Here's the handout from my workshop at the Association for Experiential Education's 2011 International Conference. During the workshop, we did six activities: Chiji Mingle, Cross the Line, Endless Loop, Chiji Zones, Blindfold Toss, and Mega Jenga. We also viewed client drawings of their Addictive Voices, discussed ideas for framing and processing to emphasize narrative approaches.
OVERCOMING THE STUCKNESS
Narrative Therapy & Experiential Learning with Substance Abusing Teens
Understanding the Stuckness
Adolescence is a discrete developmental stage focused on two primary tasks, establishing autonomy and defining identity. Because of this, prescriptive treatment programs, although common, are likely to be ineffective with teens. With this in mind, I’ve spent the last several years exploring ideas to make treatment more developmentally appropriate for adolescents.
Various developmental theories exist, but most have some things in common. For example, most include a task that needs to be accomplished in order to move to the next stage. Traditional perspectives on development state that if a task isn’t completed the person won’t progress. It seems to me this isn’t accurate. Instead, sociocultural and biological factors keep pushing individuals forward, even when tasks are unresolved or only partially completed.
With every push forward, the individual becomes less likely to complete the next stage, resulting in an ever-growing developmental debt. Developmental debt exhibits itself in maladaptive behaviors and various life problems, ultimately resulting in stuckness. Think of it like a credit card that never gets fully paid off. Not only will the person always have a balance due, but that person will also get further and further behind each month.
Other Causes of Stuckness
MANDATED TREATMENT - Teens rarely enter treatment by choice. Since establishing autonomy is an important task of adolescence, when teens are mandated or pressured to attend treatment, there is a predictable conflict that frequently results in reactance, a tendency to resist influences perceived to be a threat to one’s autonomy.
RIGID THINKING HABITS - Substance-abusing teens typically exhibit rigid thinking habits. Our clients engage in all-or-nothing thinking, catastrophize, deny having problems, and blame others. When we use confrontational or directive approaches, we reinforce these thinking habits. We also stop being allies and become adversaries.
[NOTE: During the workshop, we talked about the term thinking habit versus terms commonly used in CBT. Although we may be able to identify our clients' thoughts as irrational, errors, and maladaptive, these thinking habits exist because they serve a purpose. It seems to me those phrases can be dismissive and judgmental.]
OTHER COMPLICATING FACTORS - Many of our clients have complicating factors. 80% of substance-abusing teens have mental health challenges; 70% have a history of trauma. Other complicating factors—such as chaotic homes, family histories of substance abuse, and financial stressors—are also common.
Risking Change
Our clients are stuck in seemingly endless loops of maladaptive behaviors. Our task is to assist them in getting unstuck, not behave better, fulfill external mandates, or stop using. Hopefully those things happen, but they’re side effects of getting unstuck. When we start thinking about our task this way, we’re better able to help clients discover how to leave their Comfort Zones.
• Comfort Zone. Most people spend most of their time in their Comfort Zones, where risks and challenges are minimal, but so is change or learning.
• Challenge Zone. When you leave your Comfort Zone, you enter your Challenge Zone. Success is possible, but takes effort.
• Crisis Zone. In the Crisis Zone, stress is too high for effective learning or change.
[NOTE: In the workshop, we spent some time discussing the difference between comfort and safety. Being too comfortable is likely to contribute to stucknessor, as a client put it once, becoming comfortably stuck. Safety, on the other hand, is about feeling secure enough emotionally and physically to risk leaving your Comfort Zone and risking change. We need to create environments that are safe even when uncomfortable.]
Their behavior might suggest otherwise, but most substance-abusing teens are risk adverse. Bad risks are commonplace in their lives, but they actively avoid taking good ones. It seems to me that those behaviors we often label as resistance are actually examples of risk avoidance. Reframing resistance in this way can be extremely useful in helping clients get unstuck and risk leaving their Comfort Zones.
Developmental debt, reactance, rigid thinking habits, and other complicating factors result in clients who would rather stay in their Comfort Zones. After all, Comfort Zones are comfortable. Because of this, the longer someone stays in his or her Comfort Zone, the harder it becomes to leave.
