Beard and Wilson define experiential learning as “the sense-making process of active engagement between the inner world of the person and the outer world of the environment” (p. 19). It is during this sense-making process that a state of dissonance can develop and that change will most readily occur. However, change does not happen solely through experience. If an experience serves solely to confirm already held beliefs, it won’t serve as a catalyst of change. Instead, it will simply reinforce the individual’s current cognitive processes (Beard & Wilson, p. 20).
It seems to me that the facilitator’s goal during an experience should be to assure that learning opportunities occur during this sense-making process of active engagement. With this in mind, perhaps the facilitator must purposefully introduce a state of dissonance into the activity. Dissonance creates confusion, and “the act of restructuring or reordering to regain balance… is where change in feelings, thoughts, attitudes, and behavior patterns occur” (Luckner & Nadler, p. 23).
One way for a facilitator to create this dissonance is by holding the learning experience in an environment that is unfamiliar to the participants. This approach is commonly used in adventure programming, where the participants are placed outdoors in an unknown setting. In-patient treatment programs are also unknown settings, of course, so serve as another example of environmental dissonance being created.
This summer, I will again be leading a series of hikes with my clients. One goal of these hikes is to place them into unknown settings. Opportunities like summer hikes are often scare scarce or seasonal in many clinical settings. That means it is important to look for other ways to create dissonance. Presenting experiences with uncertain outcomes can do this.
Ropes courses and initiative activities are example of this, since participants are unsure if they will be able to successfully complete the challenge. In my experience, some clinicians only use activities that they know the participants will be able to successfully complete. I believe this is appropriate for some clinical applications of experiential learning, such as illustrating a concept or improving group cohesion (see my post “Experiential Activities in Clinical Settings,” November 2008).
However, I strongly believe doing this is a sort of codependency that is not in the best interest of the participants. For teens in treatment, failure is a real possibility and avoiding experiences with unknown outcomes is a disservice. In fact, I strongly believe that the greatest learning can come from a failed activity—as long as it is adequately and appropriately processed. In a treatment setting, it is easy to connect failed or uncompleted activities to relapse, but there are many other rich processing possibilities.
Presenting the Possibility of Success
Whatever the experience, it is the unknown aspects of the activity that force the participant to leave her Comfort Zone and enter into a state of dissonance (Priest & Gass, p. 146). Through successful completion of an activity, through going outside a position of comfort, the participant’s dissonance will decrease. For example, when on a challenging mountain hike, a timid or fearful participant is likely to expect a negative outcome. Perhaps he will fail at the activity, perhaps he will be injured, perhaps he will not be as good as his peers, or perhaps a wild animal will attack.
When none of these negative outcomes occur, the participant is confronted with a new indisputable possibility: perhaps he can be successful. As a result, he is presented an opportunity to alter his future expectations. If an opportunity is also presented to generalize this learning, these changed expectations may be extended to all dimensions of his life.
A former client, Marie, serves as a useful example. Although not fearful, she was extremely resistant to the weekly hikes that were part of her inpatient treatment program. On a couple occasions, she claimed to be sick in an effort to avoid them. Throughout the hike, she would make negative comments, stating she could not or would not go any further. One time, she actually sat down on the side of the trail and for nearly 30 minutes refused to continue. However, when we hiked Little Si, one of the most difficult hikes we made and one of her last outings while in treatment, she actually encouraged other clients by saying, “If you can complete this hike, you can stay clean!”
Priest and Gass wrote, “The mastery or competence produced by successfully resolving the adaptive dissonance presented by a situation motivates behavior change” (p. 152). This motivation to change her behavior can be seen in Marie. Through the weekly outings, not only did she come to believe that she was able to successfully complete even a challenging hike, she took on a leadership role by becoming a source of encouragement to her peers. Indeed she went a step further, connecting her ability to complete the hike to her ability to accomplish other difficult goals, such as staying clean.
Luckner and Nadler wrote that central to experiential education is the idea that “we encourage people to try things that they wouldn’t generally do on their own. In other words, they leave their safe, familiar, comfortable and predictable world for uncomfortable new territory” (p. 28). This is certainly true also for substance abuse treatment! With that in mind, I frequently talk with my clients about Growth Zones, a model common in experiential learning. In my version, these three concentric circles consist of the individual’s Comfort Zone in the middle, then the Change Zone as the middle ring, and the Crisis Zone as the outside ring.
