In my last post, I looked at cognitive scripts and the concept of stuckness. In this post, I’ll look more closely at how this concept is particularly relevant to youth with a history of trauma, abuse or neglect.
More than eight million American children suffer from serious, diagnosable trauma-related mental health problems (Perry & Szalavitz, p. 3); adolescents with impaired stress response systems resulting from long-term traumatic exposure are most likely to develop ongoing, significant drug problems (Perry & Szalavitz, p. 189) and other mental health problems (Perry & Szalavitz, p. 246). Additionally, surveys of adolescents receiving treatment for substance abuse found that more that 70% reported a history of trauma exposure, while other studies have found that 57% of adolescents in treatment come from homes where violence occurred frequently, and 40% reported being physically abused (Lawson & Lawson, p.176).
These statistics clearly show that there is a strong connection between substance abuse and a history of traumatic stress. In addition to substance abuse, adolescents with such histories often turn to a number of potentially destructive behaviors in an effort to avoid or defuse the intense negative emotions that accompany this traumatic stress. These behaviors often include engaging in risky sexual behaviors, self-mutilation, bingeing and purging, and suicidal behaviors. This serve to further traumatize these youth, reinforcing their already maladaptive cognitive scripts. Understanding the connection between substance abuse, trauma, and this cascade of chaos is important if we wish to assist our clients in moving forward.
Trauma in Early Childhood
As I’ve written before, nearly all my clients have predictable cognitive scripts. This is especially true with trauma survivors. When faced with even small life challenges, these youth predictably act up, shut down, or use. Hebb wrote, “…any two cells or systems of cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other” (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Perry and Szalavitz stated that repeated activation of the stress response system cleads to “a cascade of altered receptors, sensitivity, and dysfunction” (p. 24). In other words, over-activation of a system can result in becoming over-reactive, or they as described it “sensitized” (Perry & Szalavitz, p. 36). A common causation of this sensitized state is childhood neglect, abuse and other early childhood trauma. In these cases, that trauma becomes part of the individual's mental models. In other words, traumatic stress leads to the expectation of more traumatic stress, which becomes a self-fulfilling prophecy. After all, expecting stress is stressful all by itself.
When individuals exposed to childhood trauma move into adolescence, they face a new cascade of problems. These can include a higher incidence of mental health disorders, school-related concerns, placement in separate classes, and increased association with peers who exhibit similar maladaptive issues. This cascade of problems frequently results in youth with limited academic success, a continued escalation of behavioral problems, social marginalization, interactions with deviant peers, and a significantly increased likelihood of substance abuse. In addition, the neurobiological changes cataloged above increase the likelihood of developing anxiety disorders (Romer & Walker, p. 350) and substance-related problems (Romer & Walker, p. 446).
Simply put, not only are these youth stuck with maladaptive cognitive scripts, they are these stuck in a seemingly endless cascade of chaos. For these adolescents, school failure, negative peer relations, environmental stressors, mental health disorders, and substance abuse are all likely to co-evolve. An additional factor in this co-evolution is brain development. For an adolescent already suffering the negative impacts from early childhood trauma, the additional impact caused by these environmental problems would likely contribute to his cascade of problems.
A former client, “Andrew,” illustrates this. By the age of three, Andrew’s parents were both heroin dependent and the family lived in a car. It is reasonable to make two assumptions here. First, the environmental stressors caused by addicted parents and homelessness had already negatively impacted Andrew's brain development. Second, with both parents heroin dependent, Andrew likely had a genetic predisposition for addiction.
At age four, Andrew witnessed the death-by-overdose of both parents. With no relatives to provide care, he entered the foster care system. Between four and 15 he had over a dozen different placements. Andrew reported, “I moved around so much that I didn’t even unpack my suitcase.” Not surprisingly, his behavior became increasing problematic. He reported first use of alcohol at age 10 and first use of marijuana shortly thereafter. At 13 he went to detention for the first time. At 15, he ran away from the group home where he was living.
When I met Andrew, he was 16 years old and had just moved into a shelter after being homeless for almost a year. He reported two recent physical assaults and had mental health diagnoses that included PTSD, Conduct Disorder, ADHD and Major Depressive Disorder. He also had diagnoses for Alcohol Dependence, Cannabis Dependence, Opiate Abuse, and Amphetamine Abuse. In addition, Andrew exhibited difficulty remembering details, time frames, and other factual information. Andrew reported using because “it makes me feel normal,” even though he acknowledged amphetamines made him “jittery and paranoid.” With a blank look he continued, “I guess jittery and paranoid is my normal.”
Being Stuck
Working with teens that have co-occurring disorders, I see a lot of clients with a history of trauma. Like Andrew, these adolescents frequently appear to be stuck in an endless cascade of chaos. Here are two additional examples:
• “Carl” is 16 and a convicted felon for multiple car thefts. He suffered physical and emotional abuse from his father starting around age four. At age six his mother died. All three older brothers have drug problems; two of them are currently in jail. Carl has diagnoses of Cocaine Dependence, Cannabis Abuse, Alcohol Abuse and PTSD.
• “Melissa” is 15. She grew up subjected to significant neglect at the hands of her mentally ill mother and was sexually abused by several of her mother’s boyfriends. In addition to diagnoses of Amphetamine Dependence, Alcohol Abuse and Cannabis Abuse, Melissa has a history of disordered eating, suicidal ideation and self-harming behaviors.
Most of my clients don’t have histories as intense as Andrew, Carl or Melissa. however, the majority of them have experienced neglect, parental substance abuse, or other traumatic stress. In my experience, the more severe the history of trauma, the more likely the client will be using stimulants. Stimulants replicate trauma by releasing dopamine and noradrenaline, which are released during the hyper-arousal response. “Brain changes related to hyper-arousal may make some trauma victims more prone to stimulant addiction” (Perry & Szalavitz, p. 190). If this is so, then are these adolescents attempting to recreate the feeling of trauma from their pasts? This likely isn’t their overt intention. However, as Melissa said, “I only feel normal when I’m on meth.” Her brain has changed to make this hyper-arousal her normal state of being.
Melissa’s entire life has contributed to a trauma-focused development of her brain. By using meth, she artificially stimulates the production of those neurotransmitters that she has physically become accustomed to being present. For Melissa and others, perhaps the absence of stress-induced neurotransmitters should be considered a type of withdrawal. Perhaps, these youth are using stimulants to avoid withdrawal caused by a decrease in their accustomed levels of dopamine and noradrenaline caused by the past trauma.
Likewise, perhaps the extreme behavior many of these youth engage in—auto theft, prostitution, drug dealing, risky sex, graffiti, running away, assault, and more—is also a way to increase levels of dopamine and noradrenaline, thereby avoiding withdrawal from stress-related neurotransmitters.
For years I have referred to these clients as “chaos junkies”—a term these youth readily understand and frequently acknowledge as true—but always thought of this as a psychologically based behavioral pattern, a repeating of life strategies that had been modeled in chaotic family environments. Could there be something more happening here? Could these youth actually be physically addicted chaos? More accurately, could these youth be physically dependent upon the chemicals released as a result of the stress caused by their chaotic lifestyles and environments?
This isn’t true for all my clients, but I definitely believe some of them—such as Carl, Melissa and Andrew—are addicted to the cascades of chaos in their lives. If our goal as a substance abuse counselors is to help these adolescents create more adaptive cognitive scripts, then part of my work must to help them resolve their addictions to chaos.
In my experience, teens without a history of significant trauma do not typically identify stimulants as a drug of choice. They may have tried meth, crack or Ecstasy, but only in limited amounts. In fact, it seems to me that stimulant dependence or abuse in adolescents could be considered indicative of trauma. Unfortunately, for these youth, this sign—as well as others—is often missed. Andrew, Melissa, and Carl all came into treatment with long lists of diagnoses such as Conduct Disorder, Major Depressive Disorder, Bipolar Disorder, and Attention Deficient-Hyperactivity Disorder, among others.
While it is possible that those other issues might be present in some cases, without addressing their obvious trauma-laden histories that positive growth seems unlikely. Acknowledging, understanding and addressing the traumatic histories of these youth allows for the possibility of getting unstuck. First, though, it is important to further explore why these youth stay stuck.
Staying Stuck
Thus far, I’ve looked at traumatic experiences as causal pathway for substance abuse in adolescents. While this appears to be the primary causal pathway among adolescents and adult, it is possible for substance abuse to lead to trauma. For Melissa, prostitution helped pay for her expensive drug habit of meth and cocaine. It also led to multiple sexual assaults. For Carl, a severe lack of impulse control and untreated Attention Deficient-Hyperactivity Disorder was at the root of repeated auto thefts, high-speed car chases with the police, and stimulant dependence. It also led to repeated jail sentences. For Andrew, drug dealing supported his substance abuse. It also led to several physical assaults.
These high-risk behaviors clearly re-traumatize the youth. In other cases, such high-risk behavior could be the causation of the initial trauma. Either way, it is easy to see that these youth are stuck. As stated already, Andrew currently lives in a group home. This group home has a drug testing policy and continued use will result in him losing his placement. Yet, he continues to use. Some chemical dependency counselors would say Andrew is in denial, or maybe he’s resistant to treatment, but either way until he “hits his bottom” nobody will be able to help him.
I believe this assessment of Andrew is both simplistic and pessimistic, and so I offer a different analysis: Andrew is not resistant and he is not in denial. In fact, he readily acknowledges the problems in his life. But, he is stuck. His lifelong cascade of problems has impacted his brain’s architecture in ways that have shaped his behavior and determined his cognitive scripts. Andrew knows no responses to his world but acting up, shutting down or using. Furthermore, I believe his brain is not physically capable of making other choices. Helping Andrew become unstuck requires discovering ways to assist him create, practice and then apply more adaptive cognitive scripts.
Writing New Scripts
Evans and Sullivan wrote, “Survivors frequently have excellent artistic abilities, a reflection of their extensive use of right-hemisphere survival strategies” (p. 143). If this is true, then experiential learning—including initiatives, games, art therapy, music therapy, games, and other activities—could be a vital clinical approach for working with trauma survivors. Ross and Bernstein support this conclusion. They wrote, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd in Rose, p. 24).
Active, experiential learning achieves this goal by not only providing participants the opportunity to try new behaviors, but to also practice them in a safe, supportive environment. In addition, these interactive approaches provide opportunities to increase problem-solving skills, self-efficacy and openness to taking good risks, so that the participants are willing to implement these newly developed, more adaptive scripts.
For adolescents struggling with both substance abuse and traumatic stress, remaining stuck in chaos is a safe, tempting possibility. Melissa stated once, “When I smoke weed, all the bad feelings go away. I don’t want to cut. I don’t want to purge. As long as I’m high, everything seems okay.” As we’ve seen, substance-related disorders and traumatic stress are frequently an intricate, co-evolving, cascading series of obstacles. Helping youth get unstuck from this loop requires challenging these adolescents to risk developing new cognitive scripts.
Works Cited
Lawson, G. & Lawson, A. (1992). Adolescent Substance Abuse. Gaithersburg, ME: Aspen Publishing.
Perry, B. & Szalavitz, M. (2006). Boy Who Was Raised as a Dog, The. New York: Basic Books.
Romer, D. & Walker, E. (2007). Adolescent Psychopathology and the Developing Brain. New York: Oxford University Press.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Sunday, December 21, 2008
Saturday, December 6, 2008
Breaking the Cycle of Stuckness
As I’ve written before, my clients often have highly maladaptive cognitive scripts, routinely utilizing one of three cognitive scripts. They act up, shut down, or use mood-altering substances. While these responses might not seem especially effective to someone with more adaptive cognitive scripts, they are predictable and therefore safe. Rose wrote that most youth with multiple life problems—as is the case with nearly all my clients— “seem to have dedicated and rigid strategies for dealing with problems and are disinclined to look at other possibilities" (p. 177).
Looking at other possibilities requires a willingness to try something new, to step outside your Comfort Zone, to take risks. For youth who have had lives filled with unpredictability, even the most painful known option can feel less risky than any unknown one. “Steve,” a former client, summed this up when he said, “What I like the most about drugs is that I know what to expect. I smoke. I get high. No surprises.” For youth like Steve, there is an inherent reinforcement in a life of “no surprises.” Unlike many of other aspects of his life, he knows what to expect when he uses. And, that predictability is appealing.
However, a life of "no surprises" can lead to a cycle of stuckness. A basic tenet of brain development is that what fires together wires together. Through repetition of the same behavior, neuronal connections are created and then reinforced. Just like tying shoes becomes easier over time as a result of neurons wiring together, cognitive scripts also become hard wired in the brain. In other words, the maladaptive scripts of acting up, shutting down and using become part of the individual’s brain structure.
This means that Steve, like many youth, is cognitively stuck. His brain is hard wired to respond to life in maladaptive ways. Facilitating for change requires helping these youth break this cycle of stuckness. Experiential learning provides an effective methodology for doing this, because it “challenge[s] participants to update, refine, and alter mental programs when they emerge” (Luckner & Nadler, p. 36).
This updating, refining and altering can occur thanks to neuroplasticity, “the brain’s ability to physically change in response to stimuli and activity” (Romer & Walker, p. 484). It is “the ability of neurons to change the way they behave and relate to one another as the brain adapts to the environment through time” (Cozolino, p. 75). Neuroplasticity allows us to create new cognitive scripts.