Four ways to assist clients in leaving their Comfort Zones are:
• Acknowledge that change is risky. Increased awareness is a necessary first step for changing any behavior. Talk about the risks involved in making change.
• Never forget the client’s motivators. Stuck teens need a reason to leave their Comfort Zone. Continually revisit and reinforce their motivators.
• Provide opportunities to practice safe risk taking. Adventure outings and other experiential activities provide excellent opportunities to practice risk taking.
• Assign new experiences. I’ve had clients with treatment plans that included belly dancing, glass blowing, rock climbing, hand drumming, and more.
Super-stuck Teens
This is a term I use for those clients who are simply unwilling to do anything different. For these teens, The Known is inherently better than The Unknown. Teens with anxiety disorders, depression, neurodiversity, and past traumas are most likely to become super-stuck.
Super-stuck teens will likely spend a longer-than-usual time in treatment. However, when provided extra patience, increased empathy, and counselors focused on relationships over compliance, they can make amazing progress in treatment.
Stages of Change
Change is a process, not an event. Even when it seems change was instantaneous, we’re really seeing the end result of a process. The Stages of Change is a transtheoretical model that identifies five steps:
• Pre-contemplation. I don’t have a problem.
• Contemplation. Maybe I have a problem.
• Preparation. I have a problem and am thinking about what to do.
• Action. I’m doing something about my problem
• Maintenance. My new behavior has become habit.
Movement through these stages isn’t always linear. The most obvious example of this is recycling (or relapsing). When attempting any kind of change, relapse into old behaviors can be a necessary part of the process and a valuable teachable moment. When clients relapse, helpers often blame a lack of skills, situational factors, or client unwillingness.
These may be the extenuating circumstances, but I propose that relapse happens because we push our clients into Action too quickly. Recovery isn’t a race! We need to set our abstinence agendas aside and give clients the time they need to move through all the Stages of Change.
Experiencing New Stories
The stories we tell about ourselves and our experiences define how we act, think, and feel. They determine how we make sense of our past, present, and future, how we interpret the information of our lives, and how we interact with the world.
We create these stories by stringing together experiences from our lives, ignoring those events that don’t support our evolving narrative. Our experiences within families, communities, and society shape our stories by influencing what events become strung together. So does natural resilience and innate personality traits, adaptive or not.
Substance abusing teens typically enter treatment with problem-saturated stories. These tales of stuckness have become the defining stories for their lives. These stories are often constrictive, leaving clients trapped in an ever-shrinking Comfort Zone where they are able to identify fewer and fewer options.
Narrative therapy provides four core strategies for helping clients develop new stories focused on hope and possibility: externalizing the problem, seeking exceptions, re-authoring, and maintaining a playful approach. To this I add one more: creating exceptions.
EXTERNALIZING THE PROBLEM - Instead of having a problem or being a problem, assist clients to view problems as existing outside themselves. This helps to remove pressures rooted in blame, shame, and defensiveness. We can take this even further by encouraging clients to think of their problems as characters in their stories.
SEEK EXCEPTIONS - Clients build and sustain problem-saturated stories by ignoring times when The Problem wasn’t in control. Seeking exceptions involves assisting clients to identify those ignored times. Explore these exceptions in great detail. Much can be learned from them. Seeking exceptions is about looking into the past.
CREATE EXCEPTIONS - Anything that involves clients successfully leaving their Comfort Zone and experiencing exceptions provides useful material for new stories. I’ve had clients try belly dancing, glass blowing, rock climbing, and more. This is a place that experiential learning and adventure programming can be utilized quite dramatically. Creating exceptions is about new experiences in the present.
RE-AUTHORING - Once exceptions have been identified and created, clients can start re-authoring their problem-saturated stories. Re-authoring involves providing clients the opportunity to create new, more empowering stories. Journaling, storytelling, and art can be excellent ways for clients to engage in re-authoring their stories. Re-authoring is about imaging a changed future.
