Bloom Where You’re Planted

Along with April Fool’s Day, and Tax Day, few of us think of April without recalling the adage, that April showers bring May flowers. We relate to this saying when we experience April’s rain and then enjoy the beauty of May. But there is a deeper, more significant meaning to this traditional homage to spring…that is, no problem exists without its gift inside.

No matter where we are in our life's path, obstacles always have the potential to shake our self-assurance or, even worse, damage our self-worth. For individuals with duties such as caregiving, educating, managing, or any position that involves assisting people facing difficulties in the modern world, uncertainty about their impact is a common concern. Even for seasoned professionals, the key is to avoid allowing a preoccupation with issues to diminish the significance of showing empathy towards those who are going through them. 

My grandfather always used to emphasize the importance of continuous learning and growth. He would say that while we may know what we have been taught, there will always be more to learn and discover. As a young adolescent, I may not have fully grasped the depth of Pop’s words, but they have resonated with me throughout my entire professional journey. Even with five decades in my field, I never reached a point where I felt I had mastered all there was to know in my field let alone life. This realization pushed me to strive for excellence each day, knowing that there is always room for improvement. When faced with challenges beyond my capabilities, those moments resulted in self-doubt and more than once, flirting with burnout.

 

Upon reflecting on my grandfather’s wisdom, I came to realize that I had overlooked the most important piece of his advice. Although I may not have been as skilled on a given day as I would eventually become, I was still better than I was the day before. You see, even though one's knowledge and experience may have limitations at any given point in time, as Theodore Roosevelt once said, one must make the most of what they have and employ it where they are. Wisdom seems to develop when we acknowledge the boundaries of our knowledge. It is wisdom that urges us to seek assistance when confronting our limitations. In short, knowledge is knowing a lot of facts and wisdom is knowing which facts matter.

 

Unfortunately, Americans often balk at seeking assistance, viewing it as a sign of weakness and ignorance or a lack of ability. Paradoxically, it is the humility displayed in asking for help that paves the way for personal growth and development, leading to a brighter future. Thankfully, help exists in many forms. Formal education, finding a mentor, gaining insights from a talented supervisor, or simply engaging in conversations with others who faced similar challenges. One of the most effective ways to learn, as Albert Bandura proposed decades ago, is through observational learning. By observing and learning from experienced individuals one not only gains knowledge but also identifies potential mentors.

 

There are many ways one can learn from others and emulate their behavior…from reading biographies and autobiographies to watching documentary films, “bio-pics,” and YouTube clips to simply watching those who have mastered a skill you wish to add to your repertoire, or listening to them as they share their stories. YouTube videos are particularly useful in this regard.

 

Such “observational” learning helps us realize that what we wish we could do, can be done. Once acknowledged, the next step is an act of humility that allows me to recognize that these others have done what I have been unable to do, meaning, indeed, “This skill is doable.” This humbling admission is only possible when we let go of the belief that our previous shortcomings were evidence of being less than perfect and repurpose them as indications of a need for more work on a skill yet to be mastered. Remember, thoughts are not facts; if we want to grow personally, we need to change the way we think about ourselves as a person.

 

Upon shifting our perspective to view our shortcomings as indicators of necessary steps rather than personal flaws, we became open to learning. Through consistent action, we hone the skills that lead to the confidence and transformation we desire - essentially, practice makes perfect. Embracing the process of learning from others and applying that knowledge not only boosts confidence but also facilitates personal growth. This evolution may eventually pave the way to becoming more skillful and someone that others aspire to emulate as they journey toward their personal growth. To illustrate this point, an allegory shared by a supervisor years ago:

 

The circus’s arrival in town each spring was heralded by its parade down Main Street, the elephants traveling single file, “trunks on tails, trunks on tails.” This one year there was a baby elephant just recently born and therefore the last elephant in the parade as it left the train yard and proceeded down Main Street to the circus grounds, firmly holding its mother’s tail. Well, as the years passed and the circus continued to visit the town, new baby elephants joined the circus and the little elephant no longer found itself the last in the procession. As is the circle of life, the pachyderm’s mother eventually passed away, leaving our protagonist without a tail to grasp with its trunk and therefore no one to follow. In bewilderment, as she turned to glance behind her in hopes of finding a new leader to follow, she saw a long line of elephants following her…trunks on tails, trunks on tails; you see, she had become the lead elephant.

