to get their social needs met outside the context of drink or drugs. Substances invariably become a mediator in all major relationships. They may be a shared interest or used to get close to someone else. Or they may be used keep people away, or to express anger, or to punish others. There are many ways substances become pivotal in the relationships of those seeking help.
 
Learning how to have supportive mutual and satisfying relationships free of drink and drugs is a key task of recovery and the main aim of this form of group therapy. Interpersonal group therapy doesn’t assume that people with substance misuse problems or share a particular profile or personality type. But instead, identifies and directly addresses relevant problematic interpersonal behavior, whether that be isolating, ineffective ways of trying to be liked by others, intimacy issues, or any other maladaptive relational style.
 
An important characteristic of interpersonal group therapy in relation to other approaches is that it need not be too anxiety-provoking. Research has shown that people who are in early recovery from addiction are significantly more anxious than the general population. And approaches that focus on intentionally stimulating difficult feelings, on heavily challenging people, or intentionally provoking transference are likely to be too much for many clients to relax and trust the group process enough to express themselves and interact as freely as they would outside of therapy group. This natural expression is vital, if the problems that people need to work on are to become available to the group for therapy.
 
For interpersonal group therapy to be helpful, it’s essential that clients come to understand their substance use from a relational perspective. If they come to see how working on their relationships will support their recovery, it is far more likely that they will invest in the group. For this reason, making the model of therapy explicit at the outset is vital, as this helps clients set their goals as relational ones that groups can help with, rather than making practical, out of the group goals that tend not to be amenable to group therapy.
 
If clients learn to value sharing themselves with others and are able to develop supportive relationships, they’re again also more likely to gain from affiliation with 12-step or other mutual aid groups. And the evidence available suggests that it is those who become socially active in these recovery communities that can benefit the most.
 
The treatment setting you’ll be witnessing is offering interpersonal group therapy as part of a wider, structured day program and in a time-limited rolling format. Clients attend each weekday from 8:30 to 4:30 for several weeks, 12 in this fictional case, based on one of our treatment models. Without the support of other group and one-to-one interventions, working interpersonally might well be too challenging for many clients, as these groups often end with some people feeling exposed or vulnerable. If there are other therapeutic activities later in the day, this gives people a chance to process their feelings and be less vulnerable to relapse as a result.
 
The rolling nature of the program means that clients might enter at any time, then receive 12 weeks of treatment before leaving the group. Because of this, in the first vignette, all the participants have been in treatment for differing lengths of time. And there are already established relationships between the members of the group.
 
There are elements of four groups captured in total, each within a week or two separating them. However, in this intensive treatment setting, interpersonal group therapy is offered on four days a week. So it’s important to remember that not all the interpersonal dynamics and developments are shown.
 
We’re not going to introduce each member of the group in any detail. But a biographical portrait of each is available in the accompanying material included in the training pack. We join the group just after Jimmy has read the group preamble, a short text that reminds everyone of the purpose and function of interpersonal group therapy.
 
BRIAN: My counselor’s asked me to bring something into group about me wanting to go carry on going out to pubs and clubs. I just want to bring that to the group, so I can get feedback from you guys.
 
NATHAN: Do you know what, Brian? I’m seriously worried about you having thoughts like that. What makes you think it’s okay to surround yourself with drugs and alcohol?
 
MARK: Come on, Brian, if you keep going into a barber shop, you’re going to end up getting a haircut.
 
BRIAN: I’ll be all right. Others do it. We are allowed to have fun.
 
NATHAN: I just think you’re making excuses not to change.
 
BRIAN: I’m willing to change. I’m here doing what  I’m supposed to be doing. As I said, it’s not all about therapy. It’s not all about doing groups. I can have fun. It’s not I take life too seriously, I do.
 
JIMMY: Do you know what, Brian? I get where you’re coming from, because I did something similar when I first come into treatment. But they’re right. It’s too soon for you to be thinking about going to pubs and clubs.
 
BRIAN: See, this doesn’t really help, you all just having a go at me, being on my case.
 
SABINA: I’ve got something to bring. You see, my partner, last night, me and him had another row. It’s just getting worse and worse. He’s always on me. He’s just driving me nuts. He’s checking my phone. He’s checking my Facebook profile. It’s just so freaking claustrophobic. I can’t bear it. I don’t know what to do. He’s just on me all the time.
 
AMBER: Why don’t you just change your pin number?
 
SABINA: Because I thought marriage was about trust.
 
GEMMA: Have you ever thought about separation?
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NATHAN: I really couldn’t live with someone like that.
 