Paula Tallal of Rutgers University stated, “You create your brain from the input you get” (qtd. in Begley, p. 105). It seems to me that it logically follows that that if you change the input, you would change the brain. Therapy or counseling provides an effective methodology for changing the input in a controlled and intentional manner. Cozolino supports this conclusion by writing, “[T]he therapeutic context may enhance the brain’s ability to rewire through concurrent emotional and cognitive processing. Successful therapeutic techniques may be successful because of their very ability to change brain chemistry in a manner that enhances neural plasticity” (p. 300).
“An enriched environment is one that is characterized by a level of stimulation and complexity that enhances learning and growth… [E]nriched environments can include the kinds of challenging educational and experiential opportunities that encourage us to learn new skills and expand our knowledge” (Cozolino, p. 22-23). A study conducted by the University of British Columbia helps to support the conclusion by Priest and Gass.
In this study, mice that were provided exercise wheels developed neurons that were “dramatically different” from sedentary mice. These exercise wheels provided the mice a more enriched environment, and in response their neurons had more dendrites, which are responsible for receiving signals from other neurons. This means the thinking patterns of these mice was more complex, more able to solve problems, and more able to engage in lasting learning (Begley, p. 69).
Cozolino suggests that any therapeutic approach will provide the enriched environment he describes. It seems to me, though, that experiential learning is particularly well suited for enhancing neuroplasticity. Experiential learning takes the "talk therapy" of other methodologies and puts that learning into action. Experiential learning tests what other methodologies often leave as "inert ideas" (Whitehead, qtd. in Zull, p. 206). According to Zull, "Action forces our mental constructs out of our brains and into the reality of the physical world" ( p. 206). Without that active testing, these new ideas are unlikely to ever be integrated into new behaviors. Active testing, then, is what allows us to rehearse new cognitive scripts.
Neuroplasticity in Action
Priest and Gass outlined six characteristics of experiential learning: the participant is provided a direct and purposeful experience, the participant is appropriately challenged, the participant is presented with opportunities for synthesis and reflection, the experience provides for natural consequences, the experience emphasizes participant-driven change, and the experience has both present and future relevance (p. 146-147).
All six of these characteristics are important to assure the most beneficial learning experience possible. However, it seems to me that for facilitators of experiential learning in clinical settings, focusing on participant-driven change is especially relevant. “Challenges that force us to expand our awareness, learn new information, or push beyond assumed limits can all change our brains” (Cozolino, p. 291).
Experiential learning regularly utilizes activities intended to push participants beyond their assumed limits, or to step outside their Comfort Zone. This provides participants the opportunity to test their assumptions and reject those they discover to be faulty. Because this testing is participant-driven, it is more developmentally appropriate for teens than more prescriptive counseling methodologies.
Zull wrote, “When we test our ideas, we are changing the abstract into the concrete. We convert our mental ideas into physical events” (p. 208). Converting mental ideas into physical events is exactly why experiential learning is an especially effective methodology for ending the cycle of stuckness. I would add, though, that once a mental construct has been forced into the physical world and discovered to be faulty, it is likely to be abandoned.
Rehearsing Change
As we have seen, experiential learning provides an effective method for testing and rejecting. Experiential learning provides two additional methods for helping end the cycle of stuckness. First, this methodology provides participants an opportunity to practice alternative behavioral choices. When used effectively and chosen for their relevance to the clinical work at hand, experiential learning allows youth like Steve to alter their cognitive scripts by putting new learning into practice in ways that will be memorable and concrete. In other words, experiential learning provides an opportunity to rehearse new scripts.
Second, experiential learning provides participants the opportunity to engage in healthy risk taking. For youth like Steve who prefer a life of no surprises, acting up, shutting down and using are so germane to their maladaptive scripts that these behaviors have become normalized. Thus, they are no longer perceived as risky.
In the Stages of Change model, these youth are pre-contemplative. Part of the appeal of pre-contemplation is that it feels safe (Prochaska, Norcross & DiClemente, p. 74). These youth often exhibit significant cognitive dissonance, perceiving high-risk situations as risk-free. This is, perhaps, the ultimate maladaptive script and part of their stuckness is their inability to see it. Helping them become unstuck requires helping them to reframe this dissonance, so that they move through the Stages of Change. Helping them become unstuck requires that they come to see risky behavior as risky.
Priest and Gass have cataloged significant affective gains from participation in experiential learning. These include new self-confidence, enhanced willingness to take good risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). These affective gains would be useful for anyone engaged in the change process, but they are particularly useful for someone stuck in pre-contemplation.
As illustrated, the use of experiential learning in clinical settings seems an obvious and valuable choice, leading to a “more enriched, complex, and potentially resilient brain” (Cozolino, p. 298). Experiential learning provides an excellent methodology for assuring this treatment outcome, by providing an “enriched environment to enhance brain development” (Cozolino, p. 291). These developments result in increased confidence and optimism regarding the ability to change. This is vital in helping assure that youth like Steve will actually utilize their new developed, more adaptive cognitive scripts.
“The concept of neuroplasticity suggests that the brain is highly malleable and is subject to continual change as a result of experience, so that new connections between neurons may be formed or even brand-new neurons generated” (The Dalai Lama, qtd. in Begley, p. 24). By providing rich opportunities to test assumptions, practice new behaviors, and engage in healthy risk taking, experiential learning inevitably enhances neuroplasticity, thereby leading to lasting changes in cognitive scripts. It is through this learning, rehearsing, and ultimate using of new, more adaptive cognitive scripts that youth like Steve can break their cycle of stuckness.
Works Cited
Begley, S. (2007). Train Your Mind, Change Your Brain. New York: Ballantine Books.
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S., & Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinestics.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Romer, D. & Walker, E. (2007). Adolescent Psychopathology and the Developing Brain. New York: Oxford University Press.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Looking at other possibilities requires a willingness to try something new, to step outside your Comfort Zone, to take risks. For youth who have had lives filled with unpredictability, even the most painful known option can feel less risky than any unknown one. “Steve,” a former client, summed this up when he said, “What I like the most about drugs is that I know what to expect. I smoke. I get high. No surprises.” For youth like Steve, there is an inherent reinforcement in a life of “no surprises.” Unlike many of other aspects of his life, he knows what to expect when he uses. And, that predictability is appealing.
However, a life of "no surprises" can lead to a cycle of stuckness. A basic tenet of brain development is that what fires together wires together. Through repetition of the same behavior, neuronal connections are created and then reinforced. Just like tying shoes becomes easier over time as a result of neurons wiring together, cognitive scripts also become hard wired in the brain. In other words, the maladaptive scripts of acting up, shutting down and using become part of the individual’s brain structure.
This means that Steve, like many youth, is cognitively stuck. His brain is hard wired to respond to life in maladaptive ways. Facilitating for change requires helping these youth break this cycle of stuckness. Experiential learning provides an effective methodology for doing this, because it “challenge[s] participants to update, refine, and alter mental programs when they emerge” (Luckner & Nadler, p. 36).
This updating, refining and altering can occur thanks to neuroplasticity, “the brain’s ability to physically change in response to stimuli and activity” (Romer & Walker, p. 484). It is “the ability of neurons to change the way they behave and relate to one another as the brain adapts to the environment through time” (Cozolino, p. 75). Neuroplasticity allows us to create new cognitive scripts.
Paula Tallal of Rutgers University stated, “You create your brain from the input you get” (qtd. in Begley, p. 105). It seems to me that it logically follows that that if you change the input, you would change the brain. Therapy or counseling provides an effective methodology for changing the input in a controlled and intentional manner. Cozolino supports this conclusion by writing, “[T]he therapeutic context may enhance the brain’s ability to rewire through concurrent emotional and cognitive processing. Successful therapeutic techniques may be successful because of their very ability to change brain chemistry in a manner that enhances neural plasticity” (p. 300).
“An enriched environment is one that is characterized by a level of stimulation and complexity that enhances learning and growth… [E]nriched environments can include the kinds of challenging educational and experiential opportunities that encourage us to learn new skills and expand our knowledge” (Cozolino, p. 22-23). A study conducted by the University of British Columbia helps to support the conclusion by Priest and Gass.
In this study, mice that were provided exercise wheels developed neurons that were “dramatically different” from sedentary mice. These exercise wheels provided the mice a more enriched environment, and in response their neurons had more dendrites, which are responsible for receiving signals from other neurons. This means the thinking patterns of these mice was more complex, more able to solve problems, and more able to engage in lasting learning (Begley, p. 69).
Cozolino suggests that any therapeutic approach will provide the enriched environment he describes. It seems to me, though, that experiential learning is particularly well suited for enhancing neuroplasticity. Experiential learning takes the "talk therapy" of other methodologies and puts that learning into action. Experiential learning tests what other methodologies often leave as "inert ideas" (Whitehead, qtd. in Zull, p. 206). According to Zull, "Action forces our mental constructs out of our brains and into the reality of the physical world" ( p. 206). Without that active testing, these new ideas are unlikely to ever be integrated into new behaviors. Active testing, then, is what allows us to rehearse new cognitive scripts.
Neuroplasticity in Action
Priest and Gass outlined six characteristics of experiential learning: the participant is provided a direct and purposeful experience, the participant is appropriately challenged, the participant is presented with opportunities for synthesis and reflection, the experience provides for natural consequences, the experience emphasizes participant-driven change, and the experience has both present and future relevance (p. 146-147).
All six of these characteristics are important to assure the most beneficial learning experience possible. However, it seems to me that for facilitators of experiential learning in clinical settings, focusing on participant-driven change is especially relevant. “Challenges that force us to expand our awareness, learn new information, or push beyond assumed limits can all change our brains” (Cozolino, p. 291).
Experiential learning regularly utilizes activities intended to push participants beyond their assumed limits, or to step outside their Comfort Zone. This provides participants the opportunity to test their assumptions and reject those they discover to be faulty. Because this testing is participant-driven, it is more developmentally appropriate for teens than more prescriptive counseling methodologies.
Zull wrote, “When we test our ideas, we are changing the abstract into the concrete. We convert our mental ideas into physical events” (p. 208). Converting mental ideas into physical events is exactly why experiential learning is an especially effective methodology for ending the cycle of stuckness. I would add, though, that once a mental construct has been forced into the physical world and discovered to be faulty, it is likely to be abandoned.
Rehearsing Change
As we have seen, experiential learning provides an effective method for testing and rejecting. Experiential learning provides two additional methods for helping end the cycle of stuckness. First, this methodology provides participants an opportunity to practice alternative behavioral choices. When used effectively and chosen for their relevance to the clinical work at hand, experiential learning allows youth like Steve to alter their cognitive scripts by putting new learning into practice in ways that will be memorable and concrete. In other words, experiential learning provides an opportunity to rehearse new scripts.
Second, experiential learning provides participants the opportunity to engage in healthy risk taking. For youth like Steve who prefer a life of no surprises, acting up, shutting down and using are so germane to their maladaptive scripts that these behaviors have become normalized. Thus, they are no longer perceived as risky.
In the Stages of Change model, these youth are pre-contemplative. Part of the appeal of pre-contemplation is that it feels safe (Prochaska, Norcross & DiClemente, p. 74). These youth often exhibit significant cognitive dissonance, perceiving high-risk situations as risk-free. This is, perhaps, the ultimate maladaptive script and part of their stuckness is their inability to see it. Helping them become unstuck requires helping them to reframe this dissonance, so that they move through the Stages of Change. Helping them become unstuck requires that they come to see risky behavior as risky.
Priest and Gass have cataloged significant affective gains from participation in experiential learning. These include new self-confidence, enhanced willingness to take good risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). These affective gains would be useful for anyone engaged in the change process, but they are particularly useful for someone stuck in pre-contemplation.
As illustrated, the use of experiential learning in clinical settings seems an obvious and valuable choice, leading to a “more enriched, complex, and potentially resilient brain” (Cozolino, p. 298). Experiential learning provides an excellent methodology for assuring this treatment outcome, by providing an “enriched environment to enhance brain development” (Cozolino, p. 291). These developments result in increased confidence and optimism regarding the ability to change. This is vital in helping assure that youth like Steve will actually utilize their new developed, more adaptive cognitive scripts.
“The concept of neuroplasticity suggests that the brain is highly malleable and is subject to continual change as a result of experience, so that new connections between neurons may be formed or even brand-new neurons generated” (The Dalai Lama, qtd. in Begley, p. 24). By providing rich opportunities to test assumptions, practice new behaviors, and engage in healthy risk taking, experiential learning inevitably enhances neuroplasticity, thereby leading to lasting changes in cognitive scripts. It is through this learning, rehearsing, and ultimate using of new, more adaptive cognitive scripts that youth like Steve can break their cycle of stuckness.
Works Cited
Begley, S. (2007). Train Your Mind, Change Your Brain. New York: Ballantine Books.
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S., & Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinestics.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Romer, D. & Walker, E. (2007). Adolescent Psychopathology and the Developing Brain. New York: Oxford University Press.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Tuesday, December 2, 2008
Readiness to Change
As I’ve previously written, I believe that making change is about resolving ambivalence. Miller and Rollnick wrote that when facilitating change in others, “It is useful in understanding a person’s ambivalence to know his or her perceptions of both importance and confidence” (p. 53). This balance between importance and confidence can be thought of as an individual’s readiness for change (Miller & Rollnick, p. 54).