 

So, as you think about April’s showers and the flowers they bring in May, remember to consider that the “showers” of our lives can result in untold blooms in May, so never forget to "bloom where you’re planted."

Spirituality and Counseling: Not So Strange Bedfellows

The issue of addressing spiritual issues when working with clients/patients is a topic that often sparks passionate discussions among counseling professionals. The driving factor behind one's position on this issue is frequently their definition of spirituality and how they interpret this question. The efficacy of addressing spiritual issues in counseling is also a key consideration, as it relates to the impact on the client/patient experience.

 

My involvement as a participant in this debate or as an observer over the years, I have found that reframing spirituality as inclusive, beyond a theistic view of existence and religious dogma, can make it more acceptable as a legitimate objective of counseling services.

 

This issue surfaced when my students would submit essays in my addictions counseling classes. As I read their opinions questioning spirituality’s place in the counseling relationship, I would comment that addressing it adds an extra dimension to the delivery of services, allowing for a richer and more complete understanding of their situation. It's like the difference between looking at a two-dimensional photograph of a site and being at the site, experiencing its three dimensions and all the sensory input that comes with it.

 

Addressing spiritual issues in counseling allows the practitioner to immerse clients in their own experience, providing more than insight and understanding in the process. It highlights the importance of clients empathizing with their own experiences.

 

Viewing spirituality as a condition of connectedness to life, rather than merely participating in it, opens a third dimension in counseling and enhances a client's development. Recognizing that one is a participant in life rather than an observer of it akin to being a film's director rather than its critic in a darkened theater.

 

Although practitioners of counseling and therapy appreciate the importance of helping clients grow by identifying and removing obstacles, there has been some hesitancy, even in Counselor Education, to pursue spiritual issues in counseling services. However, there is an increasing recognition of their importance.

 

It is my belief that an appreciation for these issues, especially from a worldview perspective, often comes later in one's counseling career. Younger students pursuing counseling degrees are genuinely interested in helping, but a deep understanding of the human spirit and its role in self-actualization is born from life experiences. As we mature, physical strength and endurance may wane, but wisdom and an appreciation for the resilience and importance of the human spirit grow. Something my grandfather used to say was that knowledge is the accumulation of facts; wisdom is knowing which facts are important.

 

In my personal experience, the individuals I have encountered, including clients, acquaintances, family members, mentors, and professors, have shown me the importance of a higher power in finding meaning in life and having faith in the inherent dignity of all creation. Whether the "H" & "P" in higher power require capitalization is a matter of legitimate discussion. That said, a belief in a power greater than oneself seems to involve more than taking a simple leap of faith. Assessing someone’s—a client's—sense of connectedness to this higher power by addressing spirituality in the counseling relationship would seem at least appropriate if not necessary; what do you think?

Understanding Negative Self-Talk

Negative thinking or as some call it, negative self-talk, “stinkin’ thinkin’,” is an all too common threat to individuals with a substance use disorder. Such thinking can seriously jeopardize the ability to change one’s substance using behavior by sabotaging change efforts with doubts about one’s ability to change and the resulting fear of failure. Counselors employing Rational Emotive Behavior Therapy (REBT) can teach clients whose negative self-talk presents roadblocks to change by helping them identify and then dismantle these barriers.

 

Albert Ellis, the founder of REBT, developed the “A-B-C” approach to counseling individuals whose negative self-talk impedes their movement towards desired change goals. In this approach to cognitive behavior therapy (CBT), the “A” stands for an activating event that precedes some consequence like a negative emotion or untoward behavior, the “C” in this model. The “B” represents the belief one holds and uses to interpret this activating event (A) that results in the consequence (C). The beauty of this model is its simplicity in pointing out that it is not the event that causes one’s emotional upset but what one tells oneself about the event that is the source of the distress.