MAINTAIN A PLAYFUL APPROACH - Narrative therapy is inherently playful. This playful approach helps create an environment that allows stuck teens to risk leaving their Comfort Zones and ultimately overcome their stuckness. If that wasn’t enough, neuroscience has shown that fun in glue. In other words, people are more likely to remember—and use—what they learn while having fun.
Further Reading
• The Art of Changing the Brain, by James Zull
• Changing for Good, by James Prochaska, John Norcross & Carlo DiClemente
• Elusive Alliance, edited by David Casto-Blanco & Marc Karver
• Integrating Existential and Narrative Therapy, by Alphons Richert
• Interviewing for Solutions, by Peter de Jong & Insoo Kim Berg
• Motivational Interviewing, by William Miller & Stephen Rollnick
• Motivational Interviewing with Adolescents and Young Adults, by Sylvie Naar-King & Mariann Suarez
• Pathways to Change, by Matthew Selekman
• Playful Approached to Serious Problems, by Jennifer Freeman, David Epston & Dean Lobovits
• What is Narrative Therapy?, by Alice Miller
Monday, November 7, 2011
Monday, September 19, 2011
Counselor Camp 2011 - Overcoming the Stuckness
Here's the handout from my workshop at Counselor Camp 2001. I'm presenting a very similar workshop (it even has the same title!) in November at the Association for Experiential Education's 2011 International Conference. That workshop will focus more specifically on integrating narrative therapy and experiential education with this population.
Overcoming the Stuckness
Six Keys to Facilitating Change with Substance Abusing Teens
Presented by David Flack • Counselor Camp 2011
Teens are teens. They aren’t adults and they aren’t children. That seems obvious, right? Obvious or not, though, it is essential to remember when working with this age group. Adolescence is a discrete developmental stage that focuses on the tasks of developing identity, autonomy, intimacy, sexuality, and achievement. With substance abusing teens we often see distorted, funhouse mirror versions of these normal developmental tasks. With co-occurring teens, that mirror can be even more distorted.
It is normal for teens to question, rebel against, and ultimately reject the plans of authority figures, including the most well intentioned drug counselors. That means our clients are doing exactly what they should be doing, just in maladaptive, problematic ways. Yet, we often label them non-compliant, oppositional, or treatment resistant.
What Else Do We Know About Our Clients?
• Teens rarely enter treatment by choice. Since establishing autonomy is an important task of adolescence, when teens are mandated or pressured to attend treatment, there is a predictable conflict that frequently results in reactance.
• Substance-abusing teens typically exhibit rigid thinking habits. If we use confrontational or directive approaches, we’ll stop being allies and become adversaries. This won’t be useful for anyone!
• Most of our clients have complicating factors. 80% of substance-abusing teens have a mental health challenge; 70% have a history of trauma. If not addressed, these challenges can become insurmountable obstacles to change.
With these points in mind, I’ve developed Six Keys for facilitating change with substance-abusing teens. These Keys are a “mash up” of motivational interviewing, stages-of-change, narrative therapy, and existential psychotherapy. I think of them as the “C” in CBT — a way to assist adolescent clients in overcoming rigid thinking, getting unstuck, and moving forward.
First Key: Everyone is motivated by something.
When starting treatment, teens often deny any problems related to alcohol, marijuana, or other drugs. When this happens, many helpers quickly label them as resistant. This can be a self-fulfilling prophecy. In other words, if you expect resistance then you’ll probably get it.
When given an opportunity, even the most reluctant clients are likely to identify something that motivates them to engage in treatment — often legal, school, or family problems. These may not be the motivators we want for our clients, but change requires meeting clients where they’re at, not where we want them to be.
Help clients find their “hook” by using the Five R’s of Motivational Interviewing:
• Relevance. Why is change important?
• Risks. What are the risks of changing? What are the risks of not changing?
• Rewards. What will you gain from change?
• Roadblocks. What are the obstacles to change?
• Repetition. Review these at each session.
Second Key: Change requires leaving your Comfort Zone.