By default, an individual’s Comfort Zone contains only what is already known, feels safe, and presents no challenges or distress. It is only when an individual leaves his Comfort Zone that learning and change can occur. By doing this, though, dissonance is created, and with the dissonance comes discomfort. By working to eliminate the discomfort caused by the dissonance experienced when leaving your Comfort Zone, the change process can occur. This is true even with resistant participants like Marie, who are initially unwilling to even consider leaving her Comfort Zone.
The Role of Self-Efficacy
Important to this change process is the idea of self-efficacy. Perceptions of self-efficacy have three dimensions: magnitude, strength, and generality. Magnitude refers to the level of certainty the individual has for success (Priest & Gass, p. 55). This is primarily influenced by the participant’s perceptions of risk, as well as the perceived difficulty of the experience. Many experiential learning activities are purposefully designed to present a high apparent risk level.
This perceived risk often includes both the risk of failure and physical risks. I have heard ropes course participants say, “We can’t do this” or “I’ll break my leg if I even try that!” As important as a perceived risk of possible failure or injury is the possibility of social risks, or looking inadequate or incapable in front of peers. With all three perceived risks, successful completion of an activity that initially seemed impossible has a high likelihood of increasing perceptions of self-efficacy. Marie perceived our weekly hikes as highly challenging in all three ways. As such, her repeated successes on these hikes dramatically increased the magnitude of her self-efficacy.
Strength reflects how long a person holds onto expectations of success despite contradictory information (Priest & Gass p. 55). A history of succeeding after multiple unsuccessful attempts can play an important role in building strength. Although Marie completed every hike she participated, she frequently reported, “I’m just not good at outdoor stuff. That’s why I hate nature.” Her past experiences clearly influenced her perceptions of her own ability. However, through her repeated successes on hikes while in treatment, she was able to move past her unusual self-limiting beliefs, thereby contributed to the strength of her self-efficacy.
Generality refers to the degree of an individual’s transfer of self-efficacy beliefs from one situation to another (Priest & Gass, p. 55). Transfer is the integration of learning from the adventure program into the participant’s life (Priest & Gass, p. 184). In clinical setting, I believe this is the most important concept of the three, and an area when strong facilitation skills are especially vital. To assure that change happens as a result of participation in an experience, transfer of learning must occur.
For Marie, successfully working through her own dissonance provided an important opportunity for her to increase her sense of self-efficacy. As this 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 debriefings, during hikes she actively encouraged her struggling peers.
“When clients enter into adventure programs that focus on change, they may strongly resist [that] change… Adventure experiences often reduce such resistance by placing clients in situations that are new and unique, yet supportive” (Priest & Gass, p. 148). Marie’s initial resistance to change is 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. Through opportunities to process her experiences, she generalized her learning to other areas of her life and began to believe in her ability to accomplish other meaningful goals, such as staying clean after treatment.
Works Cited
Beard, C. & Gross, J. Experiential Learning: A Best Practice Handbook for Educators and Trainers. Philadelphia: Kogan Page, 2006.
Luckner, J. & Nadler, R. Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Co., 1997.
Priest, S. & Gross, M. Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics, 2005.
Showing posts with label adolescents. Show all posts
Showing posts with label adolescents. Show all posts
Sunday, May 17, 2009
Saturday, April 25, 2009
It’s About The Climb, Not The Destination
In all forms of experiential education, transfer of learning is considered a vital part of the process. Necessary for fostering change, this transfer involves the integration of learning from the experience into the participant’s life (Priest & Gass), in order to allow for generalizing that experience to daily events. In other words, in clinical settings transfer of learning answers the question, “What does this have to do with recovery?”
To assure transfer of learning occurs, processing is an essential component of all experiential education programs (Luckner & Nadler, p. 8). In their book, The Processing Pinnacle, Simpson, Miller and Bocher identify a variety of goals when processing. I believe that most important of these in a clinical setting are assuring participants understand the lessons of the experience, analyzing and synthesizing the action, helping give the experience permanence, and transferring the learning to daily life (p. 19).
