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

Kanter's Law and Change

January 21^st marks the start of the 3^rd week of the new year, a time when commitments to stick with that New Year’s resolution to make personal changes starts to flag. What began with the best of intentions on January 1 tends to become onerous, and burdensome to the point of questioning the appropriateness of continuing the pursuit of that targeted modification of personal behavior.

 

There are psychological factors that explain this feeling and the discouraging negative self-talk that sustains it…I can’t do this; This is stupid; This just feels wrong; What was I thinking. James Prochaska from the University of Rhode Island spoke about the “stages of readiness to change” and how if one attempts a radical behavioral change before truly ready to make that change, even if sincerely desiring it, I will falter and fail, A.K.A., relapse.

 

As this is not an essay about “how to change,” I do not explore ending habits here. NOTE: If interested in learning more about successful behavior change, click on Self-Directed Behavior Change to read a short book I have written on the topic. Rather, this essay looks at that sense of “lost commitment” to pursuing that New Year’s resolution.

 

Kanter’s Law states that, everything looks like a failure in the middle. Rosabeth Moss Kanter is a professor

in the Harvard School of Business who writes about the sabotaging of the enthusiasm and optimism felt at the start of a project by the hard work required to realize success. She suggests that this sense that accomplishing one’s objective is beyond reach is common, especially when the initial enthusiasm and optimism wane when encountering the effort required to see it through “in the middle.”

 

Like the meaning in the adage, it’s always darkest before the dawn, Kanter’s Law reminds us that success with a project or when making a change in personal behavior has less to do with one’s level of effort or skill than with patience and persistence. My grandfather used to tell me that the secret to success in any undertaking in life is “remember the 3-Ps”: patience, persistence, and perseverance.

 

So as the enthusiasm and optimism the New Year bring to change plans and resolutions to pursue them wanes, remember Kanter’s Law…or at least my grandfathers' admonishment…and as we used to say in the 60s, keep on truckin’!

Habits and the Challenges They Represent for Behavior Change

Habit is habit, and not to be flung out of the window by any man, but coaxed downstairs one step at a time.

Mark Twain

 

My hunch is that everyone reading this post lives a life dominated by habits. Many of these are beneficial and referred to as “routines” that we follow countless times throughout the day. Such routines allow us to negotiate the many and varied steps, that if requiring constant and vigilant attention would reduce our productivity to only those decisions needed to simply maintain our existence.

 

“Morning routines” like showering or oral hygiene, dressing, breakfasting, getting the kids off to school, commuting to work, or caring for the dog. Routines associated with meal preparation or household chores, driving a car, operating power equipment, or…the list is endless. The fact is these routines are essential habits, but ones we view as “good” or beneficial in nature. They are “shortcuts” we create that free our brains to engage in attending to other issues needing attention. They enable us, as the current cliché goes, to “multitask” and do 2 or more things at the same time. For example, try to imagine all the decisions that you would need to make to back your car out of the garage and headed to your destination if it were not for the car-driving habit you developed! Open the door, key in the ignition, adjust the mirrors, put the car in gear, easy on the gas, check the mirror, avoid the mailbox, etcetera, etcetera, etcetera.

 

Often, it is until when one of our routines results in a negative consequence, that we tend to label it a “bad habit.” And although there are good habits, we most often associate habits with undesirable behaviors, things like smoking, overeating, problem drinking, or maintaining a sedentary lifestyle, etc. So, let’s consider changing a bad habit by first looking at the anatomy of a habit: what it is and where they come from.

 

As suggested above, a habit is essentially a routine, a mental shortcut if you will, a pattern of behavior that through repetition becomes automatic. Such automatic behavior enables us to engage our internal “autopilot” to address repetitious behavior, thus freeing up the brain to consider other issues. When

encountering a cue that signals the start of a routine—an alarm clock sounding for example—and following through with a routine that results in a reward—getting up, showered, ready to fix breakfast and get the kids off to school or get dressed and off to work on time…or perhaps both—and repeating this multiple times, this routine becomes automatic, a shortcut…you do not even have to think about what to do or when to do it and in what order; like Nike suggests, you just do it.  Referred to as a “habit loop,” this pattern of a cue that initiates a routine resulting in a reward…cue, routine, reward; cue, routine, reward…and so on…becomes a habit.