Our clients are stuck in seemingly endless loops of maladaptive behaviors. Our task is to assist them in getting unstuck, not behave better, fulfill external mandates, or stop using. Hopefully those things happen, but they’re side effects of getting unstuck. When we start thinking about our task this way, we’re better able to help clients discover how to leave their Comfort Zones.
In the Zone
• Comfort Zone. Most people spend most of their time in their Comfort Zone, where risks and challenges are minimal, but so is change or learning.
• Challenge Zone. When you leave your Comfort Zone, you enter your Challenge Zone. This is where learning and change occurs.
• Crisis Zone. In the Crisis Zone, stress is too high for effective learning.
Risking Change
Leaving your Comfort Zone is risky. However, it is necessary if change is going to occur. Three ways to assist clients in taking this risk are:
• Acknowledge the risk. Increased awareness is one of the first steps to changing any behavior. Spend time talking with clients about the risks involved in change and ways to move forward anyway.
• Explore good risks vs. bad risks. Their behavior might suggest otherwise, but most substance-abusing teens are risk adverse. Bad risks have become commonplace in their lives, but they actively avoid taking good ones.
• Provide opportunities to practice safe risk taking. I’ve had clients try belly dancing, glass blowing, rock climbing, snowshoeing, and more. Adventure outings and other experiential activities also provide ways to practice risk taking.
Super-stuck Teens
This is a term I use for those clients who are simply unwilling to leave their Comfort Zone. For these teens, The Known — no matter how bad — is inherently better than The Unknown. Super-stuck teens are overwhelmed by existential anxiety. This can be defined as stress or anxiety rooted in our awareness of personal freedom and the responsibilities that accompany choices.
Teens with chaotic histories, unstable environments, and past traumas are most likely to become super-stuck. Super-stuckness can also occur with “timid” teens, clients who have poor self-esteem, and youth with traits of anxiety or depression, even if sub-clinical.
In my experience, super-stuck teens will likely spend a longer-than-usual time in the Contemplation and Preparation Stages of Change (see Third Key). They require extra patience, increased empathy, and counselors focused on relationships over compliance.
Third Key: Change is a process, not an event.
Even when it seems that change was instantaneous, we’re really seeing the end result of a process. The Stages of Change is a transtheoretical model that identifies five steps:
• Pre-contemplation. I don’t have a problem.
• Contemplation. Maybe I have a problem.
• Preparation. I have a problem and am thinking about what to do.
• Action. I’m doing something about my problem
• Maintenance. My new behavior has become habit.
It is important to remember that movement through these stages isn’t always linear. The most obvious example of this is Recycling (or Relapsing). When attempting any kind of change, relapse into old behaviors can be a necessary part of the process and a valuable teachable moment.
When relapse happens, we tend to blame a lack of skills, situational factors, or client unwillingness. These may be the extenuating circumstances, but I propose that relapse happens because we push our clients into Action too quickly. Recovery isn’t a race! We need to set our abstinence agendas aside and give our clients the time they need to move through all the Stages of Change.
Fourth Key: Expect ambivalence.
Ambivalence can be defined as simultaneously believing two seemingly contradictory ideas. In the case of substance-abusing teens: I want to fix my problem and I want to keep using. As we know, teens typically enter treatment because of legal, school, and family pressures, but don’t think they have a problem with alcohol, marijuana, or other drugs. Is it any surprise they’re ambivalent?
Helping clients resolve their ambivalence requires exploring both the pros and cons of using. However, drug counselors often focus solely on the problems. Our clients know they have a problem. They don’t need us telling them over and over. If anything, doing so may be invalidating and reaffirm their apparent inability to make change.
Resolving Ambivalence
As we know, substance-abusing teens have rigid thinking habits. These habits reinforce their ambivalence by keeping them stuck in extreme thinking. Resolving ambivalence requires them to think beyond the extremes. In addition to exploring the pros and cons of using, some strategies for helping with this are:
• Engage clients in activities and discussion on balance, the Middle Path, and similar concepts.
• Explore all-or-nothing thinking.