SABINA: Listen, I made my vows. And when I made them, I meant them. It’s just not an option. Separation is not an option.
 
MARK: Sounds like he has a problem. You thought  about Al-Anon?
 
SABINA: He won’t go to anything like that. He says it’s my problem. I’ve been doing this for five weeks. Why isn’t  he trusting me yet? He should be trusting me.
 
JIMMY: Yeah. Do you know what? I went and I pled to my family about a week ago. And I expected everything was going to be back to normal. They were going to be forgiving. And it’s not as simple as that. You know, these things take time. You can’t just expect everything to be back to normal straightaway.
 
AMBER: Why don’t you just change your Facebook account?
 
SABINA: I thought we were supposed to be working an “honest program”?
 
HORACE: Why don’t you try marriage counseling?
 
SABINA: And have someone analyzing every single aspect of the relationship? No. No.
 
LOUISE: Assertiveness training really helped me. Maybe should you just try and find a class.
 
SABINA: Mm, yeah, no.
 
NATHAN: I’m feeling really frustrated. Every time we try and give Sabina and Brian suggestions or advice, it’s like they’ve done it, or they just don’t want to hear it. I don’t think I’m getting anything out of them.
 
LEIGHTON: I think you’re making a good point, Nathan. I’d like to ask Sabina, do you feel you’re getting helped by this process in the group today?
 
SABINA: Well, yeah, all the comments are very nice and all and probably very helpful. But it’s not anything I haven’t really considered before. None of It’s really worked. And to be honest, I don’t think in the grand scheme of things it’s that big a deal, really. I think Gemma’s probably got bigger problems than me.
 
GEMMA: No, I just don’t see the point of this. I just don’t get it.
 
NATHAN: Maybe your problem is best addressed in one-to-one counseling, Gemma.
 
GEMMA: Well, that’s what I wanted in the first place. I just don’t get group.
 
MARK: At least, give it a go. Give it some time.
 
NATHAN: Gemma, don’t play with your towel now.
 
JIMMY: Yeah, do you know what? You’re a real valued member of this group. Don’t give up.
 
GEMMA: How?
 
LOUISE: Gemma, when I was struggling the other day, you really helped me.
 
MARK:  I’m sorry. I think your problem is that you haven’t accepted powerlessness.
 
NATHAN: That’s a bit harsh right about now. She doesn’t really need to be hearing that, Mark.
 
MARK: Trying to help.
 
BEATTY: Gemma, can I ask you a question? What are you hearing from the group right now?
 
GEMMA:  They just want me to accept I’m powerless.
 
AMBER: No one knows what they’re doing. How’s this going to help anyone?
 
ASHWOOD: Brian opens with an issue his counselor asked him to share with the group. This brings up some interesting questions. One possibility is that the counselor may be concerned about Brian’s intention to continue frequenting pubs and clubs, and hopes that his group might be able to persuade him that this isn’t a good idea. There are certain opportunities for group members to review the wisdom of proposed behavior in a group. And hearing a message from a number of people may be more persuasive than just one.
 
However, inviting this issue in this way also brings up a problem. There’s an implicit message that the function of the group is to get people to conform to a socially agreed norm of what recovery requires. And this detracts from communicating that the real power of the group is in helping people to see how they’re not getting their needs met through certain ways of relating and how they might better do this.
 
This being said, there is still an interpersonal process going on here that does create possibilities for learning. We see the group members frustrated with Brian, whose interpersonal style to date has been generally, although not exclusively, distant and dismissive of the wider group’s consensus. Many of the individual’s responses to him are typical of people who have been through certain kinds of treatment systems. Having inherited a particular philosophy of recovery, they believe that they need to confront anything they see as not in line with that philosophy.
 
The therapists do not, however, add to this confrontational style by challenging it. But instead, allow the group to feel the frustration of operating in this manner that doesn’t work so well. This way, members can learn for themselves what an ineffective group looks like and feels like, and later have an opportunity to contrast this with the group when it’s working more effectively. This helps the group to develop autonomy.
 
Various potentially problematic interpersonal styles are evident in this initial session. We see Mark trying to support people in a manner that comes across as aggressive. Nathan, appearing disconnected and critical. Even Jimmy, who seems much warmer, is still not willing to engage with Brian’s actual question. But instead, joins in the group consensus of concern about his intention to go to the pubs, maybe assuming he’s simply unmotivated for recovery.
 
As we will see in a number of examples in these vignettes, the content-focused advice giving format is found to be frustrating by the participants who feel their suggestions and concerns are not being given serious consideration. And they soon give up.
 