 

The same process is involved when “habits go bad”; cue (stress), routine (smoking/drinking/eating), reward (escape/relief). Repeated often enough—and this can require very few repetitions—and the result is a habit, albeit a bad habit. And as anyone having experienced a less than successful New Year’s Resolution can attest, a stubborn if not (seemingly) intractable habit at that!

 

So, let’s drill down just a bit further into this anatomy of a habit and look at bad habits a bit closer. When the brain relinquishes control to a habit…when it goes on autopilot…it can divert attention to other issues/matters. It is this diversion of attention to other matters that makes changing a habit so difficult because the brain, our reasoning center, is busy doing other things. Add to this the complication of physical dependence that can accompany some habitual behavior, say to the nicotine in tobacco, opioids or amphetamines in certain prescription meds, or ethyl alcohol in alcoholic beverages, and habits involving the use of these substances are that much more difficult to change. Fortunately, for most of us, physical dependence on a drug is not a complicating factor, but even if it is, change does not result from “fighting the bad habit,” it comes from re-engaging the brain to identify a different and competing behavior.

 

For example, Michael is overweight, his A1C is 11.2, and his dietary habits leave much to be desired. If after seeing his doctor and getting the results of his blood work realizes he decides to change his eating habits and lose weight by “going on a strict diet,” chances are less than good that he will succeed. The challenge he faces is taking on a well-established patter of eating behavior, one triggered by cues such as stress, anxiety, or boredom with the simple decision—and a very non-specific one at that—to rely on willpower to enforce his diet (more on willpower in another essay, but suffice it to say that willpower is a skill that one can learn and develop but Michael’s simple decision “to diet” is no match for his well-established habit).

 

Michael would be more successful in changing his eating habits if he focused less on doing battle with the carbs and more on engaging in alternative behaviors to eating them. For example, replace trying to “stop eating” donuts with “counting calories” to stick to a diet of consuming “X” calories per 24-hour period. He might focus less on food and more on exercise or less on “losing 30 pounds and more on meeting with a nutritionist. The point is, that the way to approach changing a “bad habit” is to focus less on the habit and more on an alternate or competing behavior. Put in simple terms, the trick is to pursue what you want rather than avoid what you don’t.

 

Returning to the opening quote from Mark Twain, habit is habit, meaning that it simply exists. It is neither “good” nor “bad,” it is a shortcut our brains readily welcome as an efficient means to an end. When this normal process of developing shortcuts, however, results in creating more problems than it resolves, it is time to change. But change does not so much result from doing battle with one’s demons; it results from turning off the autopilot and re-engaging the brain in the process of decision-making, especially when cues arise to ensure developing alternative or competing behaviors to the “bad habit.”

 

Remember: habits are both natural and useful. Ironically, one can use this fact to change an unwanted or “bad habit”; establish a new habit to replace the old one. Keep in mind, however, all habits are stubborn, especially “bad habits” so for a successful alternative, look for something you enjoy, something you can see yourself doing and sticking with long enough for it to become your “new routine.” 

What do you think?

Negative Self-Talk: Part III

In this third and last essay in a series on automatic thoughts, I will expand on the topic of disputing negative self-talk. In Seligman’s book, Learned Optimism: How to Change Your Mind and Your Life, which I cited in the previous essay, he suggests four basic aspects of disputing pessimistic thinking…or what Ellis called Irrational Beliefs: (1) Evidence, (2) Alternatives, (3) Implications, and (4) Usefulness.