To help assure these goals are met, the authors present a model they call “the processing pinnacle,” an approach they initially present as a continuum and then later transform into a mountain. At one end is facilitator-centered processing with the leader retaining complete control of the processing. At the other end of the continuum is participant-centered processing, with all processing tasks relinquished by the leader (p. 59).
The authors identified four specific points along this continuum: facilitator frontloading, traditional question and answer, participant-directed processing, and independent reflection.
Facilitator Frontloading
Facilitator front-loading is farthest to the facilitator-centered side of the continuum. In this approach, the leader explicitly states the purpose of the activity before it even takes place, spelling out exactly what will be experienced and learned. When frontloading occurs, reflection generally happens throughout the activity, either during pauses for discussion or as the activity proceeds (p. 59).
As I initially read this book, facilitator frontloading seemed heavy-handed to me, and I didn’t think it fit at all with my personal facilitator style. However, I do frequently use metaphors as a way to frontload an activity, and that use often shapes the experience for the participants. In addition, I always do a lot of in-the-moment processing.
For example, I sometimes frame Trolleys, a common experiential activity, with recovery metaphors, giving participants the task of crossing the Sea of Relapse using the skills they have learned in treatment (the trolleys themselves) and arriving at the finish line, Long-Term Sobriety.
To me, this type of metaphor-rich framing isn’t necessarily as heavy handed as the authors’ definition initially seems. However, it certainly fulfills their definition. In discussing the use of metaphor in frontloading, they state, “The more ways and more times that a metaphor gets linked to everyday life, the more effective it will be” (p. 88). For example, during Trolleys-As-Recovery, I encourage participants to take things “one step at a time” and to not “future-trip” about getting to the end.
In some settings, this sort of predetermined shaping of the activity could clearly limit outcomes. However, when frontloading isn’t heavy-handed, it seems to me that this processing approach can be extremely appropriate within a clinical context where a specific goal has usually been determined in advance. Indeed, moving participants toward a specific goal is most often the point for doing an activity.
Traditional Q & A
The next on the continuum is traditional question and answer, in which the facilitator leads a discussion following the activity. This discussion includes input from both the facilitator and the participants, but is leader-driven. The leader chooses the questions, calls on specific participants, and guides the discussion in a predetermined direction (Simpson, Miller & Bocher, p. 60).
The authors state that this is the most common of all processing styles, but in clinical settings I attempt to avoid this traditional question and answer approach entirely. I’ve found that with youth in treatment, it is usually most effective to provide some structure to the processing. However, I want to do this in a way that isn’t facilitator-oriented. In my experience, participant-directed processing approaches work well for balancing these seemly contradictory goals.
Participant-Directed Processing
This third point on the continuum involves processing where “the direction of the discussion and reflection is determined by the participants, not the facilitator” (Simpson, Miller & Bocher, 2006, p. 61). One example of this approach is processing cards.
About a two year ago, I started using Chiji Processing Cards, a deck of 48 cards with different images on them such as a lighthouse, a compass, and a piece of shattered pottery. The most typical way to use these cards as a processing tool is to spread them out and ask participants to “pick a card that represents your role in the group today” or a similar prompt. I have found these cards to be a powerful processing tool, encouraging even the most reluctant participants to speak.
Teens in treatment can sometimes be challenging to get talking, and it seems to me that this approach helps that to happen. As such, I use a lot of other participant-directed and active processing approaches. I have another post on this blog -- Talking Despite Themselves -- that addresses this topic in more detail.
Independent Reflection
The final point on the processing continuum, independent reflection, is what the authors called “processing in the intentional absence of formal processing” (p. 60). In Outward Bound, this approach is common and frequently referred to as “letting the mountain speak for itself.” I feel there may be times, places, and participant populations were this approach is appropriate. However, it seems to me that not providing a formal processing opportunity of some type in a clinical setting would be therapeutically inappropriate.
Time for transfer of learning is a necessary part of the therapeutic process, and I believe some formal processing should always occur. However, authors wrote, “Even though it might be used rarely, [independent processing] is the appropriate processing methodology when a particular set of conditions has been met” (p. 125). They define these conditions as an appropriate setting, that participants have a strong commitment to the experience, that participants have the requisite knowledge to understand the significance of an experience, and that the group has prior training in processing.
I suppose that if these four conditions were all present in the entire participant population, it might be appropriate to have the group sit quietly on a mountain top watching a sunset and consider that a processing experience. Even then, though, the counselor in me would follow up the independent reflection time with a short group process of it.