In short, the model moves the focus of change from an external locus of control—something over which the client has no control—to an internal locus of control where the likelihood of change is something the client can affect. Once aware of the “A” interpreted by “B” results in “C” view of negative emotions, clients can then dispute, what Ellis referred to as “D” in his model, these irrational beliefs and replace them with new effective rational beliefs, “E” in his model. 

 

Teaching clients to challenge irrational beliefs can involve a variety of techniques and strategies. One of which is cognitive restructuring. This is a therapeutic technique used to challenge and change irrational or negative thought patterns. It involves identifying and examining the underlying beliefs and assumptions that contribute to these thoughts and replacing them with more rational and positive ones. This process often involves questioning the evidence and logic behind the irrational beliefs and finding alternative, more realistic interpretations of the situation when the belief fails to stand up to such scrutiny. It aims to help individuals develop healthier and more adaptive ways of thinking, which can lead to improved emotional well-being and behavior.

 

Let's say someone holds the belief that they are a failure because they made a mistake at work. They believe this causes them to feel anxious and depressed. Through cognitive restructuring, they can challenge and replace this irrational belief with a more rational and helpful one.

First, they would identify the negative thought or belief, which in this case is “I am a failure.” Then, they would examine the evidence for and against this belief. They might realize that they have had many successes in their career and that this one mistake does not define their entire worth or competence.

 

Next, they would generate alternative, more rational thoughts or beliefs. For example, they could replace “I am a failure” with “I made a mistake, but I am capable and have learned from it. I can improve and do better in the future.”

 

Finally, they would practice and reinforce these new thoughts or beliefs through repetition and positive self-talk. Over time, this cognitive restructuring process can help them develop a more balanced and realistic perspective, leading to improved emotional well-being.

 

Another useful technique for disputing irrational beliefs is the “downward arrow technique,” sometimes called the vertical interviewing technique. This technique is a cognitive therapy technique used to identify and challenge irrational beliefs. Although developed for use in Beck’s Cognitive Therapy, it is equally useful when employing Rational Emotive Behavior Therapy (REBT). It involves asking a series of “why” questions to explore the underlying beliefs and assumptions that lead to negative thoughts or behaviors. Some thoughts on employing this technique include:

 

·      Identify a negative thought or behavior: Start by identifying a negative thought or behavior that you want to explore further. It could be something like “I'm not good enough” or “I always mess things up.”

·      Ask “why” questions: Once you have identified the negative thought or behavior, ask yourself why you believe it or why you engage in that behavior. For example, if your negative thought is “I'm not good enough,” you might ask yourself, “Why do I believe that?” or “Why do I think I'm not good enough?”

·      Explore underlying beliefs: As you ask yourself these “why” questions, pay attention to the underlying beliefs and assumptions that come up. Often deeply ingrained, these beliefs may not be immediately obvious. For example, you might uncover beliefs like “I have to be perfect to be worthy” or “I'm not lovable unless I achieve certain things.”

·      Challenge the beliefs: Once you have identified the underlying beliefs, challenge them by asking yourself if they are rational or if there is evidence to support them. For example, if your belief is “I have to be perfect to be worthy,” ask yourself if that belief is realistic or if there are examples in your life where you have felt worthy despite not being perfect.

·      NOTE: Uncover or “exposing” underlying or “core beliefs” that give rise to negative self-talk may require several successive questions such as: “and if this is true, what does that mean?” or “and your proof of this is?” Such questions often generate yet additional beliefs to which additional “why” questions or others as just cited can ultimately result in identifying one or two “core beliefs.” These core beliefs, like those noted in the previous bullet, tend to generate all the negative self-talk reported by clients. Identifying and then effectively disputing them can result in significant improvements for your client.

·      Replace with rational beliefs: Finally, replace the irrational beliefs with more rational and positive ones. For example, if your belief is “I have to be perfect to be worthy,” you could replace it with “I am worthy just as I am, flaws and all” or, “I may not be perfect but when I am not, I learn from my mistakes.”

 

Remember, the downward arrow technique is a tool to help you identify and challenge irrational beliefs. It may take time and practice to fully uncover and dispute these beliefs, but it can be a powerful tool for personal growth and self-improvement.