 

Checking for evidence connotes seeking out legitimate facts or proof that what I am telling myself is true. Such evidence can either support my self-talk or it can disprove it. This approach to challenging automatic thoughts is effective because thoughts are not facts…because I tell myself something does not necessarily make it so. Until and unless there is evidence supporting my belief, it is suspect. That said, it may just be that the facts support what I am telling myself but not necessarily how I am telling myself about it. This is where one or more of the remaining three strategies for disputing a pessimistic explanatory style becomes important.

 

Considering alternative explanations for a negative event or experience supported by facts lowers the temperature on negative self-talk and permits a more external and less personal consideration of the event. Rarely is there a single explanation as to why anything happens. Considering possible explanations other than just the one fueled by pessimism becomes important. Even if I did err, mitigating circumstances may have contributed to an outcome approaching the “perfect storm” I have built up in my mind. NOTE: It is important to check the evidence for any alternatives, as manufacturing excuses and shifting blame is not the objective of this strategy.

 

Reflecting on the implications of the event or experience helps to decatastrophize the situation. Even if I did err or “fail,” considering the implications of my failure allows looking at the event as specific and temporary rather than as something that lasts forever and brands me for life “as a loser.” In other words, asking myself how likely is it that this one event or experience will chart the course of the rest of my life in all areas of my existence?

 

The fourth of Seligman’s categories for disputing a pessimistic explanatory style is usefulness. This is essentially where I ask myself, what good will dwelling on this belief, especially if it is untrue, do? Even if I “screwed up” and create what many today refer to as “a hot mess,” what is the percentage in dwelling on the mistake, incessantly? Yes, I may have to “clean up the mess” because yes, I may be responsible…assuming there were no mitigating circumstances that proffer an alternative explanation or evidence to support it…but what is the point of ruminating about my mistake?

 

There is a phenomenon in social psych, confirmation bias, that likely serves to amplify the catastrophizing

done by those with a pessimistic explanatory style. This form of cognitive bias speaks to the preference individuals have to seek out information that supports a strongly held belief while discounting if not ignoring information that might well challenge that belief. Consequently, confirmation bias is a particularly challenging cognitive bias to elude when attempting to invite consideration of a new or different point of view. To the extent that someone with a longstanding pessimistic explanatory style reads this trilogy on challenging pessimism, confirmation bias may well result in discounting my argument if even permitting reading past part I.

 

That said, many pessimists recognize their pessimism and that it presents what economists call a very high opportunity cost. Because a pessimistic explanatory style results in spending inordinate amounts of time ruminating about negative events, mistakes made, and “OMG…what ifs” more positive thinking, planning, or acting, never takes place. But like having an expensive pair of shoes that cause blisters, regardless of how much you paid or how long you have had them, you are going to want a new pair of shoes you can comfortably wear. Perhaps challenging a pessimistic explanatory style and replacing it with optimism might just make for a comfortable fit.

 

What do you think? 

Finding the Beef: Additional Thoughts on Disputing Negative Self-Talk

Rare is it to find individuals today unfamiliar with A. A. Milne’s classic story of Winnie the Pooh. Either having read the book—or had the book read to them—or seen the animated Disney version, practically everyone knows the story of Pooh, Christopher Robin, and all the characters of the 100 Acre Wood. A character of individual interest from this tale, at least as far as this post is concerned, is Eeyore.

 

As you will recall, Eeyore presents throughout the story as the perpetually gloomy, ever-pessimistic, and apparently habitually disheartened donkey who lives in a section of the 100 Acre Wood denoted on its map as, Eeyore’s Gloomy Place. The confluence of Eeyore’s character and the point of this essay resides in what I referred to in my previous essay as “self-talk” or the negative beliefs one can hold that serve as the filter through which the processing of life experiences occurs. If this filter waxes pessimistic, which would appear is the case for Eeyore, then the resulting emotional consequences experienced are negative. And enough time spent in such emotional states will likely result in what clinicians refer to as dysthymia if not depression.