Within the chemical dependency field, an individual’s readiness to change is given much important. Per standards set by the American Society of Addiction Medicine (ASAM), readiness to change has been identified as one of six areas, or dimensions, to be evaluated during an initial substance abuse assessment and to be re-evaluated during monthly updates.
As a drug/alcohol counselor, I clearly think a lot about readiness to change in others. Indeed, much of what I do as a clinician is really about helping clients to increase their readiness to change. However, it seems to me that this is presented as a vague concept within the ASAM assessment criteria. Basically, the more resistant an individual appears, the lower his readiness to change. However, if resistance truly is “an unhelpful idea that has handicapped therapists” (Selekman, p. 32), it seems unproductive to use it as a means of assessment. Worse, this pessimist mindset seems likely to keep the client stuck.
After all, if a client is resistant and therefore completely unwilling to engage in treatment, even the most skilled clinician would be left with no options. These clients sit in treatment for a while, refusing to engage, then get discharged for being non-compliant, not amiable to treatment, or unwilling to participate in their own recovery. Shame on them! Clients may not enter treatment resistant to the process, but they do sometimes leave that way. Or, as Seligman wrote, “Pessimistic prophecies are self-fulfilling” (p. 6).
Recently, I began working with “Michael.” Michael had been working with another clinician for about two months when he was referred to me. The clinician stated, “He doesn’t want to do any work and is completely unwilling to engage in treatment. I think he needs mental health services.” Michael’s attendance at group and individual sessions had been poor thus far, and the referring clinician stated that he was “adamant” about continuing to use marijuana and alcohol. The referring clinician also used that word resistant many, many times during our one conversation about this client.
The Process of Change
I believe a useful way to evaluate readiness to change is by assessing the individual’s Stage of Change. According to Stages of Change theory, lasting change is a process, with the individual moving through six distinct stages. These are pre-contemplation, contemplation, preparation, action, maintenance, and termination. Each stage “entails a series of tasks that need to be completed before progress to the next stage” (Prochaska, Norcross & DiClemente, p. 39). Sometimes, an individual returns to a prior stage in order to do more work. Within this model, that’s not a failure, just part of the process. In fact, I believe that recovery is an experiential process, and that relapse can be the most important part of that process.
Traditionally, most substance abuse programs assumed all clients entering treatment were in the action stage. To me, this is just absurd, especially when you consider that most clients—like Michael—are mandated in the first place. Perhaps resistance is really about this misfit of stages. If an individual is pre-contemplative and being treated as if he is ready to take action, wouldn’t he appear non-compliant, not amiable to treatment, and unwilling to engage? That certainly describes Michael. When I first met him, my perspective was a bit different than the referring clinician’s.
Michael was—and remains—a challenging client who tests boundaries, is likely to debate minor details, and always does the minimum required. However, he wasn’t resistant. Rather, he was stuck in pre-contemplation. Like anyone in pre-contemplation, Michael didn’t believe he had a problem. Since he didn’t have a problem, why should he change anything? And, the more people pushed him to take action, the less likely it would happen.
Miller and Rollnick wrote, “ When the idea of change or treatment is forced on an unwilling recipient it is not uncommon for the individual to engage in the problem behavior to a greater extent in an attempt to assert his or her freedom” (p. 337). According to the referring clinician, Michael’s using had increased since starting treatment. In fact, the referring clinician offered this information as proof of Michael’s resistance.
If Michael was actually stuck in pre-contemplation, my efforts shouldn't be to get him to take action. My efforts should be to help him get unstuck. Prochaska, Norcross and DiClemente have identified specific tasks for each Stage of Change. I have found these stage-specific tasks to be useful when working with clients. I've also found that the Stages of Change model and motivational interviewing have much in common. In fact, Miller and Rollnick wrote, “[M]otivational interviewing can be used to assist individuals to accomplish the various tasks required to transition form the pre-contemplation stage through the maintenance stage” (p. 202). Employing basic motivational interviewing principles when doing Stages of Change work seems a natural choice.
Miller and Rollnick identified four general principles for motivational interviewing. These are express empathy, develop discrepancy, roll with resistance, and support self-efficacy (p. 36). Especially when combined with stage-specific tasks, these principles are highly effective in helping clients move through the Stages of Change (Miller & Rollnick, p. 203). And, when the clients are successful, they are also developing the confidence to continue their change process.
The Confidence to Change
Miller and Rollnick wrote, “Readiness [to change] implies at least some degree of both importance and confidence. A person who does not see change as important is unlikely to be ready to change. Similarly, people who see change as impossible are unlikely to say they are ready to do it” (p. 54). Initially, Michael didn’t see change as important, but he also had doubts about his ability to make meaningful change.
I proposed two goals for Michael. First, address the tasks of pre-contemplation so he could start making some movement on the Stages of Change. Second, increase his sense of self-efficacy and thereby improve his optimism. When I presented this plan to Michael, his only response was, “Whatever. As long as I don’t get my probation revoked.” That lead to a third goal for Michael: do what is necessary to stay out of detention, which meant attending weekly individual sessions with me and having clear UAs.
Michael was reluctant to stop his use, but agreed to this plan because, in his words, “I’ll go to detention if I don’t.” I’ve only been working with this client for a short time, but clear progress has already occurred. Michael has been present at all his scheduled appointments. He's also making reasonable progress on pre-contemplation tasks. In our last appointment, he stated, “I don’t think I’ve got a problem using, but everyone else does, and that’s a problem, I guess. ” This may not sound like progress to some. I’m sure it wouldn’t to that referring clinician. To me, though, it clearly represents signs of becoming unstuck.
Instead of the pessimism of resistance, a new perspective is offered by the combination of the Stages of Change model and motivational interviewing: Even the most reluctant clients are simply working on the tasks of their current stage. Thought of this way, the job of a professional helper is reframed from the thankless task of overcoming resistance to that of assisting clients to increase their readiness to change.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Seligman, M. (1990). Learned Optimism. New York: Random House.
Within the chemical dependency field, an individual’s readiness to change is given much important. Per standards set by the American Society of Addiction Medicine (ASAM), readiness to change has been identified as one of six areas, or dimensions, to be evaluated during an initial substance abuse assessment and to be re-evaluated during monthly updates.
As a drug/alcohol counselor, I clearly think a lot about readiness to change in others. Indeed, much of what I do as a clinician is really about helping clients to increase their readiness to change. However, it seems to me that this is presented as a vague concept within the ASAM assessment criteria. Basically, the more resistant an individual appears, the lower his readiness to change. However, if resistance truly is “an unhelpful idea that has handicapped therapists” (Selekman, p. 32), it seems unproductive to use it as a means of assessment. Worse, this pessimist mindset seems likely to keep the client stuck.
After all, if a client is resistant and therefore completely unwilling to engage in treatment, even the most skilled clinician would be left with no options. These clients sit in treatment for a while, refusing to engage, then get discharged for being non-compliant, not amiable to treatment, or unwilling to participate in their own recovery. Shame on them! Clients may not enter treatment resistant to the process, but they do sometimes leave that way. Or, as Seligman wrote, “Pessimistic prophecies are self-fulfilling” (p. 6).
Recently, I began working with “Michael.” Michael had been working with another clinician for about two months when he was referred to me. The clinician stated, “He doesn’t want to do any work and is completely unwilling to engage in treatment. I think he needs mental health services.” Michael’s attendance at group and individual sessions had been poor thus far, and the referring clinician stated that he was “adamant” about continuing to use marijuana and alcohol. The referring clinician also used that word resistant many, many times during our one conversation about this client.
The Process of Change
I believe a useful way to evaluate readiness to change is by assessing the individual’s Stage of Change. According to Stages of Change theory, lasting change is a process, with the individual moving through six distinct stages. These are pre-contemplation, contemplation, preparation, action, maintenance, and termination. Each stage “entails a series of tasks that need to be completed before progress to the next stage” (Prochaska, Norcross & DiClemente, p. 39). Sometimes, an individual returns to a prior stage in order to do more work. Within this model, that’s not a failure, just part of the process. In fact, I believe that recovery is an experiential process, and that relapse can be the most important part of that process.
Traditionally, most substance abuse programs assumed all clients entering treatment were in the action stage. To me, this is just absurd, especially when you consider that most clients—like Michael—are mandated in the first place. Perhaps resistance is really about this misfit of stages. If an individual is pre-contemplative and being treated as if he is ready to take action, wouldn’t he appear non-compliant, not amiable to treatment, and unwilling to engage? That certainly describes Michael. When I first met him, my perspective was a bit different than the referring clinician’s.
Michael was—and remains—a challenging client who tests boundaries, is likely to debate minor details, and always does the minimum required. However, he wasn’t resistant. Rather, he was stuck in pre-contemplation. Like anyone in pre-contemplation, Michael didn’t believe he had a problem. Since he didn’t have a problem, why should he change anything? And, the more people pushed him to take action, the less likely it would happen.
Miller and Rollnick wrote, “ When the idea of change or treatment is forced on an unwilling recipient it is not uncommon for the individual to engage in the problem behavior to a greater extent in an attempt to assert his or her freedom” (p. 337). According to the referring clinician, Michael’s using had increased since starting treatment. In fact, the referring clinician offered this information as proof of Michael’s resistance.
If Michael was actually stuck in pre-contemplation, my efforts shouldn't be to get him to take action. My efforts should be to help him get unstuck. Prochaska, Norcross and DiClemente have identified specific tasks for each Stage of Change. I have found these stage-specific tasks to be useful when working with clients. I've also found that the Stages of Change model and motivational interviewing have much in common. In fact, Miller and Rollnick wrote, “[M]otivational interviewing can be used to assist individuals to accomplish the various tasks required to transition form the pre-contemplation stage through the maintenance stage” (p. 202). Employing basic motivational interviewing principles when doing Stages of Change work seems a natural choice.
Miller and Rollnick identified four general principles for motivational interviewing. These are express empathy, develop discrepancy, roll with resistance, and support self-efficacy (p. 36). Especially when combined with stage-specific tasks, these principles are highly effective in helping clients move through the Stages of Change (Miller & Rollnick, p. 203). And, when the clients are successful, they are also developing the confidence to continue their change process.
The Confidence to Change
Miller and Rollnick wrote, “Readiness [to change] implies at least some degree of both importance and confidence. A person who does not see change as important is unlikely to be ready to change. Similarly, people who see change as impossible are unlikely to say they are ready to do it” (p. 54). Initially, Michael didn’t see change as important, but he also had doubts about his ability to make meaningful change.
I proposed two goals for Michael. First, address the tasks of pre-contemplation so he could start making some movement on the Stages of Change. Second, increase his sense of self-efficacy and thereby improve his optimism. When I presented this plan to Michael, his only response was, “Whatever. As long as I don’t get my probation revoked.” That lead to a third goal for Michael: do what is necessary to stay out of detention, which meant attending weekly individual sessions with me and having clear UAs.
Michael was reluctant to stop his use, but agreed to this plan because, in his words, “I’ll go to detention if I don’t.” I’ve only been working with this client for a short time, but clear progress has already occurred. Michael has been present at all his scheduled appointments. He's also making reasonable progress on pre-contemplation tasks. In our last appointment, he stated, “I don’t think I’ve got a problem using, but everyone else does, and that’s a problem, I guess. ” This may not sound like progress to some. I’m sure it wouldn’t to that referring clinician. To me, though, it clearly represents signs of becoming unstuck.
Instead of the pessimism of resistance, a new perspective is offered by the combination of the Stages of Change model and motivational interviewing: Even the most reluctant clients are simply working on the tasks of their current stage. Thought of this way, the job of a professional helper is reframed from the thankless task of overcoming resistance to that of assisting clients to increase their readiness to change.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Seligman, M. (1990). Learned Optimism. New York: Random House.
Saturday, November 15, 2008
Beyond Resistance
It is common in substance abuse treatment to hear clinicians label clients as resistant, meaning the individual is unmotivated to participate in the treatment process. Over the last year of so, I’ve been thinking a lot about the idea of resistance within teens. The more I think about this, the more I've come to believe that resistance is extremely rare in teens, if not in all client populations.
It seems to me that resistance is an easy answer to explain away non-engagement by clients, providing an easy excuse to not make further efforts at engagement. Selekman wrote, “The traditional psychotherapeutic concept of resistance is an unhelpful idea that has handicapped therapists” (p. 32). Motivational interviewing provides many useful ideas for moving beyond the easy excuse provided by labeling a client as resistant. According to Miller and Rollnick, motivational interviewing is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (p. 25).
In my experience, most teens are not resistant. They are ambivalent. Indeed, most of the clients I’ve worked with have held as absolute fact two seemingly incongruent thoughts: 1.) I have a problem; and, 2.) I don’t want to do anything about my problem. Its worth noting that my clients rarely define their problems the way I do, at least not initially, but that doesn't mean they believe themselves to be problem-less. It also doesn't mean they are resistant.
From my perspective as a clinician, my clients have problems stemming from drug use, truancy, illegal behavior, mental health challenges, and family dysfunction. Rarely are these the problems my clients initially identify, though. Many of my clients reluctantly enter treatment with only one self-identified problem, being on probation or an at-risk youth petition, and only one self-identified goal, avoiding detention. It would be easy to dismiss these youth as resistant. After all, they don't agree with me, the professional. In fact, though, not agreeing with me probably shouldn’t be considered pathological.