 

As noted above, there are many techniques and strategies used by cognitively oriented practitioners when assisting clients. Many of these are particularly useful when working with individuals with a substance use disorder. For mor on cognitive techniques and resources, visit https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/

Stress is something with which we are all familiar. Frequently viewed as negative, experiencing stress suggests that things are out of balance, that something is wrong. However, stress exists on a continuum that extends from good stress or “eustress” as professionals call it to distress or“bad” stress. It is the distress that gets the press as well as falsely implies that ALL stress is bad stress. 

If we did not regularly experience eustress, however, our minds and bodies would atrophy. It is the stress of exercise that develops our muscles and coordination. It is the stress associated with addressing a challenging situation that results in learning and problem-solving. So, when considering limiting the stress in one’s life we are talking about the challenge of addressing the distress in one’s life, therefore, let’s look at the sources of distress and possible approaches to dealing with them.  

The first step in controlling distress is recognizing its emotional signals – sensing fear, frustration, anger, anxiety, or grief. Although common emotions, the triggers for each may differ among diverse individuals. This is due to the unique brand of self-talk[1]or internal dialogue that everyone entertains when experiencing a given set of conditions. For example, three friends encounter the same loud and obnoxious individual yet one becomes angry while others experience fear, and a third is simply frustrated. However, irrespective of which emotional signal is present for a given individual, they all represent the presence of emotional energy. 

Emotional energy, like other forms of energy we learned about in high school science, can be (1) conserved, (2) transferred, or (3)transformed. Conserving it simply means holding it in or “bottling it up. ”Transferring it involves venting. But neither of these efforts does anything to proactively address the situational trigger and stress, perhaps distress, results. Transforming this charged or negative emotional energy is the best option as it involves a creative and therefore proactive step – making the negative energy the fuel that drives positive change. For example, turns anxiety into anticipation or excitement about an opportunity. Frustration becomes learning how to better approach a difficult person or situation. Anger transforms into the motivation to make changes. Fear converts to a challenge to think “outside the box” as a way to face adversity. Grief, especially sadness or loneliness, changes to reverence as in Dr. Seuss’s famous quote, don’t cry because it’s over; smile because it happened.  

Familiarity with these emotional signals is vital to the self-awareness needed for this transformation to occur. It is this transformation of emotional energy that documents the existence of personal control and it is this that empowers one to act on stressful situations rather than react to them. Like a car careening down a winding mountain road when its brakes fail, it is the one in the driver’s seat who determines what happens next. 

 [1]Self-talk, especially negative self-talk is an interesting topic in and of itself, but not the focus of this essay. 

Sign, Sign, Everywhere a Sign...

Thoughts on recognizing signal emotions

The refrain for The Five Man Electric Band’s 1971 song “Signs” goes:

Sign, sign

Everywhere a sign

Blockin’ out the scenery

Breakin’ my mind

Do this, don’t do that

Can’t you read the sign?

Recognizing the significance of the social and cultural signs we encounter daily is an essential—if not the quintessential—part of contemporary life. One symptom of someone on the autism spectrum is difficulty recognizing these signs and social situations in general – think Sheldon on The Big Bang. But unlike Sheldon whose difficulty recognizing these signs indicates a neurological disorder, we often fail to recognize how much they affect our relationship with others. Fortunately, just as spoken language develops through our interaction with native speakers, so does our ability to appreciate the significance of these social cues and, albeit unconsciously, enable us to interpret them and function socially.

 

As these social cues or signals enable us to navigate our external social environment, there are internal, emotional cues or signals that affect our mood, behavior, and, as a result, the way we feel and act. Recognizing these signal emotions, especially those we view as “negative,” is an important step in minimizing stress and, in general, preserving a neutral if not a positive outlook on life.

 

Appreciating that these signals, “hot-button” emotions if you will, have the potential to skew our outlook negatively is important in maintaining a positive outlook. By knowing the emotional triggers of negativity, it is possible to develop a plan to minimize stress. So, what are these “hot-button” emotions? In no order of significance, they are:

 

·      Fear

·      Frustration

·      Anger

·      Anxiety

·      Grief

 

Often, we’re taught from childhood to ignore, minimize, or simply let go of, a.k.a. deny these “feelings.” However, doing so, especially on a consistent basis, can fuel behavioral reactions that result in behavior we later regret. Like a liquid under heat in a sealed container, pressure builds until experiencing an uncontrolled release of that energy.