• Whenever possible, use continuums, spectrums, and scaling questions.
• Assist clients to develop critical thinking and mindfulness skills.
Fifth Key: Changed lives require changed stories.
The stories we tell about ourselves and our experiences define how we act, think, and feel. They determine how we make sense of our past, present, and future, how we interpret the information of our lives, and how we interact with the world.
Substance-abusing teens have lives filled with problem-saturated stories. These tales of stuckness, maladaptive behavior, and treatment failures have become the defining stories for their lives. These stories are constrictive, leaving our clients trapped in an ever-shrinking Comfort Zone, with fewer and fewer options. As helpers, we need to provide opportunities to create new, more hopeful stories.
Externalizing the Problem
• Instead of having a problem or being a problem, assist clients to view problems as existing outside themselves.
• Externalizing the problem removes pressures rooted in blame, shame, and defensiveness.
• We can take this even further by encouraging clients to think of their problems as characters in their stories.
• You can assist clients to externalize their ambivalence by presenting the idea of both an Addictive Voice and a Rational Voice.
Seek Exceptions
• Clients build and sustain problem-saturated narratives by ignoring times when The Problem wasn’t in control.
• Seeking exceptions involves assisting clients to identify those ignored times.
• Explore these exceptions in great detail. Much can be learned from them.
• Identifying exceptions assists clients to discover the skills they already possess but have been ignoring because The Problem was in control.
Re-authoring
• Once exceptions have been identified, clients can start re-authoring their problem-saturated stories.
• Re-authoring involves giving clients the opportunity to create new, more empowering stories.
• Anything that involves clients successfully leaving their Comfort Zone and experiencing exceptions to their problem-saturated narratives can provide useful material for these new stories.
Sixth Key: Maintain a playful approach.
I conceptualize the challenges faced by some adolescent clients as developmental debt. Various developmental theories exist, but most have some things in common. For example, most include stages of development that are linked to age ranges. Also, most include a task that needs to be accomplished in order to move to the next stage.
Traditional perspectives on development suggest that if a task isn’t successfully completed, then the person becomes stuck at that stage. While that may have been accurate when these developmental models were created, it seems to me this is no longer true. Instead, sociocultural and biological factors keep pushing individuals forward, even if developmental tasks are unresolved or only partially completed.
With every push forward, these individuals become less likely to successfully complete the next stage, resulting in an ever-growing developmental debt. Think of it like a credit card that never gets fully paid off. Not only will you always have a balance due, but you’ll also get further and further behind each month.
Maintaining a playful approach is one way to meet our “in debt” clients where they’re at both emotionally and cognitively. Also, play and playfulness creates an environment that allows these teens to start paying off some of that debt. In other words, a playful approach provides opportunities for our clients to go backwards in order to catch up.
Activities from the Workshop
The following activities and exercises were part of the workshop: Chiji Mingle, Endless Loop, Chiji Zones, Mega Jenga, Gutter Ball, Brainstorm Posters (The Good, the Bad, and the Ugly), and Whack 'Em.
Further Reading
• The Art of Changing the Brain, by James Zull
• Changing for Good, by James Prochaska, John Norcross & Carlo DiClemente
• Elusive Alliance, edited by David Castro-Blanco & Marc Karver
• Interviewing for Solutions, by Peter de Jong & Insoo Kim Berg
• Motivational Interviewing, by William Miller & Stephen Rollnick
• Motivational Interviewing with Adolescents & Young Adults, by Sylvie Naar-King & Mariann Suarez
• Pathways to Change, by Matthew Selekman
• The Primal Teen, by Barbara Strauch
• Real Boys, by William Pollack
• Reviving Ophelia, by Mary Pipher
• What is Narrative Therapy?, by Alice Miller
Overcoming the Stuckness
Six Keys to Facilitating Change with Substance Abusing Teens
Presented by David Flack • Counselor Camp 2011
Teens are teens. They aren’t adults and they aren’t children. That seems obvious, right? Obvious or not, though, it is essential to remember when working with this age group. Adolescence is a discrete developmental stage that focuses on the tasks of developing identity, autonomy, intimacy, sexuality, and achievement. With substance abusing teens we often see distorted, funhouse mirror versions of these normal developmental tasks. With co-occurring teens, that mirror can be even more distorted.