Miller and Rollnick wrote, “Understanding the dynamics of ambivalence… provides an alternative to thinking of people as (and blaming them for being) ‘unmotivated.’ People are always motivated for something” (p. 18). Avoiding detention—the sole initial motivation with many of my clients—is an extremely concrete goal and an excellent place to begin. It is easy to develop discrepancy with these youth, a key principle of motivational interviewing (Miller & Rollnick, p. 37). This principle requires that the helper “create and amplify, from the client’s perspective, a discrepancy between present behavior and his or her broader goals and values” (Miller & Rollnick, p. 38).
“If we want to help people learn, we should not worry about how we can motivate them but try to identify what already is motivating them” (Zull, p. 53). For teens on probation or an at-risk youth petition, continued use of alcohol and other drugs will lead to a violation that could send them to detention. Staying out of detention—their self-defined goal—requires clean UAs and attendance at treatment. When I talk about this with a client, I’m not telling him to stop using alcohol and other drugs. Instead, I’m being collaborative and helping him solve his problem as he defined it. Sure, the client is doing what I hoped for, but he's doing he for his reasons, not mine.
The threat of detention may not motivate a youth to change her behavior, but it is usually sufficiently motivating to start the process. Once this process has begun, “the overall goal is to increase intrinsic motivation, so that change arises from within rather than being imposed from without and so that change serves the person’s own goals and values” (Miller & Rollnick, p. 34).
Mental Logjams
Many of my clients are adequately motivated by extrinsic rewards to start the change process. However, for a client who simultaneously hold as true “I have a problem” and “I don’t want to do anything about my problem,” the mental logjam created from these incongruent beliefs can serve to reinforce his maladaptive cognitive scripts, encouraging him to remain stuck. After all, resolving this discrepancy will be hard and brains are lazy. They’d rather continue to use the same ol’ well-rehearsed scripts. Those brains would rather continue to Act Up, Shut Down, or Use.
When lazy brains do what lazy brains do, it may appear to be resistance or a lack of motivation. However, it seems to me that this is really just basic neuroscience in action. What fires together wires together, and then wants to keep firing that way. Getting unstuck requires getting lazy brains to do something different; that requires overcoming an apparent lack of motivation. Miller and Rollnick wrote that lack of motivation “can be thought of as unresolved ambivalence. To explore ambivalence is to work at the heart of the problem of being stuck” (p. 14).
In my experience, professional helpers often do their work only on the “I have a problem” side of ambivalence. I believe this is ineffective for two reasons. First, as discussed above, my clients already know they have a problem. They don’t need me to repeatedly tell them that. If anything, doing so is invalidating and reaffirms their apparent inability to be effective or make change. In fact, it would seem to me that repeatedly telling a client she has a problem contributes to keeping her stuck.
The second reason working on the “I have a problem” side is ineffective is that it is developmentally inappropriate with adolescents. Lectures don’t persuade teens. Neither does forcing compliance to a pre-determined solution they had no input on. Adolescents are supposed to question, rebel against, and ultimately resist the plans authority figures. Most professional helpers may be reluctant to view themselves as authority figures, but our clients never forget it.
“The theory of psychological reactance predicts an increase in the rate and attractiveness of a ‘problem’ behavior if a person perceives that his or her personal freedom is being infringed or challenged” (Miller & Rollnick, p. 18). If I tell my clients to stop using alcohol and other drugs, I may be increasing the likelihood of them continuing their use! That's true for any client, child, adolescent, or adult. However, as an unavoidably authoritarian figure working with adolescents who are supposed to rebel against what I say, this is magnified. So, not only does telling a client he has a problem contributes to keeping him stuck, so does telling him what to do about his problem.
Reframing Resistance
I started this post by stating that resistance meant that the individual is not amiable to treatment. Miller and Rollnick propose a different definition for resistance, “movement away from change” (p.47). Forced compliance doesn’t lead to change, but as we’ve seen above it may lead to movement away from change.
With mandated clients, I could create a pressure cooker situation that forced them into compliance, and I’ve seen counselors, parents, and probation officers take this approach. However, it is vital to avoid this sort of taking sides. “If the counselor argues for one side of the conflict, it is natural for the client to give voice to the other side… Hearing themselves vigorously arguing that they don’t have a problem and don’t need to change, they become convinced” (p. 56-57).
One way to avoid taking sides is to externalize the problem (Selekman, p. 93). This therapeutic strategy involves talking about the problem as if it was a separate being from the client, complete with sentience and decision-making abilities. About two years ago, when I initially read Selekman, I started externalizing ambivalence when working with reluctant clients. Inspired by a treatment-oriented board game, I began talking about Addictive Voices and Rational Voices. I’ve integrated the Voices throughout my groups—including role plays, art activities, the board game, and experiential activities—and I’ve found my clients readily embrace this concept.
In both individual and group sessions, I often assume the role of a client’s Addictive Voice, leaving the Rational Voice to the client. According to Miller and Rollnick, “If taking up one side of the argument causes an ambivalent person to defend the other, then the process ought to work both ways… By the nature of ambivalence, when the counselor raises only one side the client is inclined to explore the other” (p. 107).
In my experience, even the most ambivalent client is able to effectively speak for her Rational Voice. According to Miller and Rollnick, this is exactly the goal of motivational interviewing—for the client to “present the arguments for change” (p. 76). In doing so, the client can begin the process of breaking through the mental logjam caused by ambivalence.
Mandates may bring clients into treatment, but they don’t lead to lasting change. Motivational interviewing “focuses on intrinsic motivation for change, even with those who initially come for counseling as a direct result of extrinsic pressure” (Miller & Rollnick, p. 26). Looking beyond the simple answer of resistance is vital if this process is to occur.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
It seems to me that resistance is an easy answer to explain away non-engagement by clients, providing an easy excuse to not make further efforts at engagement. Selekman wrote, “The traditional psychotherapeutic concept of resistance is an unhelpful idea that has handicapped therapists” (p. 32). Motivational interviewing provides many useful ideas for moving beyond the easy excuse provided by labeling a client as resistant. According to Miller and Rollnick, motivational interviewing is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (p. 25).
In my experience, most teens are not resistant. They are ambivalent. Indeed, most of the clients I’ve worked with have held as absolute fact two seemingly incongruent thoughts: 1.) I have a problem; and, 2.) I don’t want to do anything about my problem. Its worth noting that my clients rarely define their problems the way I do, at least not initially, but that doesn't mean they believe themselves to be problem-less. It also doesn't mean they are resistant.
From my perspective as a clinician, my clients have problems stemming from drug use, truancy, illegal behavior, mental health challenges, and family dysfunction. Rarely are these the problems my clients initially identify, though. Many of my clients reluctantly enter treatment with only one self-identified problem, being on probation or an at-risk youth petition, and only one self-identified goal, avoiding detention. It would be easy to dismiss these youth as resistant. After all, they don't agree with me, the professional. In fact, though, not agreeing with me probably shouldn’t be considered pathological.
Miller and Rollnick wrote, “Understanding the dynamics of ambivalence… provides an alternative to thinking of people as (and blaming them for being) ‘unmotivated.’ People are always motivated for something” (p. 18). Avoiding detention—the sole initial motivation with many of my clients—is an extremely concrete goal and an excellent place to begin. It is easy to develop discrepancy with these youth, a key principle of motivational interviewing (Miller & Rollnick, p. 37). This principle requires that the helper “create and amplify, from the client’s perspective, a discrepancy between present behavior and his or her broader goals and values” (Miller & Rollnick, p. 38).
“If we want to help people learn, we should not worry about how we can motivate them but try to identify what already is motivating them” (Zull, p. 53). For teens on probation or an at-risk youth petition, continued use of alcohol and other drugs will lead to a violation that could send them to detention. Staying out of detention—their self-defined goal—requires clean UAs and attendance at treatment. When I talk about this with a client, I’m not telling him to stop using alcohol and other drugs. Instead, I’m being collaborative and helping him solve his problem as he defined it. Sure, the client is doing what I hoped for, but he's doing he for his reasons, not mine.
The threat of detention may not motivate a youth to change her behavior, but it is usually sufficiently motivating to start the process. Once this process has begun, “the overall goal is to increase intrinsic motivation, so that change arises from within rather than being imposed from without and so that change serves the person’s own goals and values” (Miller & Rollnick, p. 34).
Mental Logjams
Many of my clients are adequately motivated by extrinsic rewards to start the change process. However, for a client who simultaneously hold as true “I have a problem” and “I don’t want to do anything about my problem,” the mental logjam created from these incongruent beliefs can serve to reinforce his maladaptive cognitive scripts, encouraging him to remain stuck. After all, resolving this discrepancy will be hard and brains are lazy. They’d rather continue to use the same ol’ well-rehearsed scripts. Those brains would rather continue to Act Up, Shut Down, or Use.
When lazy brains do what lazy brains do, it may appear to be resistance or a lack of motivation. However, it seems to me that this is really just basic neuroscience in action. What fires together wires together, and then wants to keep firing that way. Getting unstuck requires getting lazy brains to do something different; that requires overcoming an apparent lack of motivation. Miller and Rollnick wrote that lack of motivation “can be thought of as unresolved ambivalence. To explore ambivalence is to work at the heart of the problem of being stuck” (p. 14).
In my experience, professional helpers often do their work only on the “I have a problem” side of ambivalence. I believe this is ineffective for two reasons. First, as discussed above, my clients already know they have a problem. They don’t need me to repeatedly tell them that. If anything, doing so is invalidating and reaffirms their apparent inability to be effective or make change. In fact, it would seem to me that repeatedly telling a client she has a problem contributes to keeping her stuck.
The second reason working on the “I have a problem” side is ineffective is that it is developmentally inappropriate with adolescents. Lectures don’t persuade teens. Neither does forcing compliance to a pre-determined solution they had no input on. Adolescents are supposed to question, rebel against, and ultimately resist the plans authority figures. Most professional helpers may be reluctant to view themselves as authority figures, but our clients never forget it.
“The theory of psychological reactance predicts an increase in the rate and attractiveness of a ‘problem’ behavior if a person perceives that his or her personal freedom is being infringed or challenged” (Miller & Rollnick, p. 18). If I tell my clients to stop using alcohol and other drugs, I may be increasing the likelihood of them continuing their use! That's true for any client, child, adolescent, or adult. However, as an unavoidably authoritarian figure working with adolescents who are supposed to rebel against what I say, this is magnified. So, not only does telling a client he has a problem contributes to keeping him stuck, so does telling him what to do about his problem.
Reframing Resistance
I started this post by stating that resistance meant that the individual is not amiable to treatment. Miller and Rollnick propose a different definition for resistance, “movement away from change” (p.47). Forced compliance doesn’t lead to change, but as we’ve seen above it may lead to movement away from change.
With mandated clients, I could create a pressure cooker situation that forced them into compliance, and I’ve seen counselors, parents, and probation officers take this approach. However, it is vital to avoid this sort of taking sides. “If the counselor argues for one side of the conflict, it is natural for the client to give voice to the other side… Hearing themselves vigorously arguing that they don’t have a problem and don’t need to change, they become convinced” (p. 56-57).
One way to avoid taking sides is to externalize the problem (Selekman, p. 93). This therapeutic strategy involves talking about the problem as if it was a separate being from the client, complete with sentience and decision-making abilities. About two years ago, when I initially read Selekman, I started externalizing ambivalence when working with reluctant clients. Inspired by a treatment-oriented board game, I began talking about Addictive Voices and Rational Voices. I’ve integrated the Voices throughout my groups—including role plays, art activities, the board game, and experiential activities—and I’ve found my clients readily embrace this concept.
In both individual and group sessions, I often assume the role of a client’s Addictive Voice, leaving the Rational Voice to the client. According to Miller and Rollnick, “If taking up one side of the argument causes an ambivalent person to defend the other, then the process ought to work both ways… By the nature of ambivalence, when the counselor raises only one side the client is inclined to explore the other” (p. 107).
In my experience, even the most ambivalent client is able to effectively speak for her Rational Voice. According to Miller and Rollnick, this is exactly the goal of motivational interviewing—for the client to “present the arguments for change” (p. 76). In doing so, the client can begin the process of breaking through the mental logjam caused by ambivalence.
Mandates may bring clients into treatment, but they don’t lead to lasting change. Motivational interviewing “focuses on intrinsic motivation for change, even with those who initially come for counseling as a direct result of extrinsic pressure” (Miller & Rollnick, p. 26). Looking beyond the simple answer of resistance is vital if this process is to occur.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Sunday, November 2, 2008
Experiential Activities In Clinical Settings
The more I explore ideas about facilitating change, the more I come to see my job as a substance abuse counselor as helping my clients become unstuck by providing them the opportunities to write new cognitive scripts, rather than simply getting them to stop using alcohol and other drugs. It seems to me that our job as counselors and therapists is not to eliminate those old cognitive scripts, but to help them discover new, more adaptive possibilities.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Saturday, October 25, 2008
Getting Unstuck
According to the Yale Medical School web site, cognitive script is "the term used for the themes that flow habitually through our thoughts. These cognitive scripts can influence both our emotions and our behavior. They have been described as the tapes we play repeatedly in our heads—those things we tell ourselves over and over again, often without conscious awareness."