 

In high school physics, we learn that energy is neither created nor destroyed, only conserved, transferred, or transformed. Likewise, we can say the same of emotional energy as well. “Conserving” this energy results in holding it in by suppressing it, which can produce potential physical consequences such as high blood pressure, insomnia, and substance use, not to mention the likelihood of verbal and/or behavioral outbursts. To transfer this emotional energy involves emoting or “venting” but this simply moves it from one place—me, to another—you, and does nothing to address its source.

 

Transforming emotional energy may be the only true “practical means” by which to address this emotional energy associated with these hot-button issues. This involves a creative, more proactive step. In short, a move that “transforms” the negative energy associated with these emotions into a type of fuel that enables the conversion of fear into a challenge, frustration into learning, anger into motivation, anxiety into anticipation, and grief into reverence.

 

For example, the fear I feel as the result of a mistake I made becomes a challenge to identify how to avoid repeating it in the future if not resolve its consequences in the present. My frustration about having to deal once again with an obstinate “other” becomes an opportunity to learn a new approach or strategy for dealing with such individuals. The anger felt because things did not go the way I hoped becomes the motivation to “think outside the box” for a different solution. My anxiety about making a presentation to executives becomes an anticipation of sharing my ideas with those who can appreciate them. And my grief on losing my close friend becomes, as Dr. Seuss said, not a reason to cry because it’s over but an opportunity to smile because it happened.

 

Self-awareness allows us to transform hot-button emotions. This act of conversion is evidence of personal control. And maintaining a sense of personal control in high-stress or emotionally charged situations becomes a safety valve that encourages acting on rather than reacting to whatever life happens to pass our way.

 

We all know what we learn and learn what’s taught, but it is important to remember that that’s not all there is to be known.

What do you think?

The Long and Winding Road

We live in a world where instant gratification appears the norm -- next-day delivery of online orders, frustration when text messages go unanswered within minutes, irritation when having to wait for an appointment to repair an appliance or see the doctor.

When things or events happen as we think they should, we are satisfied…content…we are happy; when they don’t, our emotional response ranges from disappointment to anger, as if some external event somehow rides herd over our emotional state. We live in a time when how we feel seems somehow controlled by circumstances beyond our power, as if puppets on a string with fate the marionette. But is this true?

Epictetus, an ancient Greek stoic philosopher, wrote that there is only one way to happiness: to cease worrying about things beyond our control. But what is under our control? Our thoughts, our beliefs, and our actions…for “things” are not always what they appear to be:

There once was a farmer who owned a horse and lived in ancient China with his family. His neighbors said how lucky he was to have such a fine horse to pull his plow through the fields.

The farmer said, “Maybe yes, maybe no.”

One day the horse broke through the gate and ran away. His neighbors came around to lament his terrible loss, saying it was a terrible bit of bad luck.

The farmer said, “Maybe yes, maybe no.”

Days later the horse returned to the farm along with seven wild horses. His neighbors came around to exclaim his remarkable good fortune, saying, “Now you are rich!”

The farmer said, “Maybe yes, maybe no.”

A few weeks later the farmer’s son was training the new wild horses and fell off and broke his leg. The neighbors came around to commiserate his misfortune and said, “What bad luck!”

The farmer replied, “Maybe yes, maybe no.”

The next week the army came around taking all the able-bodied young men from the village to fight in the war. The farmer’s son with the broken leg was left behind. The neighbors now lamented the loss of their sons and commented on how lucky the farmer was to have his son. 

And so the story goes on…

Marcus Aurelius, the Roman emperor, and stoic philosopher once said, if you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.

There is no way to happiness; happiness is the way[2], and as The Beatles sang, the way is “a long and winding road.”