Climbing the Mountain
I see processing as an important part of experiential learning. In fact, it may be the most important part, since it provides participants the opportunity to develop awareness, identify thinking patterns, and practice mindfulness—all skills I believe essential for recovery. In a clinical setting, it seems to me that the activity is often less important than the processing opportunities it provides. In other words, climbing a mountain is not about reaching the pinnacle, but about what happens along the way.
Early in the book, the authors wrote, “According to Chinese Tao thinking, action and reflection cannot exist without each other” (p. 18). I found this book interesting and practical in many ways, providing a comprehensive system for viewing various processing methodologies. Independent reflection is one extreme end of a spectrum, and fostering movement toward independent processing has obvious value. After all, a client will eventually no longer be a client, and the skills learned in a clinical context need to transfer to life.
That said, the authors failed to convince me that achieving independent reflection should be the ultimate goal of processing, at least within a clinical context. Getting to the pinnacle is not what’s important in a learning experience. Working toward the pinnacle is. Without a formal processing experience of some sort, it seems to me that this dialectic of action and reflection will not be assured, and transfer of learning may not occur.
Work Cited
Luckner, J., and Nadler, R. (1997). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Company.
Priest, S., and Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Simpson, S., Miller, D., and Bocher, B. (2006). The Processing Pinnacle. Oklahoma City, OK: Wood’n’Barnes.
To assure transfer of learning occurs, processing is an essential component of all experiential education programs (Luckner & Nadler, p. 8). In their book, The Processing Pinnacle, Simpson, Miller and Bocher identify a variety of goals when processing. I believe that most important of these in a clinical setting are assuring participants understand the lessons of the experience, analyzing and synthesizing the action, helping give the experience permanence, and transferring the learning to daily life (p. 19).
To help assure these goals are met, the authors present a model they call “the processing pinnacle,” an approach they initially present as a continuum and then later transform into a mountain. At one end is facilitator-centered processing with the leader retaining complete control of the processing. At the other end of the continuum is participant-centered processing, with all processing tasks relinquished by the leader (p. 59).
The authors identified four specific points along this continuum: facilitator frontloading, traditional question and answer, participant-directed processing, and independent reflection.
Facilitator Frontloading
Facilitator front-loading is farthest to the facilitator-centered side of the continuum. In this approach, the leader explicitly states the purpose of the activity before it even takes place, spelling out exactly what will be experienced and learned. When frontloading occurs, reflection generally happens throughout the activity, either during pauses for discussion or as the activity proceeds (p. 59).
As I initially read this book, facilitator frontloading seemed heavy-handed to me, and I didn’t think it fit at all with my personal facilitator style. However, I do frequently use metaphors as a way to frontload an activity, and that use often shapes the experience for the participants. In addition, I always do a lot of in-the-moment processing.
For example, I sometimes frame Trolleys, a common experiential activity, with recovery metaphors, giving participants the task of crossing the Sea of Relapse using the skills they have learned in treatment (the trolleys themselves) and arriving at the finish line, Long-Term Sobriety.
To me, this type of metaphor-rich framing isn’t necessarily as heavy handed as the authors’ definition initially seems. However, it certainly fulfills their definition. In discussing the use of metaphor in frontloading, they state, “The more ways and more times that a metaphor gets linked to everyday life, the more effective it will be” (p. 88). For example, during Trolleys-As-Recovery, I encourage participants to take things “one step at a time” and to not “future-trip” about getting to the end.
In some settings, this sort of predetermined shaping of the activity could clearly limit outcomes. However, when frontloading isn’t heavy-handed, it seems to me that this processing approach can be extremely appropriate within a clinical context where a specific goal has usually been determined in advance. Indeed, moving participants toward a specific goal is most often the point for doing an activity.
Traditional Q & A
The next on the continuum is traditional question and answer, in which the facilitator leads a discussion following the activity. This discussion includes input from both the facilitator and the participants, but is leader-driven. The leader chooses the questions, calls on specific participants, and guides the discussion in a predetermined direction (Simpson, Miller & Bocher, p. 60).