It is normal for teens to question, rebel against, and ultimately reject the plans of authority figures, including the most well intentioned drug counselors. That means our clients are doing exactly what they should be doing, just in maladaptive, problematic ways. Yet, we often label them non-compliant, oppositional, or treatment resistant.
What Else Do We Know About Our Clients?
• Teens rarely enter treatment by choice. Since establishing autonomy is an important task of adolescence, when teens are mandated or pressured to attend treatment, there is a predictable conflict that frequently results in reactance.
• Substance-abusing teens typically exhibit rigid thinking habits. If we use confrontational or directive approaches, we’ll stop being allies and become adversaries. This won’t be useful for anyone!
• Most of our clients have complicating factors. 80% of substance-abusing teens have a mental health challenge; 70% have a history of trauma. If not addressed, these challenges can become insurmountable obstacles to change.
With these points in mind, I’ve developed Six Keys for facilitating change with substance-abusing teens. These Keys are a “mash up” of motivational interviewing, stages-of-change, narrative therapy, and existential psychotherapy. I think of them as the “C” in CBT — a way to assist adolescent clients in overcoming rigid thinking, getting unstuck, and moving forward.
First Key: Everyone is motivated by something.
When starting treatment, teens often deny any problems related to alcohol, marijuana, or other drugs. When this happens, many helpers quickly label them as resistant. This can be a self-fulfilling prophecy. In other words, if you expect resistance then you’ll probably get it.
When given an opportunity, even the most reluctant clients are likely to identify something that motivates them to engage in treatment — often legal, school, or family problems. These may not be the motivators we want for our clients, but change requires meeting clients where they’re at, not where we want them to be.
Help clients find their “hook” by using the Five R’s of Motivational Interviewing:
• Relevance. Why is change important?
• Risks. What are the risks of changing? What are the risks of not changing?
• Rewards. What will you gain from change?
• Roadblocks. What are the obstacles to change?
• Repetition. Review these at each session.
Second Key: Change requires leaving your Comfort Zone.
Our clients are stuck in seemingly endless loops of maladaptive behaviors. Our task is to assist them in getting unstuck, not behave better, fulfill external mandates, or stop using. Hopefully those things happen, but they’re side effects of getting unstuck. When we start thinking about our task this way, we’re better able to help clients discover how to leave their Comfort Zones.
In the Zone
• Comfort Zone. Most people spend most of their time in their Comfort Zone, where risks and challenges are minimal, but so is change or learning.
• Challenge Zone. When you leave your Comfort Zone, you enter your Challenge Zone. This is where learning and change occurs.
• Crisis Zone. In the Crisis Zone, stress is too high for effective learning.
Risking Change
Leaving your Comfort Zone is risky. However, it is necessary if change is going to occur. Three ways to assist clients in taking this risk are:
• Acknowledge the risk. Increased awareness is one of the first steps to changing any behavior. Spend time talking with clients about the risks involved in change and ways to move forward anyway.
• Explore good risks vs. bad risks. Their behavior might suggest otherwise, but most substance-abusing teens are risk adverse. Bad risks have become commonplace in their lives, but they actively avoid taking good ones.
• Provide opportunities to practice safe risk taking. I’ve had clients try belly dancing, glass blowing, rock climbing, snowshoeing, and more. Adventure outings and other experiential activities also provide ways to practice risk taking.
Super-stuck Teens
This is a term I use for those clients who are simply unwilling to leave their Comfort Zone. For these teens, The Known — no matter how bad — is inherently better than The Unknown. Super-stuck teens are overwhelmed by existential anxiety. This can be defined as stress or anxiety rooted in our awareness of personal freedom and the responsibilities that accompany choices.
Teens with chaotic histories, unstable environments, and past traumas are most likely to become super-stuck. Super-stuckness can also occur with “timid” teens, clients who have poor self-esteem, and youth with traits of anxiety or depression, even if sub-clinical.