 

Martin Seligman, author of Learned Optimism: How to Change Your Mind and Your Life, refers to what

he calls personal “explanatory styles,” which can predict one’s degree of optimism or pessimism. One’s explanatory style is composed of three dimensions: (1) Personalization - the internal or personal and the external, (2) Permanence - the stable or permanent and the unstable or temporary, and (3) Pervasiveness - the global or pervasive and local or specific. Let’s consider a scenario by way of demonstrating.

 

Michael fails to complete the analysis of data needed by his boss to report on a project’s progress to investors.

 

 I really screwed up this time; I’m such a failure (internal or personal explanation). I knew this might happen; it always does (stable or permanent explanation). I can’t seem to do anything (global or pervasive explanation). The longer Michael ruminates about his “failure,” the more likely he is to become depressed. He has what Seligman calls a “pessimistic explanatory style.”

 

Let’s look at the same situation, but as someone with an “optimistic explanatory style” might:

 

Oh boy…I’m not going to make the deadline. I was afraid this might happen because of that server glitch (external explanation). Now that the server is back, I can finish the final section and give him what’s finished (unstable/temporary explanation). Stuff happens…he knows about the server problem and that this was not my doing (local/specific explanation).

 

If explanatory style or what I tell myself about an event or experience can result in emotional upset, then it stands to reason that changing one’s pessimistic explanatory style can improve it. And if explanatory style is a function of one’s belief system or one’s “self-talk,” then this means it is something open to personal manipulation. In other words, if what I tell myself is self-defeating and negative, then telling myself something different—disputing the pessimistic self-talk—can affect its emotional result. In short, if I choose to “act on” instead of “react to” life events and personal experiences, I can rewrite the story of my life.

 

That said, it would be nice if all I had to do was acknowledge that my pessimistic explanatory style needed an overhaul and, voila, it changed. Unfortunately, change, especially change in one’s way of thinking…worldview if you will…does not happen simply because of a flash of insight. It takes time and hard work but Seligman notes that several months of cognitive therapy that attends to explanatory style not only yields results but essentially inoculates one against pessimism and lessens if not prevents it in the future. In his book, he outlines a self-directed regimen to affect explanatory style.

 

You know what you’ve learned and learn what you’re taught…but it is important to realize that that is not all there is to be known. Change is an inside job and as such, something over which we each have ultimate control. If unhappy with the story of your life, rewrite it! If, as Jonathan Winters once said, you are tired of waiting for your ship to come in, then swim out to meet it.

 

Returning to the 100 Acre Wood, even our dysthymic Eeyore can display hints of optimism…the nicest thing about the rain is that it always stops. Eventually. Fortunately, we have a say as to when.

 

What do you think?

 

Where's the Beef?! Challenging Negative Self-Talk

Anyone older than 50 likely recalls the 1984 Wendy’s Hamburger commercial affectionately known as the “where’s the beef” commercial. If you do not recall this ad…or simply want to smile again at this cleaver piece of advertising…visit CLICK https://tinyurl.com/5n7xefn5.

As humorous as the ad may be, it has a parallel that is used by cognitive therapists and counselors to treat self-defeating and negative self-talk, what is often referred to as stinkin’ thinkin’. This counseling strategy begins with a simple question remarkably like that asked by actress Clara Pellar when she exhorts in the Wendy’s commercial, Where’s the Beef! – its clinical parallel being, Where’s the proof?  

 

Too often we fixate on some negative thought, often related to a mistake made or something “stupid” or “hurtful” someone said or did, perhaps some event reported in the news done by “those people.” The more time spent in stinkin’ thinkin’ the angrier or more depressed, or sad, or ___ fill in the blank with whatever negative emotion may result in your situation.

 

In cognitive therapy, individuals learn that it is not events or “things” that cause us to become sad, mad, angry, afraid, or become enraged, depressed, anxious, or terrified. It is what we tell ourselves about the event or “thing” that happened that generates these emotional states and our all too often behavioral reactions that we later regret.