The authors state that this is the most common of all processing styles, but in clinical settings I attempt to avoid this traditional question and answer approach entirely. I’ve found that with youth in treatment, it is usually most effective to provide some structure to the processing. However, I want to do this in a way that isn’t facilitator-oriented. In my experience, participant-directed processing approaches work well for balancing these seemly contradictory goals.
Participant-Directed Processing
This third point on the continuum involves processing where “the direction of the discussion and reflection is determined by the participants, not the facilitator” (Simpson, Miller & Bocher, 2006, p. 61). One example of this approach is processing cards.
About a two year ago, I started using Chiji Processing Cards, a deck of 48 cards with different images on them such as a lighthouse, a compass, and a piece of shattered pottery. The most typical way to use these cards as a processing tool is to spread them out and ask participants to “pick a card that represents your role in the group today” or a similar prompt. I have found these cards to be a powerful processing tool, encouraging even the most reluctant participants to speak.
Teens in treatment can sometimes be challenging to get talking, and it seems to me that this approach helps that to happen. As such, I use a lot of other participant-directed and active processing approaches. I have another post on this blog -- Talking Despite Themselves -- that addresses this topic in more detail.
Independent Reflection
The final point on the processing continuum, independent reflection, is what the authors called “processing in the intentional absence of formal processing” (p. 60). In Outward Bound, this approach is common and frequently referred to as “letting the mountain speak for itself.” I feel there may be times, places, and participant populations were this approach is appropriate. However, it seems to me that not providing a formal processing opportunity of some type in a clinical setting would be therapeutically inappropriate.
Time for transfer of learning is a necessary part of the therapeutic process, and I believe some formal processing should always occur. However, authors wrote, “Even though it might be used rarely, [independent processing] is the appropriate processing methodology when a particular set of conditions has been met” (p. 125). They define these conditions as an appropriate setting, that participants have a strong commitment to the experience, that participants have the requisite knowledge to understand the significance of an experience, and that the group has prior training in processing.
I suppose that if these four conditions were all present in the entire participant population, it might be appropriate to have the group sit quietly on a mountain top watching a sunset and consider that a processing experience. Even then, though, the counselor in me would follow up the independent reflection time with a short group process of it.
Climbing the Mountain
I see processing as an important part of experiential learning. In fact, it may be the most important part, since it provides participants the opportunity to develop awareness, identify thinking patterns, and practice mindfulness—all skills I believe essential for recovery. In a clinical setting, it seems to me that the activity is often less important than the processing opportunities it provides. In other words, climbing a mountain is not about reaching the pinnacle, but about what happens along the way.
Early in the book, the authors wrote, “According to Chinese Tao thinking, action and reflection cannot exist without each other” (p. 18). I found this book interesting and practical in many ways, providing a comprehensive system for viewing various processing methodologies. Independent reflection is one extreme end of a spectrum, and fostering movement toward independent processing has obvious value. After all, a client will eventually no longer be a client, and the skills learned in a clinical context need to transfer to life.
That said, the authors failed to convince me that achieving independent reflection should be the ultimate goal of processing, at least within a clinical context. Getting to the pinnacle is not what’s important in a learning experience. Working toward the pinnacle is. Without a formal processing experience of some sort, it seems to me that this dialectic of action and reflection will not be assured, and transfer of learning may not occur.
Work Cited
Luckner, J., and Nadler, R. (1997). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Company.
Priest, S., and Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Simpson, S., Miller, D., and Bocher, B. (2006). The Processing Pinnacle. Oklahoma City, OK: Wood’n’Barnes.
Saturday, March 21, 2009
Puzzle Pieces
I've recently read two books, Beautiful Boy and Tweak. Beautiful Boy, by David Sheff, is about the author’s struggles with his son Nic’s addiction, as well as his own denial and codependency. David wrote, “Addicts are in denial and their families are in it with them because often the truth is too inconceivable, too painful, and too terrifying” (p. 15). One aspect of this book I found especially interesting is the way the author integrates three different threads—his son’s addiction, general information on chemical dependency, and his own growing codependency. Tweak, by son Nic, provides another perspective.
While Beautiful Boy covered Nic’s entire life, Tweak covers about two years when Nic is in his early twenties, starting with a relapse that becomes a 28 day methamphetamine and heroin binge, followed by a stint in at an inpatient facility, about a year of clean time, another relapse, and another stint at an inpatient facility. While Beautiful Boy contains much confusion and helplessness, Tweak is about anger and desperation.