 The Story of the Chinese Farmer – a fable widely circulated online

[2] Wayne Dyer

Thoughts on Responding to Client Resistance

Counseling with individuals who have a diagnosis of a substance use disorder often finds one faced with
challenging client situations. Frequently, such challenges manifest themselves in an assortment of client comments, three examples of which are: (1) “how can you help me if you’re not an addict”; (2) “when I have to come to this group all of the time and hear about drugs it makes me want to use” and (3) “how does anyone expect me to get ahead when coming here takes time away from my job and my family.”

 

Let me address these one at a time:

 

1.    “how can you help me if you’re not an addict”

 

I found that reminding myself that someone in a pre-contemplative stage of readiness to change will use any obvious difference between us to rationalize a lack of willingness to engage. Whether the client truly believes this difference matters or is just using it to resist engagement, in that client's eyes the absence of a counselor’s dependence on the client’s drug of choice casts practitioners as incapable of understanding their situation...a true "us and them" situation in the client's eyes.

 

Knowing this and understanding that such statements are not so much resistance born of hostility but rather an effort to maintain some degree of control in what to this point feels like manipulation by “the system,” allows us to “act on” a client’s objection to our ability to make a difference rather than “react to it,” or to use Miller's terminology, “dance with the client” rather than wrestle. It is important to mention here that this could just as easily be a client who questions our ability to help because of the difference in our ages, genders, sexual orientation, race, etcetera. Our clients often feel “trapped” and as a result, resort to any means available to maintain some degree of control over their situation, even if that is to control the counseling agenda by pointing out how “we are different.”

 

To argue with clients about why we can help only places them in the position of control as they direct the focus of the session. The more we argue or attempt to convince them that they are wrong, the more they retain the high ground in this exchange.

 

What I did when faced with a situation like this, not being in recovery -- or being male, too old, straight, white, or whatever -- was to agree with my client: You are right. I am not addicted (or male or white or whatever) and there are parts of being addicted (a woman, black, gay, or whatever) I probably cannot understand or relate to. But, I have attended “X" AA/NA meetings and listened to the stories of countless addicts and have worked with substance dependent individuals for "Y" years and listened to their stories too and have come to an understanding of addition that I think can help me to be of help to you. NOTE: Practitioners need to translate this type of response into their own words :)

 

If the client came back and said something like, That's bullshit. I don't care how many of those meetings you went to, those people are not like me and you can't possibly know anything about me that can help! I would again, respond by agreeing with the client: Perhaps you are right and maybe hearing hundreds of stories by people addicted to alcohol or other drugs doesn't prepare me to know exactly what you have been through but if you have ever been angry, felt betrayed, were insulted, disrespected, paralyzed by fear or anxiety, or taken advantage of or ignored, I have experienced all those things, personally. I may not know what it is like to go through a withdrawal from (client's drug of choice) but I do know what it is like to deal with the crap (depending on the client and my read of that client I might use expletives) that life can throw at us. NOTE: Employ a matter-of-fact voice and NOT one that sounds angry or aggressive.

 

I would then change the subject since continuing the discussion risks it starting to feel like an argument. 

 

Changing the subject to something non-threatening but nonetheless appropriate for a counseling session allows us to regain control of the session. This “something” to which we shift the focus can be almost anything, just not anything that suggests “a problem.” Examples include:

·      Tell me something about what you expected these sessions would be like before coming.

·      I know from the paperwork that came with you why the folks that referred you want you to be here, but why do you think you are here?

·      Even though you doubt that I can understand your situation seeing that I am not an addict, what could result in you leaving this session today thinking that, “that wasn’t as bad as I thought it was going to be”?

·      Assuming for a minute that something useful could come out of coming here, what might that be?

 

NOTE: Make sure your question is open-ended otherwise you will likely just get “yes” or “not” answers at best.

 

2.     “when I have to come to this group all of the time and hear about drugs it makes me want to use.”

 

This is another common point raised by clients, although more often by someone in a contemplative stage of readiness to change.

 

As in the previous situation, statements like this may come from clients who try to rationalize their belief that “coming here” is not helpful and therefore a waste of time. It is also possible that a statement like this can come from clients who believe they have “dealt with their drug issue” and now just need to fix everything else in their life without the constant reminder of “back then.”