 

Therapists help those with whom they are working to understand that thoughts are not facts! Because I “think” something, that does not make it so. There is a simple little formula that spells this out and may make it a bit easier to grasp when you see it: A + B = C where “A” stands for the activating event or “thing” that happened, “B” stands for the belief I have related to that thing or what I tell myself about it, and “C” stands for the emotional consequence that results from having told myself whatever “B” is…over, and over, and over again!

 

One way to interrupt this negative self-talk is to simply challenge the “B” or what I am telling myself when I feel that twinge of anger/sadness/anxiety or whatever the upsetting emotion is I experience following an event - Albert Ellis, the godfather of Rational Emotive Behavior Therapy, refers to this a disputing the "B". Treatment could then be referred to as A + B/D = C+ where "B/D" represents disputing the "B" and C+ is an improved emotional consequence. How, you ask? With simple questions not unlike Clara Pellar’s “where’s the beef”; Where's the proof?

 

Let’s use an example by way of demonstration. John arrives at work one morning. He enters the parking lot at the same time as a co-worker he knows. They have worked together for several years and socialize outside of work on occasion and he helped jumpstart her car earlier in the week when it wouldn’t start. As they approach the building’s entrance, John says good morning and asks about her plans for the weekend. He receives a non-committal, “mornin’” as they enter the building and she doesn’t make eye contact. “What’s up with her?” thinks John.  As he enters the building, this is the internal dialogue going on inside John’s mind:

 

“What’s she so upset about…what did I do?!”

“She has some nerve…I was just trying to be nice; I didn’t do anything!”

“She must think I’m hitting on her…asking about the weekend?”

“Where does she get off thinking that?! I know she has a boyfriend! What does she think I am, anyway?”

“Wait ‘til the next time she asks me for help when her car won’t start…bitch!”

 

Notice how John’s first thought is “what did I do.” For all we know, his co-worker could have just received some bad news or got a ticket on the way to work, or simply is “coming down with something.” His first thought “lights the fuse” for his subsequent thoughts…his “Bs” if you will…that take him farther down the wrong road resulting in his becoming angry and resentful…in a matter of minutes!

 

Here is where the “where’s the proof question” becomes important. Although his very first thought…“what’s she so upset about”…may have been reasonable, his jumping to the conclusion that it was something he did or said was not. At that “what did I do” question, had John paused and said to himself, “STOP! Where’s the proof that you said or did anything, John,” his entire internal dialogue may have gone in an entirely different and more empathetic direction.

 

True, perhaps John could rationalize the second part of his initial thought, especially if he tends to be

quick with a mildly inappropriate comment, but this is where a second activity used by cognitive therapists comes in handy in helping individuals prevent or at least derail their escalating irrational thoughts and the negative emotional consequences that follow. Referred to as the Downward Arrow Technique, this exercise can help by drilling down to the base or Core Belief, often generated in childhood, that give rise to the automatic negative thoughts that seem to “pop” into one’s mind when experiencing a negative or unpleasant event.

 

This technique is quite simple but nonetheless effective in uncovering these “core beliefs” and once identified, they too can yield to the “where’s the proof” question mentioned above. I will use John’s internal dialogue outlined above to illustrate the technique:

 

“What’s she so upset about…what did I do?!”

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Why does that bother you?

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“Because she must think I said or did something to ignore me like that.”

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Where’s the proof that you said or did anything…and even if you did, why does that bother you?

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“Well, she’s a co-worker and I’d like to count her as a friend.”

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Again, where’s the proof that you can’t be?

\/

“I must have done something or she wouldn’t be like that.”

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And if you did, what would that mean?

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“That she doesn’t like me and we can’t be friends.”

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Why does that bother you?

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"Because I have always had a tough time making friends.”

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What does that suggest?

\/

“That there is something wrong with me and people don’t like me.”

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What are you worried that might mean?

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“That my father was right when he said I won’t amount to anything.”

\/

And where is the proof that he was right?

 

At this point, a cognitive counselor might ask John how the accomplishments in his life jive with his father’s prediction. A bit further in their conversation…or after John has cataloged his personal accomplishments…an appropriate question may again be, “…and getting back to your co-worker, where’s the proof that you said or did anything wrong or upsetting? Might there be another reason for your co-worker's distraction this morning?