In my experience, substance-abusing teens generally have three basic cognitive scripts: act up, shut down, and use. With such limited options, these youth are stuck continuously rerunning these same maladaptive scripts, perpetuating already internalized beliefs that they are ineffective, incapable, and unable to make more adaptive choices.
Every time a youth uses the same maladaptive script, it becomes more likely that he will use it again. This is basic neuroscience. Hebb wrote, “[A]ny two cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other" (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Cognitive scripts are learned. For an individual who experienced a positive childhood environment, her scripts will be adaptive and flexible. However, when a youth has only maladaptive scripts, eventually acting up, shutting down, and using can become so normalized that these scripts are no longer seen as problematic.
“Jennifer,” a former client, had a history of running away, shoplifting, and abusing marijuana. When I worked with her, she was on her third treatment episode. Jennifer lived in a group home with a drug testing policy and continued use would result in her losing her placement. Yet, she continued to use. Some drug counselors would say she was in denial or resistant to treatment. This seems overly simplistic to me. Jennifer couldn’t be successful because she had no mental model of success. All Jennifer knew was acting up, shutting down, and using. All Jennifer knew was being stuck.
If creating change in our clients is about helping them write new, more adaptive scripts, how do we make that happen? I’ve always believed the answer is not to provide endless didactic lectures. Rather, the answer is to present clients opportunities to try new behaviors. As they practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other words, they are starting to get unstuck.
Beyond the Comfort Zone
In my experience, substance-abusing teens and other at-risk youth continue to engage in maladaptive behaviors until they break their cycle of stuckness. If this is true, then it seems to me that the goal of substance abuse treatment should be to help clients create new, more adaptive cognitive scripts. It seems to me that the first step in this process is encouraging participants to risk going outside their Comfort Zones.
There's a paradox among many of my clients. While they have done things I consider extremely high risk—like getting high on drugs acquired from a stranger who is inherently a criminal, exchanging sex for drugs, or stealing to support their habit—they almost universally present as risk-adverse. I'm frequently perplexed by how to confront this Risk Dichotomy, which my clients are usually unable to recognize. It seems those things have become so normalized to them that they are no longer perceived as risky.
For these clients, staying stuck seems safe. Acting up, shutting down, and using are solidly within their Comfort Zones, so don't seem like risky behavior. This cycle keeps the youth stuck—and every time this cycle repeats itself, it becomes more likely the youth will stay stuck. What fires together wires together. That's basic neuroscience. And, every time that happens it becomes more likely to happen again.
Getting unstuck requires the individual to step outside her Comfort Zone and experiment with new behaviors. This is much riskier—not to mention harder—than sticking with rigid, predictable responses. However, it is only through trying new behaviors that the individual will have the opportunity to develop more adaptive cognitive scripts.
Through participation in experiences that move them outside their Comfort Zones, experiential learning provides substance-abusing teens an opportunity to test their assumptions and reject those they discover to be faulty. It seems to me that this testing and rejecting is vital for movement through the Stages of Change, especially those stages most likely to be encountered in a treatment setting—pre-contemplation, contemplation, and preparation.
For a pre-contemplative client, testing and rejecting “increases the likelihood of serious consideration of change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting fosters the likelihood of “a considered evaluation that leads to a decision to change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting increases self-efficacy and can result in “an action plan that will be implemented in the near term” (DiClemente, p. 27).
You’re Freaking Me Out!
If opportunities to test and reject assumptions are necessary for movement through the Stages of Change, so, too, is some discomfort. According to Cozolino, “[M]oderate stress triggers the release of neurohormones that enhance cortical reorganization and new learning” (p. 24). In addition, Zull wrote, “Plasticity in the brain probably depends more on signals from the emotional centers than it does on new sensory input” (p. 223).
In other words, it is emotions—especially stress—that make our brains learn and change. Experiential learning is an excellent methodology for creating this change environment. In most experiential activities, there is a high level of perceived risk. In some cases, such as white water rafting or high ropes activities, this perceived risk is physical. In other cases, this perceived risk could be emotional or social.
Whether physical, emotional, or social, the perception of risk in experiential activities will likely result in a sense of disequilibrium. According to Luckner and Nadler, “Disequilibrium refers to an individual’s awareness that a mismatch exists between old ways of thinking and new information” (p. 19). "Vincent," a former client, provided an example of disequilibrium during a group activity.
I talk about appropriate risk-taking frequently during group sessions, and often use an activity called Pass the Mousetraps to illustrate this idea. As the title suggests, this activity involves passing around set mousetraps. Actually, this activity also includes tripping mousetraps with hands.
Although completely safe when certain parameters are followed, this activity appears to be fairly risky. In fact, while sitting in a room filled with teens tripping mousetraps, Vincent, a former client, blurted, “You’re freaking me out!” and quickly left the room. For Vincent, the perceived risk was simply too high, even after my extremely detailed safety directions prior to the activity.
Watching his group-mates trip mousetraps with their hands created too strong of a mismatch for Vincent. He believed this to be extremely dangerous behavior, yet nobody was being injured. Unable to revise his thinking quickly enough to reflect the reality of the situation, Vincent had no choice but to flee. Later, Vincent stated, “I left because I was sure someone was going to get hurt. And I couldn’t figure out why that wasn’t happening.” Vincent wasn't worried someone might get hurt; he was upset because what he expected to happen didn't.
With all my clients, disequilibrium appears when acting up, shutting down, and using become no longer effective. When faced with this scenario, a participant is confronted with one of two choices: assimilation or accommodation. According to Piaget’s developmental theory, when presented with new information an individual tries to assimilate it, or fit it into his existing understanding of the world. If this is impossible, the individual is forced to accommodate the new information by altering his schema, or mental models (Kassin, p. 343). When presented with an experience that requires accommodation, an individual is forced to alter his cognitive scripts.
Experiential learning is rich in these opportunities. Marie—the client discussed in my earlier posting Reflecting on Reflection—and her experience on the hike is a good example. Marie was confronted with two choices. She could give up by sitting on the side of the mountain and refusing to continue the hike, or she could resume the hike even though it was difficult and clearly outside her Comfort Zone. When Marie chose to continue the hike, she was required to accommodate this new option and alter her cognitive scripts.
I believe that these opportunities are one of the major values of experiential learning in treatment setting. Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in many experiential activities], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18). It seems to me that by definition, insurmountable tasks only exist outside one’s Comfort Zone. Perhaps, then, taking the risk of tackling an insurmountable task means a participant will automatically be more open to becoming unstuck.
For Marie, an insurmountable task was accomplished and the change was almost immediate. In Vincent’s case, he never tripped a mousetrap with his bare hand, but he did confront a powerful mismatch. What he expected didn’t happen and to accommodate that new experience, he needed to alter his cognitive scripts.
So, what does being slightly less afraid of a mousetrap has to do with sobriety? As a result of his experience that day, Vincent discovered that mousetraps aren’t inherently dangerous after all. This new learning required him to rearrange information in ways that formed new neural networks based on actively testing and rejecting an outdated belief. And, perhaps, with that was born a new perspective: There are possibilities other than those you’ve always believed to be true. Experiential learning helps participants become unstuck by helping them create new, more adaptive cognitive scripts and helping them discover those other possibilities.
Works Cited
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
DiClemente, C. (2003). Addiction and Change. New York: Guilford Press.
Kassin, S. (2004). Essentials of Psychology. Upper Saddle River, NJ: Prentice-Hall.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Yale Medical School. (n.d.). Glossary. Retrieved October 22, 2008, from
http://info.med.yale.edu/psych/3s/glossary_items/cog_script.html
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
In my experience, substance-abusing teens generally have three basic cognitive scripts: act up, shut down, and use. With such limited options, these youth are stuck continuously rerunning these same maladaptive scripts, perpetuating already internalized beliefs that they are ineffective, incapable, and unable to make more adaptive choices.
Every time a youth uses the same maladaptive script, it becomes more likely that he will use it again. This is basic neuroscience. Hebb wrote, “[A]ny two cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other" (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Cognitive scripts are learned. For an individual who experienced a positive childhood environment, her scripts will be adaptive and flexible. However, when a youth has only maladaptive scripts, eventually acting up, shutting down, and using can become so normalized that these scripts are no longer seen as problematic.
“Jennifer,” a former client, had a history of running away, shoplifting, and abusing marijuana. When I worked with her, she was on her third treatment episode. Jennifer lived in a group home with a drug testing policy and continued use would result in her losing her placement. Yet, she continued to use. Some drug counselors would say she was in denial or resistant to treatment. This seems overly simplistic to me. Jennifer couldn’t be successful because she had no mental model of success. All Jennifer knew was acting up, shutting down, and using. All Jennifer knew was being stuck.
If creating change in our clients is about helping them write new, more adaptive scripts, how do we make that happen? I’ve always believed the answer is not to provide endless didactic lectures. Rather, the answer is to present clients opportunities to try new behaviors. As they practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other words, they are starting to get unstuck.
Beyond the Comfort Zone
In my experience, substance-abusing teens and other at-risk youth continue to engage in maladaptive behaviors until they break their cycle of stuckness. If this is true, then it seems to me that the goal of substance abuse treatment should be to help clients create new, more adaptive cognitive scripts. It seems to me that the first step in this process is encouraging participants to risk going outside their Comfort Zones.
There's a paradox among many of my clients. While they have done things I consider extremely high risk—like getting high on drugs acquired from a stranger who is inherently a criminal, exchanging sex for drugs, or stealing to support their habit—they almost universally present as risk-adverse. I'm frequently perplexed by how to confront this Risk Dichotomy, which my clients are usually unable to recognize. It seems those things have become so normalized to them that they are no longer perceived as risky.
For these clients, staying stuck seems safe. Acting up, shutting down, and using are solidly within their Comfort Zones, so don't seem like risky behavior. This cycle keeps the youth stuck—and every time this cycle repeats itself, it becomes more likely the youth will stay stuck. What fires together wires together. That's basic neuroscience. And, every time that happens it becomes more likely to happen again.
Getting unstuck requires the individual to step outside her Comfort Zone and experiment with new behaviors. This is much riskier—not to mention harder—than sticking with rigid, predictable responses. However, it is only through trying new behaviors that the individual will have the opportunity to develop more adaptive cognitive scripts.
Through participation in experiences that move them outside their Comfort Zones, experiential learning provides substance-abusing teens an opportunity to test their assumptions and reject those they discover to be faulty. It seems to me that this testing and rejecting is vital for movement through the Stages of Change, especially those stages most likely to be encountered in a treatment setting—pre-contemplation, contemplation, and preparation.
For a pre-contemplative client, testing and rejecting “increases the likelihood of serious consideration of change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting fosters the likelihood of “a considered evaluation that leads to a decision to change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting increases self-efficacy and can result in “an action plan that will be implemented in the near term” (DiClemente, p. 27).
You’re Freaking Me Out!
If opportunities to test and reject assumptions are necessary for movement through the Stages of Change, so, too, is some discomfort. According to Cozolino, “[M]oderate stress triggers the release of neurohormones that enhance cortical reorganization and new learning” (p. 24). In addition, Zull wrote, “Plasticity in the brain probably depends more on signals from the emotional centers than it does on new sensory input” (p. 223).
In other words, it is emotions—especially stress—that make our brains learn and change. Experiential learning is an excellent methodology for creating this change environment. In most experiential activities, there is a high level of perceived risk. In some cases, such as white water rafting or high ropes activities, this perceived risk is physical. In other cases, this perceived risk could be emotional or social.
Whether physical, emotional, or social, the perception of risk in experiential activities will likely result in a sense of disequilibrium. According to Luckner and Nadler, “Disequilibrium refers to an individual’s awareness that a mismatch exists between old ways of thinking and new information” (p. 19). "Vincent," a former client, provided an example of disequilibrium during a group activity.
I talk about appropriate risk-taking frequently during group sessions, and often use an activity called Pass the Mousetraps to illustrate this idea. As the title suggests, this activity involves passing around set mousetraps. Actually, this activity also includes tripping mousetraps with hands.
Although completely safe when certain parameters are followed, this activity appears to be fairly risky. In fact, while sitting in a room filled with teens tripping mousetraps, Vincent, a former client, blurted, “You’re freaking me out!” and quickly left the room. For Vincent, the perceived risk was simply too high, even after my extremely detailed safety directions prior to the activity.
Watching his group-mates trip mousetraps with their hands created too strong of a mismatch for Vincent. He believed this to be extremely dangerous behavior, yet nobody was being injured. Unable to revise his thinking quickly enough to reflect the reality of the situation, Vincent had no choice but to flee. Later, Vincent stated, “I left because I was sure someone was going to get hurt. And I couldn’t figure out why that wasn’t happening.” Vincent wasn't worried someone might get hurt; he was upset because what he expected to happen didn't.
With all my clients, disequilibrium appears when acting up, shutting down, and using become no longer effective. When faced with this scenario, a participant is confronted with one of two choices: assimilation or accommodation. According to Piaget’s developmental theory, when presented with new information an individual tries to assimilate it, or fit it into his existing understanding of the world. If this is impossible, the individual is forced to accommodate the new information by altering his schema, or mental models (Kassin, p. 343). When presented with an experience that requires accommodation, an individual is forced to alter his cognitive scripts.