 

Again, starting a reply by agreeing with the client is likely to signal understanding and a willingness to listen while at the same time earning the opportunity to challenge this rationalization without appearing to argue: (This assumes that facilitators do not allow the group to focus on the joys of drug use) I can appreciate that talking about drug and drug use in the group does place your use front and center, but how does discussing the costs and consequences of using drugs result in your “wanting to use?”

 

A client might reply with something like, Well, all I can think about when all we do is talk about drugs and using them is that that has been such a big part of my life for so long that it’s all I know. Even when others are talking about their problems all I think about is, “I’m not like them. I’m different and I can control this.” I know dealing with this is hard but coming here and sitting in those drug groups makes it harder. Notice how such a reply to your question allows more of the client’s story to come out, which provides additional “grist for the counseling mill.”

 

Now, I have no idea how an individual client would respond to a counselor’s reply of, “group makes me want to do drugs.” I suspect that in the scenario I outline here, the counselor could come back with reflective listening…not a retort or follow-up question: Hearing others discuss their drug use in a group makes you wonder if your drug use will ever change. NOTE: This is a statement and NOT a question.

 

I could extend this hypothetical dialogue on for several exchanges but my point here is that whether the client is trying to rationalize leaving or is genuinely concerned about how the group threatens his making any type of progress, the issue is not so much “the group” as it is the what the client is telling himself about the group…it’s a waste of time/bullshit…or it is a threat to me. Keeping the client, not the group, as the focus is one way to address such client challenges.

 

3.    “how does anyone expect me to get ahead when coming here takes time away from my job and my family.” 

 

Traditionally, addictions counselors would see such a statement as resistance to treatment if not indicative of denial and respond with, …and how much time did you spend with your family when using and how did that use affect your attendance and job performance? Such a reply is confrontational and draws a line in the sand and sets up an adversarial relationship between the client and counselor.

 

Another approach, one more in line with M.I. in general and the spirit of M.I. specifically, is to respond to such a statement with reflective listening to elicit more of the client’s story and what is the real hidden meaning in this statement. For example:

 

·      Coming here is frustrating because it is a waste of your time. NOTE: There is no question mark at the end, meaning that this is NOT a question but a statement…a reflection.

o   Although clients may reply, “Yes, that’s right,” compliant clients might say something like, “it’s not so much a waste of time as it’s time I could be using to fix things at home/on the job.”

o   If they respond, “yes that’s right” a counselor could respond, A waste of time? And then process however the client responds, keeping the focus on the client and not the ‘time in group.’

o   If they respond, “it’s not so much a waste of time, it’s that they were mad when I using and now they are mad because I am going to group and those meetings”[1] a counselor could respond:

§  (Reflection) It’s not that the group is a waste of time as much as your family and job don’t understand the need for all this counseling. OR

§  (Summery) O.K., let me see if I understand: if you did not have to attend group you would have “X” hours more time each week with your family and to focus on your job. What would you do with those “X” hours that could improve things at home and on the job? OR

§   (Reflection) You’re caught between the rock and a hard place and feel trapped…by what your family wants on the one hand and what we here in the program are recommending on the other.

 

These client situations are typical of what counselors treating SUDs face routinely. That said, no matter how a counselor responds to such client comments, different clients will react differently. My point is that there are 2 simultaneous objectives for the counselor who faces such situations:

 

·      Such client comments come more from individuals who feel trapped or at least somewhat impotent and have lost control over their lives, and

·      A counselor who realizes this is better prepared to “act on” rather than “react to” these types of client situations.

 

If I view my work with an individual with a SUD as not so much a contest to win but a relationship to forge, I increase the likelihood of engaging my client in an eventual consideration of making a change, especially if viewing that client as a person first and the client second. Try as I will, however, on my best day I can only help the individuals with whom I work I cannot save them…I may be able to influence their behavior, but I cannot control it.

 

What do you think?

Robert

 

 

 

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[1] Notice how such a client response to the counselor’s reflective comment elicits more of the client’s story…and what is really going on in the client’s original statement