 

Again, the downward arrow technique gets at CORE BELIEFS and this may not be necessary for use each time one becomes aware of emotional upset. Often the simple, "Where’s the Beef” question is sufficient to derail a runaway and irrational train of thought, but identifying core beliefs is an effective way to prevent future automatic thoughts and derailing negative self-talk.

 

Often absolute thinking fuels the automatic thoughts that result in this negative self-talk, thoughts like, “They shouldn’t have/should have done this or that” or things like, “This always happens to me” or “This is terrible/awful; I can’t bear it.” In closing, a couple of “Where’s the Beef” type questions to ask whenever catching yourself thinking in absolute terms:

 

·      “They shouldn’t have/should have done whatever” – Says who? And so what if they did/didn’t, they have a right to be a jerk, right?

·      “This always happens to me!” – Nothing ALWAYS happens! It may happen a lot recently, but nothing always happens.

·      “This is terrible/awful; I can’t bear it.” – It may be difficult to deal with and totally unexpected, but where’s the proof you can’t bear it? This too shall pass.

 

There is any number of useful resources, essays, and exercises available online related to dealing with irrational thinking and its role in fostering anxiety, depression, anger issues, etcetera. For more on the downward arrow and other related exercises, CLICK https://tinyurl.com/yxvs77hz; for core beliefs CLICK https://tinyurl.com/bdmduja8.

 

What do you think?

Dr. Robert

The Self-Directed Daily Inventory

It is tempting to think that a "good" or "bad" day results from a single event. Although a particularly wonderful event can buoy one’s spirits or an equally upsetting experience result in sadness or emotional upset, most days tend to be typical, the result of a series of events or experiences…some “good” and some “not so good.”

Individual events that become the exclusive focus of one’s attention can impact we evaluate a given day. When assessing a given day as “good” or “bad,” considering an isolated event or series of events restricted to a narrow focus of experience during that day can result in frustration if not depression. This is especially likely if several such “bad days” occur in a row. Such experiences foster what professional counselors and therapists refer to as “negative self-talk” or what those familiar with A.A. call, stinkin’ thinkin’.

The purpose of the exercise outlined here is to increase the likelihood of considering the “big picture” when evaluating a typical day. The Self-Directed Daily Inventory (SDI) is a daily activity designed to help one slow down their thinking, step back to consider multiple variables that affect mood, and look at the “big picture.” In doing so, it is possible to realize that things are not always the way they appear to be when considering just a “snapshot” of events in one’s day to evaluate it.

When employing the SDI, identifying specific categories of experience that YOU view as important in evaluating your day and then considering them independently to assess how “good” or “bad” your day was in each of those categories provides a more objective and therefore accurate assessment of one’s true experience. Using a set of evaluating criteria you establish for each of these categories facilitates this “stepping back” to consider the bigger picture. For example, identifying a minimum of five and a maximum of seven key assessment categories you deem important areas in your life and then evaluating your day in each category provides a more realistic overview of that day. Averaging the individual scores assessed for each of these 5 to 7 critical areas then yields a more accurate “score” regarding the day.

Specifically, use a simple “1 to 5” scale to evaluate each category. Describe the criteria that denote the lower and upper ends of this scale for each category with conditions or experiences you believe describe “bad” or “good” for that category. Next, total the scores for each category, find the average score (the total of all daily scores divided by the number of scores), and post this average on a graph to view progress or “change” on a daily basis.

This simple technique “forces” consideration of the “big picture” when determining progress or improvement in regaining personal control in one’s life.

To create your own step-by-step set of instructions, using 7 sample categories. You will need to choose your own important life categories and define the scale used for evaluation for this exercise to be effective. You can find a sample set of worksheets and instructions at https://tinyurl.com/S-DDaily-inventory

Becoming Your Own Best Friend: Affirmation #1

Negative self-talk or "stinkin' thinkin' " sabotages self-confidence, fosters procrastination, and is a primary contributor to doubt, irrational fear, and anxiety. It often results from long-forgotten but nonetheless influential criticism, the thoughtlessness of others, or the disregard or neglect of someone important in your life.