Experiential learning is rich in these opportunities. Marie—the client discussed in my earlier posting Reflecting on Reflection—and her experience on the hike is a good example. Marie was confronted with two choices. She could give up by sitting on the side of the mountain and refusing to continue the hike, or she could resume the hike even though it was difficult and clearly outside her Comfort Zone. When Marie chose to continue the hike, she was required to accommodate this new option and alter her cognitive scripts.
I believe that these opportunities are one of the major values of experiential learning in treatment setting. Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in many experiential activities], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18). It seems to me that by definition, insurmountable tasks only exist outside one’s Comfort Zone. Perhaps, then, taking the risk of tackling an insurmountable task means a participant will automatically be more open to becoming unstuck.
For Marie, an insurmountable task was accomplished and the change was almost immediate. In Vincent’s case, he never tripped a mousetrap with his bare hand, but he did confront a powerful mismatch. What he expected didn’t happen and to accommodate that new experience, he needed to alter his cognitive scripts.
So, what does being slightly less afraid of a mousetrap has to do with sobriety? As a result of his experience that day, Vincent discovered that mousetraps aren’t inherently dangerous after all. This new learning required him to rearrange information in ways that formed new neural networks based on actively testing and rejecting an outdated belief. And, perhaps, with that was born a new perspective: There are possibilities other than those you’ve always believed to be true. Experiential learning helps participants become unstuck by helping them create new, more adaptive cognitive scripts and helping them discover those other possibilities.
Works Cited
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
DiClemente, C. (2003). Addiction and Change. New York: Guilford Press.
Kassin, S. (2004). Essentials of Psychology. Upper Saddle River, NJ: Prentice-Hall.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Yale Medical School. (n.d.). Glossary. Retrieved October 22, 2008, from
http://info.med.yale.edu/psych/3s/glossary_items/cog_script.html
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Saturday, October 18, 2008
Talking Despite Themselves
Zull wrote that reflection is an attempt to find unity in experiences (p. 154). He continued, “We get our data quickly, but it takes longer to see the unity it in" (p. 163). I believe that discovering this unity is especially important when using experiential activities in clinical settings. Without connecting the activity to the real world, transfer of learning will not occur. Processing a learning experience helps assure that this transfer happens.
Processing is “an activity that is structured to encourage individuals to plan, reflect, describe, analyze and communicate about experiences” (Luckner & Nadler p. 8). In experiential learning settings, a typical processing session involves participants answering facilitator-asked questions following some type of experience. Some participants are resistant to this approach, especially initially. In my experience, processing sessions that are simply facilitator-led question-and-answer sessions often lack depth. It seems to me this can be especially true when working with teens in treatment, where the youth are often reluctant to participate in the first place and may lack the skills necessary to be introspective.
Mandated to Change
Nearly all the youth I work with enter services in the pre-contemplation stage-of-change. They are there due to probation, other court involvements, school requirements, family pressures, or other external reasons. For them, treatment is viewed as the lesser of two evils, and minimal effort is all they initially will commit. The compelling nature of experiential activities works well with these youth for encouraging participation. However, attempting to lead these youth to process deeply can be painful at times!
There is a special challenge involved in working with these mandated youth, and the work can be filled with paradoxes. I consider their treatment voluntary, but not participating could result in a probation violation. I never force clients to participate in experiential activities, but not participating could be considered non-compliance. I try to minimize the coercive aspect of this throughout all dimensions of treatment, but mandated clients are always aware of it.
That said, although the mandated client is required to participate, that doesn’t mean she can’t choose to do so. Indeed, that is exactly what I always hope will occur with these clients, that their thinking will move from “I have to be here” to “I want to be here.” When this happens, I see it as a clear sign of movement through the stages-of-change.
Whether clients are mandated to treatment or not, one of the advantages of experiential activities is that the activities are inherently engaging. Priest and Gass refer to these as “activities that provide compelling tasks to accomplish” (p. 17). Even most reluctant clients want to participate in them, at least after an appropriate “I’m not doing that” protest. Perhaps they believe that the activities aren’t really treatment and therefore acceptable. That’s fine with me. I know there’s much more to juggling rubber chickens than meets the eye.
Reflection Skills
Reflection takes skill and developing this skill requires practice (Stanchfield, p. 134). In my experience, it is common for youth in treatment to lack the skills necessary to reflect. As a way to help my clients develop this skill, I’ve recently added a new element to my group sessions. At every session, we now start with a Question from the Box. I’ve created about 60 questions, which I have on strips of paper. At the start of each group session, a participant draws a slip out of the box and all the youth take turns answering the question.
Some of the questions are directly recovery oriented, such as “Describe the last time you felt like using.” Others are about self-disclosure, such as “Share something about yourself that nobody here knows.” Still others are simply for the sake of practicing reflection skills, such as “If you were a super hero, what would your super-power be?”
Recently, group members have spontaneously started asking each other follow up questions, which suggests to me that this processing practice is having a positive impact. In a simple, safe way, these Questions from the Box are providing my clients an opportunity to improve their skills at self-reflection. In some cases, though, it seems to me that a lack of reflective ability may suggest more than simply a skills deficit. It might indicate a history of trauma, abuse and/or neglect.
Many of the youth I work with have such histories. For these participants, introspection may be something they’ve spent years actively avoiding. Their use of alcohol and other drugs may be part of that effort to avoid introspection. Their other maladaptive behaviors may also be part of that pattern of avoidance. Yet, here I am as the facilitator, pushing them to do exactly what they have been trying to avoid. No wonder they seem reluctant.
It seems to me that providing opportunities to practice reflection is an important aspect of any treatment program. Once learned, the ability to think reflectively is a valuable skill these youth will take with them and be able to apply to life in general. Since so many of my clients have histories of trauma or neglect, facilitating for change means finding ways for my clients to feel safe while being reflective.
That Silly Amygdala
The amygdala is also where the fight-or-flight response is centered. The “fear center” of the brain, it is used primarily for analyzing experiences, assigning meaning to those experiences, and monitoring those experiences for danger (Zull, p. 59). When the amygdala senses danger, it communicates this to the body, so that the body can prepare to act (Zull, p. 60). Imagine a youth reluctant to attend group. Maybe he doesn’t think he has a problem and resent the mandate. Maybe she has a history of trauma. Maybe he doesn’t possess the skills to be introspective. It seems to me that these are exactly the type of situations that would be considered dangerous by the vigilant amygdala.
So what does this have to do with getting teens to talk? Well, according to Zull, there are times when the amygdala is less active, less vigilant. One of these times is when the cortical brain is busy with a cognitive task such as solving a puzzle (p. 60). Under those circumstances, the amygdala doesn’t have time to sense fear. It seems to me that presenting puzzles or other active processing approaches could be useful when working with reluctant-to-process teens. By keeping the cortical brain busy, they would be more likely to process.
Indeed, without knowing it, I’ve done this in the past. Occasionally I have Game Day in groups and one of my favorite games is Totika. Similar to Jenga, but with blocks of different colors, after successfully removing a block from the stack the player answers a color-coded question. About a year ago, we were playing Totika during a Game Day. While playing, “Carl”— street savvy, extremely guarded, and reluctant to engage in discussions, activities, or any self-disclosure—was asked to describe the worse day of his life. Without hesitation, he started talking about his mother’s death when he was four years old. Within moments, he was in tears as he continued telling his life story to the group.
For nearly a year now, I’ve been thinking about this incident, trying to figure out why Carl was suddenly willing to be introspective that day. Had he finally come to feel safe in the group environment? Was it simply that he was playing by the rules of the game? Had his need to talk about this overwhelmed his reluctance to engage? All of these are likely true to some extent, but it would seem that the task of carefully pulling a block out of the stack kept his cortical brain too busy to be fearful about sharing this experience.
Surely there are ways that I can more intentionally bring this knowledge about the amygdala into my groups in order help facilitate change.
Beyond Q & A
Totika is one example of ways to move beyond a traditional question-and-answer processing approach, to help assure a richer outcome for teens in treatment. “There are many innovative ways to engage a group in dialogue and reflection kinesthetically, emotionally, and socially that aren’t dependent on the facilitator’s leading a didactic question-and-answer session” (Stanchfield, p. 106).
One example is the use of consensus in processing. Stanchfield stated, “The value of practicing consensus in the context of developing group processing skills is that consensus is all about quality discussion and embracing and understanding the opinions of those with differing viewpoints” (p. 94). Stanchfield wrote about a processing activity that involved the providing the group a set of cards with metaphorical images on each, such as Chiji Cards (see www.chiji.com). The group’s goal is to choose one card by consensus that represented what they had achieved as a group.
I like this as a processing activity and have used it before. Not only does it function as an exercise in consensus, it turns processing into a decision making experience. Getting teens to process deeply can be challenging, so having participates engage in an activity like this can be an excellent choice. As Stanchfield wrote, “[P]articipants can become so involved in identifying with a card, and making an argument for their card, that they are unaware they are engaging in reflection” (p. 96).
As we have seen, if participants’ brains are engaged in such problem solving, they may truly be unaware they are processing. Even so, the reflection that occurs helps to assure transfer of learning. As a facilitator, becoming more intentional with processing approaches can also help assure the most value possible from participating in an experiential activity.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Stanchfield, J. (2007). Tips and Tools: The Art of Experiential Group Facilitation. Oklahoma City, OK: Wood'N'Barnes Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Processing is “an activity that is structured to encourage individuals to plan, reflect, describe, analyze and communicate about experiences” (Luckner & Nadler p. 8). In experiential learning settings, a typical processing session involves participants answering facilitator-asked questions following some type of experience. Some participants are resistant to this approach, especially initially. In my experience, processing sessions that are simply facilitator-led question-and-answer sessions often lack depth. It seems to me this can be especially true when working with teens in treatment, where the youth are often reluctant to participate in the first place and may lack the skills necessary to be introspective.
Mandated to Change
Nearly all the youth I work with enter services in the pre-contemplation stage-of-change. They are there due to probation, other court involvements, school requirements, family pressures, or other external reasons. For them, treatment is viewed as the lesser of two evils, and minimal effort is all they initially will commit. The compelling nature of experiential activities works well with these youth for encouraging participation. However, attempting to lead these youth to process deeply can be painful at times!
There is a special challenge involved in working with these mandated youth, and the work can be filled with paradoxes. I consider their treatment voluntary, but not participating could result in a probation violation. I never force clients to participate in experiential activities, but not participating could be considered non-compliance. I try to minimize the coercive aspect of this throughout all dimensions of treatment, but mandated clients are always aware of it.
That said, although the mandated client is required to participate, that doesn’t mean she can’t choose to do so. Indeed, that is exactly what I always hope will occur with these clients, that their thinking will move from “I have to be here” to “I want to be here.” When this happens, I see it as a clear sign of movement through the stages-of-change.
Whether clients are mandated to treatment or not, one of the advantages of experiential activities is that the activities are inherently engaging. Priest and Gass refer to these as “activities that provide compelling tasks to accomplish” (p. 17). Even most reluctant clients want to participate in them, at least after an appropriate “I’m not doing that” protest. Perhaps they believe that the activities aren’t really treatment and therefore acceptable. That’s fine with me. I know there’s much more to juggling rubber chickens than meets the eye.
Reflection Skills
Reflection takes skill and developing this skill requires practice (Stanchfield, p. 134). In my experience, it is common for youth in treatment to lack the skills necessary to reflect. As a way to help my clients develop this skill, I’ve recently added a new element to my group sessions. At every session, we now start with a Question from the Box. I’ve created about 60 questions, which I have on strips of paper. At the start of each group session, a participant draws a slip out of the box and all the youth take turns answering the question.
Some of the questions are directly recovery oriented, such as “Describe the last time you felt like using.” Others are about self-disclosure, such as “Share something about yourself that nobody here knows.” Still others are simply for the sake of practicing reflection skills, such as “If you were a super hero, what would your super-power be?”
Recently, group members have spontaneously started asking each other follow up questions, which suggests to me that this processing practice is having a positive impact. In a simple, safe way, these Questions from the Box are providing my clients an opportunity to improve their skills at self-reflection. In some cases, though, it seems to me that a lack of reflective ability may suggest more than simply a skills deficit. It might indicate a history of trauma, abuse and/or neglect.
Many of the youth I work with have such histories. For these participants, introspection may be something they’ve spent years actively avoiding. Their use of alcohol and other drugs may be part of that effort to avoid introspection. Their other maladaptive behaviors may also be part of that pattern of avoidance. Yet, here I am as the facilitator, pushing them to do exactly what they have been trying to avoid. No wonder they seem reluctant.
It seems to me that providing opportunities to practice reflection is an important aspect of any treatment program. Once learned, the ability to think reflectively is a valuable skill these youth will take with them and be able to apply to life in general. Since so many of my clients have histories of trauma or neglect, facilitating for change means finding ways for my clients to feel safe while being reflective.
That Silly Amygdala
The amygdala is also where the fight-or-flight response is centered. The “fear center” of the brain, it is used primarily for analyzing experiences, assigning meaning to those experiences, and monitoring those experiences for danger (Zull, p. 59). When the amygdala senses danger, it communicates this to the body, so that the body can prepare to act (Zull, p. 60). Imagine a youth reluctant to attend group. Maybe he doesn’t think he has a problem and resent the mandate. Maybe she has a history of trauma. Maybe he doesn’t possess the skills to be introspective. It seems to me that these are exactly the type of situations that would be considered dangerous by the vigilant amygdala.