LEIGHTON: One important concept critical to understanding the model is that of process, as contrasted with content. It is fairly obvious what the content of the dialogue is. It’s the subject matter, what gets talked about. But what this model of group therapy intends us to understand is the process. That is, what do the way people talk to each other, the manner of their bringing material to the group, and its timing, and the way that group members respond to each other tell us about the nature and meaning of the relationships between them. It’s pretty obvious what the content of Sabina’s contribution is. It’s about the behavior of her husband. But what is the process as she interacts with her group?
 
Sabina complains about her husband. And clearly, there is little the members of the group can do to help her situation, as she’s presenting the problem as being his. There is a willingness from group members to try to help her by offering advice. However, this is typically dismissed by her, which is in itself indicative of something about Sabina that she brings to the group problems that cannot be addressed in the group.
 
Jimmy, who has been in treatment the longest and has had more chance to see how group works, offers his support in the form of identification. And this at least has the potential to develop the relationship between him and Sabina. The unsatisfying way the group is operating is not at this point highlighted by the therapists. They might, at some stage, point towards the process that’s going on. However, in this case, it’s not necessary, as Nathan comes in and makes an important comment about the process, that he is frustrated with all the advice giving and how ineffective it is.
 
NATHAN: I’m feeling really frustrated. Every time we try and give Sabina and Brian suggestions or advice, it’s like they’ve done it, or they just don’t want to hear it. I don’t think I’m getting anything out of them.
 
LEIGHTON: It’s almost always better if clients make commentary about group process themselves, rather than the therapist always taking the lead, as this helps the members of the group take responsibility for their own therapy. The group is much more productive if this is encouraged. And it makes it much more likely that   group members will carry their gains on into recovery once treatment’s over. I encourage this by affirming and emphasizing Nathan’s comments, which will help develop the group norm, or unwritten rule, that clients can make process commentary.
 
I then attempt to highlight this learning further by asking if the process is helpful to Sabina. And while she acknowledged people’s efforts to support her, she clearly says that the advice isn’t very helpful. It might be that at this point, Sabina is uncomfortable about doing any more meaningful work and suggests her problems are less important than another group member’s. This again, shows an aspect of Sabina’s interpersonal style. But it isn’t picked up on. The group seemed happy to go with her suggestion of inviting Gemma to use group time.
 
ASHWOOD: Gemma seems ambivalent about the group. But it shows that there is at least some healthy cohesion, that they encourage her to give it a go, and to show her that she is a valued member of the group. If she hadn’t asked for specific feedback about how she was valued, this would’ve been a perfect opportunity for the therapists to ask this of the members of the group, to be specific. A specific interpersonal feedback is always more helpful than generalized comments. In this case, though, Gemma asks the question herself. Again, allowing the group to take responsibility lets its members see themselves as agents of change, rather than looking for the professionals to provide this.
 
Louise, who is usually quite quiet, is able to offer a little interpersonal feedback by pointing out how Gemma has helped her. This kind of interpersonal commentary is therapeutic on a number of levels. It helps Gemma to see that she has intrinsic value, as she is able to be of help to others. It also develops group cohesiveness, as members build trust and learn to value the group.
 
Members of the group also see how they can mutually benefit each other. And it allows those witnessing the exchange to see how offering skillful interpersonal feedback in a group deepens relationships and relational understanding in a way that’s emotionally attractive to them. This models healthy group behavior and develops positive group norms for the future.
 
BEATTY: Mark’s notion of support received some initial feedback from Nathan, which gives Mark an opportunity to highlight his intentions, which he says are trying to help. This is a theme that gets little attention now but is picked up on in a later vignette. The possible merits of Mark’s suggestion are very dependent on him having a shared language with Gemma. However, even if they had this, Mark’s delivery comes across as a criticism, and so Gemma can’t engage with it.
 
I attempt to highlight the support Gemma  is offered by asking her what she is hearing from the group. However, Gemma focuses on what she saw as the most critical comment, at the expense of missing all the encouragement she was getting. Her dismissiveness of help and support is not picked up on by the therapist just yet.
 
And it’s important when conducting interpersonal group therapy that the group leader doesn’t jump onto every sign of interpersonal pathology, as doing so tends to put people on their guard and inhibit the natural flow of the group. Instead, the members of the group are largely left to be themselves in the session. So their relational problems can be seen and addressed by the wider group once it is obvious they are not getting the desired results. The vignette ends with Amber echoing Gemma’s earlier comment and expressing her frustration at what she sees as a general lack of understanding about how group therapy works.
 
