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