So what does this have to do with getting teens to talk? Well, according to Zull, there are times when the amygdala is less active, less vigilant. One of these times is when the cortical brain is busy with a cognitive task such as solving a puzzle (p. 60). Under those circumstances, the amygdala doesn’t have time to sense fear. It seems to me that presenting puzzles or other active processing approaches could be useful when working with reluctant-to-process teens. By keeping the cortical brain busy, they would be more likely to process.
Indeed, without knowing it, I’ve done this in the past. Occasionally I have Game Day in groups and one of my favorite games is Totika. Similar to Jenga, but with blocks of different colors, after successfully removing a block from the stack the player answers a color-coded question. About a year ago, we were playing Totika during a Game Day. While playing, “Carl”— street savvy, extremely guarded, and reluctant to engage in discussions, activities, or any self-disclosure—was asked to describe the worse day of his life. Without hesitation, he started talking about his mother’s death when he was four years old. Within moments, he was in tears as he continued telling his life story to the group.
For nearly a year now, I’ve been thinking about this incident, trying to figure out why Carl was suddenly willing to be introspective that day. Had he finally come to feel safe in the group environment? Was it simply that he was playing by the rules of the game? Had his need to talk about this overwhelmed his reluctance to engage? All of these are likely true to some extent, but it would seem that the task of carefully pulling a block out of the stack kept his cortical brain too busy to be fearful about sharing this experience.
Surely there are ways that I can more intentionally bring this knowledge about the amygdala into my groups in order help facilitate change.
Beyond Q & A
Totika is one example of ways to move beyond a traditional question-and-answer processing approach, to help assure a richer outcome for teens in treatment. “There are many innovative ways to engage a group in dialogue and reflection kinesthetically, emotionally, and socially that aren’t dependent on the facilitator’s leading a didactic question-and-answer session” (Stanchfield, p. 106).
One example is the use of consensus in processing. Stanchfield stated, “The value of practicing consensus in the context of developing group processing skills is that consensus is all about quality discussion and embracing and understanding the opinions of those with differing viewpoints” (p. 94). Stanchfield wrote about a processing activity that involved the providing the group a set of cards with metaphorical images on each, such as Chiji Cards (see www.chiji.com). The group’s goal is to choose one card by consensus that represented what they had achieved as a group.
I like this as a processing activity and have used it before. Not only does it function as an exercise in consensus, it turns processing into a decision making experience. Getting teens to process deeply can be challenging, so having participates engage in an activity like this can be an excellent choice. As Stanchfield wrote, “[P]articipants can become so involved in identifying with a card, and making an argument for their card, that they are unaware they are engaging in reflection” (p. 96).
As we have seen, if participants’ brains are engaged in such problem solving, they may truly be unaware they are processing. Even so, the reflection that occurs helps to assure transfer of learning. As a facilitator, becoming more intentional with processing approaches can also help assure the most value possible from participating in an experiential activity.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Stanchfield, J. (2007). Tips and Tools: The Art of Experiential Group Facilitation. Oklahoma City, OK: Wood'N'Barnes Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Sunday, October 12, 2008
Reflecting on Reflection
In the reflection stage of the learning cycle, participants process learning from an experiential activity in order to generalize it to other areas of their lives (Luckner & Nadler, p. 10). This processing provides an opportunity for participants to review their behavior during the experience and connect those reflections to the “real world.”
Processing most often occurs at the completion of an experience. However, it can occur at anytime. Indeed, if a facilitator stops an activity in progress because the participants are stuck and processes what is happening in the moment, an extremely powerful transfer of learning is possible.
When leading experiential activities or adventure programs in the past, I have always tended toward low levels of facilitation, preferring to allow participants the opportunity to get unstuck on their own. Only when this doesn't occur in a timely manner or when participants start to become escalated have I stopped the activity, with a problem solving prompt directed to the participants such as, “Who can name an obstacle for the group right now?”
Most often, this in-the-moment processing will be enough for the participants to get themselves unstuck, usually by trying something new and thereby stepping out of their collective comfort zone and making a change in hopes of decreasing the dissonance they are experiencing. However, I'm wondering if I should expect more from in-the-moment processing than the participants simply getting over an obstacle.
Luckner and Nadler wrote, “It is in the brief moment or moments prior to a unique action or breakthrough that the ingredients for change are found” (p. 28). When utilizing experiential learning to foster change, those moments prior to that breakthrough action should, perhaps, be the primary focus of the facilitator.
Luckner and Nadler refer to this as “edgework.” They wrote, “It is at the edge of the breakthrough where processing the experience is most important” (p. 29). I conceptualize this edge as the dividing line between a participant’s comfort zone and change zone. “When at this dividing line, “individuals either break through and take the leap or turn back to their safe territory” (Luckner & Nadler, p. 30). When at that dividing line, in-the-moment processing could be vital for assuring forward movement.
With this in mind, my low-level facilitation style might not always be the most effective strategy. Instead, a more active role focused on emphasizing those moments prior to that breakthrough action might be more beneficial to the participants.
Processing on the Edge
An example of this processing at the edge is “Marie,” a client from when I worked in the in-patient program at Ryther Child Center. As the experiential treatment facilitator, one of my roles at Ryther was to lead weekly hikes. When selecting a destination, I always tried to choose a hike that was clearly outside the participants’ collective comfort zones, but which I thought everyone could successfully complete. By moving outside their comfort zones, I hoped the participants would practice being unstuck. Not surprisingly, there was sometimes much resistance.
Marie always complained about and during the hikes. This day, though, she actually gave up, sitting down on the side of the mountain trail and refusing to continue. She wasn’t just stuck. She was immobilized. My best motivational speeches failed with her, and finally I asked, “Do you always quit when things get tough?”
Unimpressed, Marie responded, “Oh. You’re doing that metaphor thing, huh?”
I acknowledged that I was, indeed, doing that metaphor thing, then suggested she try something new and not give up this time. Eventually, she agreed to continue the hike. After attempting this new “don’t give up just because it’s hard” behavior, giving up was no longer the only option within her comfort zone.
For Marie, it was the processing on the edge that helped her become unstuck and move forward. Whenever it occurs, though, processing provides participants the opportunity to reflect, analyze, describe, and discuss an experience, while reinforcing perceptions of change and promoting transfer of learning (Luckner & Nadler, p. 8). Indeed, I would say it is the processing that turns an activity into a therapeutic experience.
As Marie’s sense of self-efficacy increased, her engagement in processing grew. Initially, she would say little during debriefing sessions, even when called on directly. Toward the end of her treatment, not only was she increasingly vocal during processing sessions, during hikes she actively encouraged her struggling peers.
Marie’s initial resistance to change was clearly evident. She was taken out of her comfort zone and repeatedly placed into new and unique situations that she considered risky. In her efforts to reduce the dissonance she felt, she was forced to reconsider her preconceived views. Because she was regularly placed into these new and unique situations, Marie’s resistance decreased dramatically.
Would this have occurred without processing? I believe so, but only to a limited degree. It was through opportunities to process her experiences that Marie generalized her learning to other areas of her life. It was through opportunities to process her experiences that Marie became unstuck.
Types of Transfer
The ideas about reflection presented in The Art of Changing the Brain and Processing the Experience made me think back to another idea about transfer of learning. Priest and Gass identified three types of transfer: specific transfer, non-specific transfer, and metaphoric transfer (p. 185).
Specific transfer is learning a particular skill or habit for use in a closely related situation. Non-specific transfer is learning general principles or behaviors and applying to different situations. Metaphoric transfer refers to discovering the parallels between two learning environments. At various times, Marie exhibited all three types of transfer, but most notable was her metaphoric transfer. This is clearly evident in her statement, “If I can complete this hike, I can stay clean.”
Zull wrote, “We need reflection to develop complexity. We may start with a direct and sometimes relatively simple concrete experience, but that experience grows richer as we allow our brain the freedom to search for those still unknown connections” (p. 164). In other words, reflection is about finding connections between the activity and the real world. For Marie, completing the hike may have had value in itself, but change occurred not when she stood at the mountain’s summit, but when she made connections between the hike, her recovery and life beyond.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Processing most often occurs at the completion of an experience. However, it can occur at anytime. Indeed, if a facilitator stops an activity in progress because the participants are stuck and processes what is happening in the moment, an extremely powerful transfer of learning is possible.
When leading experiential activities or adventure programs in the past, I have always tended toward low levels of facilitation, preferring to allow participants the opportunity to get unstuck on their own. Only when this doesn't occur in a timely manner or when participants start to become escalated have I stopped the activity, with a problem solving prompt directed to the participants such as, “Who can name an obstacle for the group right now?”
Most often, this in-the-moment processing will be enough for the participants to get themselves unstuck, usually by trying something new and thereby stepping out of their collective comfort zone and making a change in hopes of decreasing the dissonance they are experiencing. However, I'm wondering if I should expect more from in-the-moment processing than the participants simply getting over an obstacle.
Luckner and Nadler wrote, “It is in the brief moment or moments prior to a unique action or breakthrough that the ingredients for change are found” (p. 28). When utilizing experiential learning to foster change, those moments prior to that breakthrough action should, perhaps, be the primary focus of the facilitator.
Luckner and Nadler refer to this as “edgework.” They wrote, “It is at the edge of the breakthrough where processing the experience is most important” (p. 29). I conceptualize this edge as the dividing line between a participant’s comfort zone and change zone. “When at this dividing line, “individuals either break through and take the leap or turn back to their safe territory” (Luckner & Nadler, p. 30). When at that dividing line, in-the-moment processing could be vital for assuring forward movement.
With this in mind, my low-level facilitation style might not always be the most effective strategy. Instead, a more active role focused on emphasizing those moments prior to that breakthrough action might be more beneficial to the participants.
Processing on the Edge
An example of this processing at the edge is “Marie,” a client from when I worked in the in-patient program at Ryther Child Center. As the experiential treatment facilitator, one of my roles at Ryther was to lead weekly hikes. When selecting a destination, I always tried to choose a hike that was clearly outside the participants’ collective comfort zones, but which I thought everyone could successfully complete. By moving outside their comfort zones, I hoped the participants would practice being unstuck. Not surprisingly, there was sometimes much resistance.
Marie always complained about and during the hikes. This day, though, she actually gave up, sitting down on the side of the mountain trail and refusing to continue. She wasn’t just stuck. She was immobilized. My best motivational speeches failed with her, and finally I asked, “Do you always quit when things get tough?”
Unimpressed, Marie responded, “Oh. You’re doing that metaphor thing, huh?”
I acknowledged that I was, indeed, doing that metaphor thing, then suggested she try something new and not give up this time. Eventually, she agreed to continue the hike. After attempting this new “don’t give up just because it’s hard” behavior, giving up was no longer the only option within her comfort zone.
For Marie, it was the processing on the edge that helped her become unstuck and move forward. Whenever it occurs, though, processing provides participants the opportunity to reflect, analyze, describe, and discuss an experience, while reinforcing perceptions of change and promoting transfer of learning (Luckner & Nadler, p. 8). Indeed, I would say it is the processing that turns an activity into a therapeutic experience.
As Marie’s sense of self-efficacy increased, her engagement in processing grew. Initially, she would say little during debriefing sessions, even when called on directly. Toward the end of her treatment, not only was she increasingly vocal during processing sessions, during hikes she actively encouraged her struggling peers.
Marie’s initial resistance to change was clearly evident. She was taken out of her comfort zone and repeatedly placed into new and unique situations that she considered risky. In her efforts to reduce the dissonance she felt, she was forced to reconsider her preconceived views. Because she was regularly placed into these new and unique situations, Marie’s resistance decreased dramatically.
Would this have occurred without processing? I believe so, but only to a limited degree. It was through opportunities to process her experiences that Marie generalized her learning to other areas of her life. It was through opportunities to process her experiences that Marie became unstuck.
Types of Transfer
The ideas about reflection presented in The Art of Changing the Brain and Processing the Experience made me think back to another idea about transfer of learning. Priest and Gass identified three types of transfer: specific transfer, non-specific transfer, and metaphoric transfer (p. 185).
Specific transfer is learning a particular skill or habit for use in a closely related situation. Non-specific transfer is learning general principles or behaviors and applying to different situations. Metaphoric transfer refers to discovering the parallels between two learning environments. At various times, Marie exhibited all three types of transfer, but most notable was her metaphoric transfer. This is clearly evident in her statement, “If I can complete this hike, I can stay clean.”
Zull wrote, “We need reflection to develop complexity. We may start with a direct and sometimes relatively simple concrete experience, but that experience grows richer as we allow our brain the freedom to search for those still unknown connections” (p. 164). In other words, reflection is about finding connections between the activity and the real world. For Marie, completing the hike may have had value in itself, but change occurred not when she stood at the mountain’s summit, but when she made connections between the hike, her recovery and life beyond.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Saturday, September 27, 2008
Sequencing Change
Sequencing a progression of activities can be an important part of assuring the greatest learning—or changing—opportunity possible. Stanchfield wrote that sequencing is “the careful ordering of group activities based on the group’s needs, goals and setting” (p. 34). From this perspective, thoughtful sequencing of activities is important because it will help “maximize learning opportunities and the emotional and physical safety of the group” (Stanchfield, p. 34).