ASHWOOD: It’s worth mentioning that the participants all attended an introductory workshop to prepare them to take part in and make the best use of interpersonal groups. In this, the relevance of developing healthy relationships to recovery was explored in some depth to help the clients to understand that their task in these groups is to better understand and improve how they relate with others. This is an important prerequisite for working interpersonally. However, the relevance and importance of this way of operating isn’t always learned right away, especially if people are still in detox, or have only recently completed their medicated detox when being introduced to the model.
 
Without understanding how focusing on relationships will help support recovery, it’s difficult for clients to fully invest in the group. And therefore, cohesiveness is weakened. For this reason, part of the ongoing function of a group must be to help remind clients why and how group therapy operates. This doesn’t need to be done didactically. And it’s often best done experientially by allowing members of the group to see for themselves what works and what doesn’t. The identification of relational goals to work on in group therapy can always be gone back to in one-to-one sessions with the client outside of the group.
 
LEIGHTON: This vignette is one where the group is going through a stage of relative infancy, something that comes and goes in rolling groups, as stronger members leave and new members join. There is some evidence of cohesiveness, that members value each other and the group. They are willing to offer support in the form of advice. And Louise gave some supportive feedback about how helpful Gemma was to her. But one of the main ways the group communicates at this stage, by giving advice, is experienced as frustrating. Because it doesn’t seem to lead anywhere.
 
A lack of cohesiveness is evidenced most strongly by the group members’ awkwardness in engaging with each other. When there is feedback, one or two more vocal members tend to give this in a very critical way, leaving the group feeling less connected to each other. It’s unsurprising that group members find it difficult to give each other direct interpersonal feedback. It isn’t normal in our society to do this outside of very intimate relationships, or interactions between people with different levels of social power, such as schoolteachers or parents and children. Receiving specific feedback from others about how our behavior affects others, or how we are perceived by others, can make us feel childlike and stripped of power.
 
But when a group learns to do this in a mutual direct and respectful way, it engenders a depth of relationship that is energizing and often experienced by members as quite new. The therapist’s role in a group like this one is to help the group to build cohesiveness. This can be done in a number of ways– by focusing on identification, on similarities between group members, common goals, mutually supportive relationships, and also by pointing out the sense of vibrancy when the group are working in the here and now, rather than wrestling with external or historical issues.
 
When the group is struggling, encouraging feedback on each other’s strengths, rather than an interpersonal challenge or undermining a client’s defenses is more supportive and tends to produce a more positive and hopeful atmosphere. Best evidence suggests that group cohesiveness is a precondition of the trust and risk-taking required for effective group therapy. So it is important to help groups develop, maintain, or recover this sense of cohesiveness.
 
In addiction treatment, there are factors such as the common predicament, which are conducive to group cohesiveness. But the post-detoxification volatility, vulnerability, and anxiety of members also tends to threaten it.
 
The next scenario occurs a week after the first. And new member, Sam, has joined the group. Although new, he was a therapist in the field himself before his alcoholism stopped him from working. Now his detoxification is complete. And after attending just three sessions, he is often quiet. But when he does speak, he’s a very supportive group member.
 
SABINA: Okay, yeah, I want to talk again. It’s just my husband again. I just– I’m at the end of my tether. He’s saying, where am I? Am I actually at the agency? He’s checking my breath again. What am I supposed to do? It’s just driving me crazy.
 
MARK: We’ve spoken about this last week. We’re not here for your husband. We’re here for you. You need to start focusing on yourself. Start taking responsibility.
 
SABINA: You don’t get it.
 
MARK: If it’s all your husband’s fault, why isn’t he in treatment?
 
BRIAN: Sabina, it would be nice to hear something new from you, something different.
 
JIMMY: Yeah, I’ve got something I need to bring to the group.
 
BEATTY: Jimmy, could you go on, please?
 
JIMMY: It’s my mom, she died last year. I used to care for her. I used to have to give her her medication to stop her from being in pain. But I used to steal them. I’d steal them just for a hit.
 
NATHAN: Thanks for sharing that, Jimmy. That’s pretty big stuff.
 
BRIAN: We’ve all got secrets, mate.
 
AMBER: I’ve done stuff I’m not proud of.
 
HORACE: You’re still just you, Jimmy. When I was using, none of my family wanted nothing to do with me, except for my granddad. He’s the only one I had any contact with. He was pretty old, though. He used to send me down to the post office to get his pension every week. And I used to nick the money because I needed to use.
 
JIMMY: That’s just money. This is medication that actually stopped her from being in pain.
 
MARK: I’ve stolen from my family. Might not be the same circumstances, but I could certainly

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