We know what we learn and learn what we are taught, hence, how often do I have to hear "you will never amount to anything" or "you are a real disappointment" before I start to believe what I am being taught?

But although I know what I have learned and learned what I was taught, that does not represent all there is to know. Someone else's opinion is not synonymous with fact. And my negative self-talk is simply the thoughts I have that echo those opinions of others and THOUGHTS ARE NOT FACTS.

Because thoughts are not facts, we can challenge and refute them. Referring back to my previous post, I might ask myself, "Robert...where's the proof that ____ is fact? And even if there is some history that suggests it was so in the past, what's to say it must always be?"

What follows is the first of several affirmations or "negative self-talk challenging messages" that may help improve confidence and self-respect as well as turn down the volume just a bit on the "stinkin' thinkin' "

If one or more of these affirmations resonate for you, write it down and look for opportunities to speak it aloud (if alone) or read it to yourself several times a day...the more you practice, the lower the volume on negative self-talk. (if you want an exercise designed to help you accomplish this, leave a note in the comments section below). NOTE: Established negative thinkers will react to these affirmations when first reading them as if they are nonsense. Say/read them anyway..."fake it till you make it"

AFFIRMATION #1: • Everything that happens around me shall work out for the good of all concerned o When I do my best and work my hardest I will succeed. If success in my specific task eludes me, then the success is learning from the experience - What do I do next time? What could I do differently next time? What can I avoid next time? What can I add to my plan next time? No one ever fails, we simply succeed at learning what to try differently next time.

3rd Person Self-Talk and Self-Directed Behavior Change; How to Talk Sense to Yourself

Has a friend or family member ever approached you seeking advice on how best to deal with a personal issue or approach an important personal decision? If you are like most humans, the answer is yes. And when approached, were you able to proffer an opinion or provide the requested advice? Again, the answer is likely yes. This is because most of us are relatively good in such situations because we view ourselves as “detached” from the situation. Because of this detachment, we are more objective and offer reasoned advice.

 

Ethan Kross, a psychologist at the University of Michigan, has published research that finds that when individuals conduct their self-talk in the 3^rd person, that is referring to themselves by 1^st name or as he/she, him/her we can achieve that same degree of psychological detachment that enables us to provide more logical and rational advice to ourselves. Consider this example:

 

Instead of thinking, I can lose the weight needed to look good on the beach this summer, I say to myself, Robert, you can lose the weight needed to look good on the beach this summer.

 

Thinking in the 1^st person is a habit that is difficult to break. Why? Because we have likely been doing it for decades! However, when finding myself thinking in the 1^st person, I can “translate” those thoughts into the 3^rd person easily by simply inserting a 3^rd person pronoun or my first name, a nickname I go by, or my last name if that is how others generally refer to me – think “Gibbs” on NCIS – and create that psychological detachment that brings added clarity, reason, and logic to my thinking.

 

This can be a very helpful aid to accomplishing self-directed behavior change. Engaging in 3^rd-person self-talk about losing weight, quitting smoking, drinking less, or exercising more can help prevent self-doubt from derailing a change plan.

 

Before dismissing this idea by saying you do not want to sound like Dobby the House Elf in Harry Potter, remember we are talking about "self-talk" here...that is $10 psychobabble for "private personal thoughts," the ones no one hears except you :)

 

Robert – remember that willpower is a skill that you develop with practice rather than, I don’t have the willpower necessary to succeed; I’ll never be able to change.

Change is an inside job, Robert; one that you can accomplish because it is more about attitude than effort rather than, Change is just too hard for me; I will never be able to do this.

 

What do you think?

 

To read more about 3^rd-person self-talk as an aid in stress management, ending negative self-talk, or quietening anxiety, CLICK HERE.

 

Dr. Robert