To help assure this happens, ordering activities in a logical order is clearly important. For example, if I were facilitating a short session on a ropes course, I would most likely start with an icebreaker or warm-up activity to help focus the group’s energy and establish a collective environment. Following this warm-up activity, I'd lead a more challenging activity, such as a problem solving initiative. Only after the successful completion of these “easier” activities would the group move to the ropes course’s built elements.
Until reading Zull and now Stanchfield, I’ve never thought much about sequencing activities. The above ordering of activities is just how you do it—start small and get bigger. That seemed so obvious to me that there was no reason to think about it. This sequencing helps assure good group dynamics and safety in the progressively challenging activities. It also provides the facilitator the opportunity to continuously assess the group’s functioning level as the challenge level increases. Finally, careful sequencing of activities helps assure the group’s success.
Progress Toward a Goal
However, another value in the careful sequencing of activities is creating a sense of movement. Zull wrote, “Pleasure in learning… comes from the perception of progress toward a goal” (p. 234). It seems to me that careful sequencing of activities can help reinforce this progress.
If a series of activities were all of an equal level of challenge, there would be no forward movement. If a series of activities progressed in a manner that didn’t seem intentional, any movement that did happen would seem confused and unconvincing. If, however, the day starts by playing Elbow Tag, undoubtedly includes a setback or two along the way, and ultimately ends with our hero dangling on a zip-line, the progress is undeniable. The progress is a story.
Like a story, effective sequencing has a beginning, middle and end. And, it seems to me that effective sequencing creates a sort of story from the experience. Stories are essential to learning, involving all areas of the brain, allowing us to “package events and knowledge in complex neuronal nets, any part of which can trigger the others” (Zull, p. 228). Remember the setback and you'll remember the whole story.
Beyond simply helping learning to stick, though, Zull wrote that the undeniable progress of this sequencing is also reinforcing and even motivates a desire to learn. He wrote, “Achievement itself is rewarding, and that may simply be because it is recognized as movement” (p. 62). Elsewhere, he wrote, “People cannot stay motivated enough to learn unless they experience some success” (p. 238). Hanging from a zip-line must certainly qualify as success under most any circumstance.
Cycle of Learning
“Stories engage all parts of the brain” (Zull, p. 228). If the goal is to facilitate change, structuring experiential learning as stories makes sense to me. Sequencing has another function, though, and that is assuring that learning occurs.
Kolb defined a four stage learning cycle, which consists of experience, reflection, abstraction and active testing (Zull, p. 13). For true learning to occur, all four stages must happen and "all are necessary for learning that is important, long lasting and meaningful” (Jacobson & Ruddy, p. 14).
According to Zull, this sequencing of the learning cycle parallels the manner in which the brain processes information. When an experience occurs, the cerebral cortex has three functions in processing the information regarding that experience. These are sensing, integrating and acting (Zull, p. 15). These natural biological functions of the brain are paralleled in Kolb’s learning cycle. As Zull stated, “[T]he learning cycle arises naturally from the structure of the brain” (p. 19).
The Four Ps
Most of the treatment groups I lead are focused on building skills and nearly every session includes experiential activities to help illustrate and/or practice new information. Based on the information above, as well as what has been effective for me in the past, I’ve been thinking about how I sequence group sessions.
I’ve realized that my most effective group sessions generally follow a four-step sequence. I’ve named these steps Prepare, Present, Practice and Process.
Prepare – Warm-up the participants’ brains.
A few ways I do this include using an opening activity, having participants conduct peer interviews related to the topic, and creating “brainstorm posters” that serve as a sort of collective pre-test. Not only does this step warm-up the brains of participants, but it also starts the session off by acknowledging prior knowledge.
Present – Share the new information.
At their core, the treatment groups I facilitate are psychoeducational in nature. That means there is new information to be presented during most sessions. When sharing this new information, I always strive for what I think of as “more do and less you.” In other words, the less I lecture, the better. In addition, Zull suggests limiting the amount of new information to three or four items at one time (p. 184).
Practice – Put the new information into action.
Experiential learning provides rich opportunities to practice alternate behaviors and engage in healthy risk taking. This is at the very core of the use of experiential learning in clinical settings. Neuroscience provides additional insight. Sensory input from an experience is most valued by the brain (Zull, p. 145). In addition, the brain remembers what the body does. In other words, experiential activities build new neuronal networks that hopefully contain more adaptive behavioral choices.
Process – Create connections.
This step is about making links between the new information, the practice step and the real world. Without these connections, transfer of learning is unlikely to occur and change won’t happen.
This final step helps assure integration of my model with Kolb’s learning cycle. It is such an important part of experiential learning that it warrants further exploration in the future. As such, I will hold of saying much about it for now.
Works Cited
Jacobson, M. & Ruddy, M. (2004). Open to Outcome. Oklahoma City, OK: Wood'N'Barnes Publishing.
Stanchfield, J. (2007). Tips and Tools: The Art of Experiential Group Facilitation. Oklahoma City, OK: Wood'N'Barnes Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
To help assure this happens, ordering activities in a logical order is clearly important. For example, if I were facilitating a short session on a ropes course, I would most likely start with an icebreaker or warm-up activity to help focus the group’s energy and establish a collective environment. Following this warm-up activity, I'd lead a more challenging activity, such as a problem solving initiative. Only after the successful completion of these “easier” activities would the group move to the ropes course’s built elements.
Until reading Zull and now Stanchfield, I’ve never thought much about sequencing activities. The above ordering of activities is just how you do it—start small and get bigger. That seemed so obvious to me that there was no reason to think about it. This sequencing helps assure good group dynamics and safety in the progressively challenging activities. It also provides the facilitator the opportunity to continuously assess the group’s functioning level as the challenge level increases. Finally, careful sequencing of activities helps assure the group’s success.
Progress Toward a Goal
However, another value in the careful sequencing of activities is creating a sense of movement. Zull wrote, “Pleasure in learning… comes from the perception of progress toward a goal” (p. 234). It seems to me that careful sequencing of activities can help reinforce this progress.
If a series of activities were all of an equal level of challenge, there would be no forward movement. If a series of activities progressed in a manner that didn’t seem intentional, any movement that did happen would seem confused and unconvincing. If, however, the day starts by playing Elbow Tag, undoubtedly includes a setback or two along the way, and ultimately ends with our hero dangling on a zip-line, the progress is undeniable. The progress is a story.
Like a story, effective sequencing has a beginning, middle and end. And, it seems to me that effective sequencing creates a sort of story from the experience. Stories are essential to learning, involving all areas of the brain, allowing us to “package events and knowledge in complex neuronal nets, any part of which can trigger the others” (Zull, p. 228). Remember the setback and you'll remember the whole story.
Beyond simply helping learning to stick, though, Zull wrote that the undeniable progress of this sequencing is also reinforcing and even motivates a desire to learn. He wrote, “Achievement itself is rewarding, and that may simply be because it is recognized as movement” (p. 62). Elsewhere, he wrote, “People cannot stay motivated enough to learn unless they experience some success” (p. 238). Hanging from a zip-line must certainly qualify as success under most any circumstance.
Cycle of Learning
“Stories engage all parts of the brain” (Zull, p. 228). If the goal is to facilitate change, structuring experiential learning as stories makes sense to me. Sequencing has another function, though, and that is assuring that learning occurs.
Kolb defined a four stage learning cycle, which consists of experience, reflection, abstraction and active testing (Zull, p. 13). For true learning to occur, all four stages must happen and "all are necessary for learning that is important, long lasting and meaningful” (Jacobson & Ruddy, p. 14).
According to Zull, this sequencing of the learning cycle parallels the manner in which the brain processes information. When an experience occurs, the cerebral cortex has three functions in processing the information regarding that experience. These are sensing, integrating and acting (Zull, p. 15). These natural biological functions of the brain are paralleled in Kolb’s learning cycle. As Zull stated, “[T]he learning cycle arises naturally from the structure of the brain” (p. 19).
The Four Ps
Most of the treatment groups I lead are focused on building skills and nearly every session includes experiential activities to help illustrate and/or practice new information. Based on the information above, as well as what has been effective for me in the past, I’ve been thinking about how I sequence group sessions.
I’ve realized that my most effective group sessions generally follow a four-step sequence. I’ve named these steps Prepare, Present, Practice and Process.
Prepare – Warm-up the participants’ brains.
A few ways I do this include using an opening activity, having participants conduct peer interviews related to the topic, and creating “brainstorm posters” that serve as a sort of collective pre-test. Not only does this step warm-up the brains of participants, but it also starts the session off by acknowledging prior knowledge.
Present – Share the new information.
At their core, the treatment groups I facilitate are psychoeducational in nature. That means there is new information to be presented during most sessions. When sharing this new information, I always strive for what I think of as “more do and less you.” In other words, the less I lecture, the better. In addition, Zull suggests limiting the amount of new information to three or four items at one time (p. 184).
Practice – Put the new information into action.
Experiential learning provides rich opportunities to practice alternate behaviors and engage in healthy risk taking. This is at the very core of the use of experiential learning in clinical settings. Neuroscience provides additional insight. Sensory input from an experience is most valued by the brain (Zull, p. 145). In addition, the brain remembers what the body does. In other words, experiential activities build new neuronal networks that hopefully contain more adaptive behavioral choices.
Process – Create connections.
This step is about making links between the new information, the practice step and the real world. Without these connections, transfer of learning is unlikely to occur and change won’t happen.
This final step helps assure integration of my model with Kolb’s learning cycle. It is such an important part of experiential learning that it warrants further exploration in the future. As such, I will hold of saying much about it for now.
Works Cited
Jacobson, M. & Ruddy, M. (2004). Open to Outcome. Oklahoma City, OK: Wood'N'Barnes Publishing.
Stanchfield, J. (2007). Tips and Tools: The Art of Experiential Group Facilitation. Oklahoma City, OK: Wood'N'Barnes Publishing.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Tuesday, September 23, 2008
What I Did Last Summer
This past summer, I was provided the opportunity to create an adventure therapy component for my treatment groups. I put together a series of eight day-long hikes that all youth enrolled in my Monday group, which has a focus on motivational enhancement, went on.
Hikes included the Snoqualimie Tunnel, Denny Creek, Boulder River and Twin Falls, among others. None of these would be considered especially challenging by an experienced hiker. However, many of my clients were stepping outside their Comfort Zone just by participating. I felt choosing accessible hikes to enjoyable locations provided an effective introduction to adventure therapy for these youth.
My principal goal for the hikes was to integrate nature experiences into the treatment process. Just being in the wilderness was a powerful and therapeutic experience. In addition, I hoped to provide my clients opportunities to experientically discover the inherent spirituality of nature, and increase group cohesion. Having led adverture therapy outings with youth before, I was also looking forward to the many opportunities to explore nature as an amazing metaphor for recovery, sobriety, change and moving forward.
More than that happened. These hikes built group cohesion and trust within the participants that transferred from the outings and into the group room, leading to more meaningful treatment experiences. This is true not just with the youth who participated, but even with their group-mates whom have experienced the positive modeling of the hikers.
Occassionally during adventure outings amazing personal breakthroughs occur. I've witnessed them in the past and know these can be powerful. This didn't happen during Summer 2008. What I did clearly observe, though, are slow, steady steps--the steps that take you up the side of a mountain, through a glacier-fed creek, or into a pitch-dark tunnel. Those are all places the participants didn't think they could go, maybe didn't want to try, but went anyway this summer. All while taking slow, steady steps toward a life free from substance abuse.
On hikes, I'm generally goofy and spin sometimes over-the-top metaphors about rocky paths, slippery slopes, the destination being worth the journey, and--well, you get the idea. Slow, steady steps, though, now that's the real life stuff of recovery. That may be the best possible metaphor to leave lingering in the minds of the youth who spent the summer hiking with me.
Hikes included the Snoqualimie Tunnel, Denny Creek, Boulder River and Twin Falls, among others. None of these would be considered especially challenging by an experienced hiker. However, many of my clients were stepping outside their Comfort Zone just by participating. I felt choosing accessible hikes to enjoyable locations provided an effective introduction to adventure therapy for these youth.
My principal goal for the hikes was to integrate nature experiences into the treatment process. Just being in the wilderness was a powerful and therapeutic experience. In addition, I hoped to provide my clients opportunities to experientically discover the inherent spirituality of nature, and increase group cohesion. Having led adverture therapy outings with youth before, I was also looking forward to the many opportunities to explore nature as an amazing metaphor for recovery, sobriety, change and moving forward.
More than that happened. These hikes built group cohesion and trust within the participants that transferred from the outings and into the group room, leading to more meaningful treatment experiences. This is true not just with the youth who participated, but even with their group-mates whom have experienced the positive modeling of the hikers.
Occassionally during adventure outings amazing personal breakthroughs occur. I've witnessed them in the past and know these can be powerful. This didn't happen during Summer 2008. What I did clearly observe, though, are slow, steady steps--the steps that take you up the side of a mountain, through a glacier-fed creek, or into a pitch-dark tunnel. Those are all places the participants didn't think they could go, maybe didn't want to try, but went anyway this summer. All while taking slow, steady steps toward a life free from substance abuse.
On hikes, I'm generally goofy and spin sometimes over-the-top metaphors about rocky paths, slippery slopes, the destination being worth the journey, and--well, you get the idea. Slow, steady steps, though, now that's the real life stuff of recovery. That may be the best possible metaphor to leave lingering in the minds of the youth who spent the summer hiking with me.
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