In my experience, super-stuck teens will likely spend a longer-than-usual time in the Contemplation and Preparation Stages of Change (see Third Key). They require extra patience, increased empathy, and counselors focused on relationships over compliance.
Third Key: Change is a process, not an event.
Even when it seems that change was instantaneous, we’re really seeing the end result of a process. The Stages of Change is a transtheoretical model that identifies five steps:
• Pre-contemplation. I don’t have a problem.
• Contemplation. Maybe I have a problem.
• Preparation. I have a problem and am thinking about what to do.
• Action. I’m doing something about my problem
• Maintenance. My new behavior has become habit.
It is important to remember that movement through these stages isn’t always linear. The most obvious example of this is Recycling (or Relapsing). When attempting any kind of change, relapse into old behaviors can be a necessary part of the process and a valuable teachable moment.
When relapse happens, we tend to blame a lack of skills, situational factors, or client unwillingness. These may be the extenuating circumstances, but I propose that relapse happens because we push our clients into Action too quickly. Recovery isn’t a race! We need to set our abstinence agendas aside and give our clients the time they need to move through all the Stages of Change.
Fourth Key: Expect ambivalence.
Ambivalence can be defined as simultaneously believing two seemingly contradictory ideas. In the case of substance-abusing teens: I want to fix my problem and I want to keep using. As we know, teens typically enter treatment because of legal, school, and family pressures, but don’t think they have a problem with alcohol, marijuana, or other drugs. Is it any surprise they’re ambivalent?
Helping clients resolve their ambivalence requires exploring both the pros and cons of using. However, drug counselors often focus solely on the problems. Our clients know they have a problem. They don’t need us telling them over and over. If anything, doing so may be invalidating and reaffirm their apparent inability to make change.
Resolving Ambivalence
As we know, substance-abusing teens have rigid thinking habits. These habits reinforce their ambivalence by keeping them stuck in extreme thinking. Resolving ambivalence requires them to think beyond the extremes. In addition to exploring the pros and cons of using, some strategies for helping with this are:
• Engage clients in activities and discussion on balance, the Middle Path, and similar concepts.
• Explore all-or-nothing thinking.
• Whenever possible, use continuums, spectrums, and scaling questions.
• Assist clients to develop critical thinking and mindfulness skills.
Fifth Key: Changed lives require changed stories.
The stories we tell about ourselves and our experiences define how we act, think, and feel. They determine how we make sense of our past, present, and future, how we interpret the information of our lives, and how we interact with the world.
Substance-abusing teens have lives filled with problem-saturated stories. These tales of stuckness, maladaptive behavior, and treatment failures have become the defining stories for their lives. These stories are constrictive, leaving our clients trapped in an ever-shrinking Comfort Zone, with fewer and fewer options. As helpers, we need to provide opportunities to create new, more hopeful stories.
Externalizing the Problem
• Instead of having a problem or being a problem, assist clients to view problems as existing outside themselves.
• Externalizing the problem removes pressures rooted in blame, shame, and defensiveness.
• We can take this even further by encouraging clients to think of their problems as characters in their stories.
• You can assist clients to externalize their ambivalence by presenting the idea of both an Addictive Voice and a Rational Voice.
Seek Exceptions
• Clients build and sustain problem-saturated narratives by ignoring times when The Problem wasn’t in control.
• Seeking exceptions involves assisting clients to identify those ignored times.
• Explore these exceptions in great detail. Much can be learned from them.
• Identifying exceptions assists clients to discover the skills they already possess but have been ignoring because The Problem was in control.
Re-authoring
• Once exceptions have been identified, clients can start re-authoring their problem-saturated stories.
• Re-authoring involves giving clients the opportunity to create new, more empowering stories.
• Anything that involves clients successfully leaving their Comfort Zone and experiencing exceptions to their problem-saturated narratives can provide useful material for these new stories.
Sixth Key: Maintain a playful approach.