Throughout Beautiful Boy, David reports on his ongoing attempts to talk Nic into treatment for one more try. Like most addicts, Nic does not believe he needs treatment and does not believe it will help. Considering at least four treatment attempts are documented in David’s book, Nic’s skepticism seems understandable. It hasn’t worked before, why will it this time? This is something I face with clients frequently.
Most of my clients have been in treatment before, some several times. In fact, I’m currently working with a client who has completed inpatient twice in the past, has been in three different outpatient programs, and has been to mental health therapists off and on for nearly five years. This client is now eighteen and court mandated. Failure to follow through with all treatment recommendations would most likely lead to jail time. So he reluctantly agreed to begin treatment one more time, but he reported, “It probably won’t do any good.” Why would he think otherwise?
There is another level to Nic’s ambivalence, though, which seems quite common. Nic wrote, “Using is suck a fucking ridiculous little circle of monotony. The more I use, the more I need to kill the pain, so the more I need to keep using. Pretty soon it seems like going back, facing all my shit, well, it’s just too goddamn overwhelming. I’d rather dies than go through it” (p. 146).
At a certain point, using is no longer about getting high or the initial positive reinforcements. Instead, it becomes about escaping—at least temporarily—from the ever-mounting number of negative outcomes of using. It seems easier to just keep using. Nic wrote, “I don’t care. Isn’t that the greatest gift in the world—just not to care? I feel so grateful for it. That’s nothing I ever knew sober” (p. 60). Why give that up? For many of my clients, that’s the biggest question that needs answering in treatment.
Getting clean is hard work. It means changing everything in your life. It also means taking huge risks. Nic wrote, “Trying is terrifying because I know I will just fail” (p. 296). Nearly all my clients know that feeling. Nearly all my clients have made very similar comments. What if they say they want to get clean, but then can’t actually do it? What if they take that risk, but then fail? If they don’t try, then there's no possibility of failure. My clients know how to use. They've never failed at using. That sounds strange, perhaps, but addicts understand. And, that “circle of monotony” may be a bit of a bore, but at least it is predictable.
Many of my clients live in highly dysfunctional families, frequently filled with the chaotic fallout of substance abusing parents, family members with mental health issues, economic pressures, and similar stressors. For these youth, the predictable circle of monotony can have a certain appear. As a client once said, "I use. I get high. No surprises."
Chaos is not Nic’s history, though. Although divorced, both parents are successful and his childhood appears reasonably healthy. He went to private schools. He was successful and popular as a child, active in sports and other extracurricular activities. He doesn’t seem like a future meth addict. So what happened? I wondered that the entire time I was reading Beautiful Boy. I wondered that through much of Tweak.
Nic has a certain level of genetic predisposition, a grandfather who was an alcoholic. However, one grandparent who died before he was even born doesn’t seem enough to me, even though Nic wrote about his first using experience, with alcohol, “I drank some and then I just had to drink more until the whole glass was drained completely. I’m not sure why. Something was driving me that I couldn’t identify and still can’t comprehend” (p. 2).
Although this sounds very disease-like, I don’t believe in the disease model all that much, especially for adolescents. There must be more. There must be a missing puzzle piece. If Nic finds that missing puzzle piece, maybe he can get and stay clean. If I can help my clients find their missing pieces, maybe they can get and stay clean, too.
Maybe recovery is really about finding missing puzzle pieces.
In Beautiful Boy, this missing piece is not addressed. David is simply too helpless to look beyond the next crisis. In Tweak, though, it seemed obvious fairly quickly that Nic might have mental health issues. At first, I wondered if I was looking for this because of my work experience. After all, my clients all have co-occurring disorders, I’ve always worked with co-occurring clients, and I feel strongly that most adolescents with significant substance abuse issues probably have challenges in this area.
Much of Nic’s writing reflects a depressive state. At other times, though, he seems almost manic, even though it usually seems related to his use of meth. Nic wrote, “I… have an incredible anxiety socializing with people. I mean, if I’m at work, or I’m high, then that’s okay. But sober, going out with people my age, I am just really uncomfortable.” (p. 161). Eventually, after all his other treatment episodes, all the therapists he’s seen in his life, past diagnoses of depression and prescriptions for antidepressants that he simply abuses, and all the time spent high, Nic is given a diagnosis of bipolar disorder.