I conceptualize the challenges faced by some adolescent clients as developmental debt. Various developmental theories exist, but most have some things in common. For example, most include stages of development that are linked to age ranges. Also, most include a task that needs to be accomplished in order to move to the next stage.
Traditional perspectives on development suggest that if a task isn’t successfully completed, then the person becomes stuck at that stage. While that may have been accurate when these developmental models were created, it seems to me this is no longer true. Instead, sociocultural and biological factors keep pushing individuals forward, even if developmental tasks are unresolved or only partially completed.
With every push forward, these individuals become less likely to successfully complete the next stage, resulting in an ever-growing developmental debt. Think of it like a credit card that never gets fully paid off. Not only will you always have a balance due, but you’ll also get further and further behind each month.
Maintaining a playful approach is one way to meet our “in debt” clients where they’re at both emotionally and cognitively. Also, play and playfulness creates an environment that allows these teens to start paying off some of that debt. In other words, a playful approach provides opportunities for our clients to go backwards in order to catch up.
Activities from the Workshop
The following activities and exercises were part of the workshop: Chiji Mingle, Endless Loop, Chiji Zones, Mega Jenga, Gutter Ball, Brainstorm Posters (The Good, the Bad, and the Ugly), and Whack 'Em.
Further Reading
• The Art of Changing the Brain, by James Zull
• Changing for Good, by James Prochaska, John Norcross & Carlo DiClemente
• Elusive Alliance, edited by David Castro-Blanco & Marc Karver
• Interviewing for Solutions, by Peter de Jong & Insoo Kim Berg
• Motivational Interviewing, by William Miller & Stephen Rollnick
• Motivational Interviewing with Adolescents & Young Adults, by Sylvie Naar-King & Mariann Suarez
• Pathways to Change, by Matthew Selekman
• The Primal Teen, by Barbara Strauch
• Real Boys, by William Pollack
• Reviving Ophelia, by Mary Pipher
• What is Narrative Therapy?, by Alice Miller
Saturday, January 22, 2011
Association for Experiential Education's Northwest Regional Conference
I'm excited to be presenting two workshops at the upcoming Northwest Regional Conference of the Association for Experiential Education. The conference will be held March 25-27, 2011 at the 4H Center in Salem, Oregon.
Fun & Games in Clinical Settings
Come prepared to play, because this workshop is packed with games and activities for teens and older children in treatment groups. We’ll explore at least a dozen activities appropriate for a variety of clinical settings and treatment goals, such as building group cohesion, illustrating psychoeducational concepts, fostering emotion regulation, nurturing mindfulness, and more. This 3 hour workshop is part of a special conference-long Therapeutic Experiences strand.
Creating Connectedness
No matter what population you work with, connectedness is essential for building group cohesion and achieving the best possible outcomes. Lucky for us as facilitators, counselors, and group leaders, connectedness doesn’t need to be left to chance. It can be intentionally created. All we need to do is remember this formula: Connectedness = Fun + Trust. This workshop will be packed full of activities that bring this formula to life, including icebreakers and initiatives, frame drumming and spontaneous music making, and processing activities.
For more about the conference, go to www.aee.org and click on Conferences.
Fun & Games in Clinical Settings
Come prepared to play, because this workshop is packed with games and activities for teens and older children in treatment groups. We’ll explore at least a dozen activities appropriate for a variety of clinical settings and treatment goals, such as building group cohesion, illustrating psychoeducational concepts, fostering emotion regulation, nurturing mindfulness, and more. This 3 hour workshop is part of a special conference-long Therapeutic Experiences strand.
Creating Connectedness
No matter what population you work with, connectedness is essential for building group cohesion and achieving the best possible outcomes. Lucky for us as facilitators, counselors, and group leaders, connectedness doesn’t need to be left to chance. It can be intentionally created. All we need to do is remember this formula: Connectedness = Fun + Trust. This workshop will be packed full of activities that bring this formula to life, including icebreakers and initiatives, frame drumming and spontaneous music making, and processing activities.
For more about the conference, go to www.aee.org and click on Conferences.
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