In my opinion, bipolar disorder is the new overly diagnosed condition. However, when accurately applied, I’ve seen treatment for this condition change lives dramatically. After two weeks on medications for bipolar disorder, Nic wrote, “Something has changed. And then it hits me—maybe it’s the medication… Sure, the change isn’t very dramatic. It’s no like shooting meth or something. But there is a slight difference. Keeping my head above water suddenly doesn’t seem so tiring. The blackness doesn’t swallow me up to such a horribly suffocating depth” (p. 204).
Both Beautiful Boy and Tweak can be grueling. David seems to often be lost in his helplessness and codependency, unable to live his life or even care for his other children. Indeed, David frequently wrote that he is addicted to Nic’s addiction. This is apparent throughout his book. This is also something I see frequently in the family members of clients.
Reading the relentless passages about using, crime, prostitution, and self-inflicted trauma is almost unbearable at times. After being diagnoses with bipolar disorder, Nic wrote, “How could I have spent my whole life battling so hard, not knowing what was wrong?” The better question, I think, is how could so many therapists, treatment centers, and other counselors have missed that puzzle piece?
With some of my clients, treatment is about learning skills to resist using. That's pretty simple. For other clients, though, there's much more. They know these skills. Heck, they could lead group sessions on triggers, relapse prevention, emotion regulation, and mindfulness. But, they still use. There's something missing in their recovery. They haven't found their puzzle piece. Yet.
While Beautiful Boy covered Nic’s entire life, Tweak covers about two years when Nic is in his early twenties, starting with a relapse that becomes a 28 day methamphetamine and heroin binge, followed by a stint in at an inpatient facility, about a year of clean time, another relapse, and another stint at an inpatient facility. While Beautiful Boy contains much confusion and helplessness, Tweak is about anger and desperation.
Throughout Beautiful Boy, David reports on his ongoing attempts to talk Nic into treatment for one more try. Like most addicts, Nic does not believe he needs treatment and does not believe it will help. Considering at least four treatment attempts are documented in David’s book, Nic’s skepticism seems understandable. It hasn’t worked before, why will it this time? This is something I face with clients frequently.
Most of my clients have been in treatment before, some several times. In fact, I’m currently working with a client who has completed inpatient twice in the past, has been in three different outpatient programs, and has been to mental health therapists off and on for nearly five years. This client is now eighteen and court mandated. Failure to follow through with all treatment recommendations would most likely lead to jail time. So he reluctantly agreed to begin treatment one more time, but he reported, “It probably won’t do any good.” Why would he think otherwise?
There is another level to Nic’s ambivalence, though, which seems quite common. Nic wrote, “Using is suck a fucking ridiculous little circle of monotony. The more I use, the more I need to kill the pain, so the more I need to keep using. Pretty soon it seems like going back, facing all my shit, well, it’s just too goddamn overwhelming. I’d rather dies than go through it” (p. 146).
At a certain point, using is no longer about getting high or the initial positive reinforcements. Instead, it becomes about escaping—at least temporarily—from the ever-mounting number of negative outcomes of using. It seems easier to just keep using. Nic wrote, “I don’t care. Isn’t that the greatest gift in the world—just not to care? I feel so grateful for it. That’s nothing I ever knew sober” (p. 60). Why give that up? For many of my clients, that’s the biggest question that needs answering in treatment.
Getting clean is hard work. It means changing everything in your life. It also means taking huge risks. Nic wrote, “Trying is terrifying because I know I will just fail” (p. 296). Nearly all my clients know that feeling. Nearly all my clients have made very similar comments. What if they say they want to get clean, but then can’t actually do it? What if they take that risk, but then fail? If they don’t try, then there's no possibility of failure. My clients know how to use. They've never failed at using. That sounds strange, perhaps, but addicts understand. And, that “circle of monotony” may be a bit of a bore, but at least it is predictable.
Many of my clients live in highly dysfunctional families, frequently filled with the chaotic fallout of substance abusing parents, family members with mental health issues, economic pressures, and similar stressors. For these youth, the predictable circle of monotony can have a certain appear. As a client once said, "I use. I get high. No surprises."
Chaos is not Nic’s history, though. Although divorced, both parents are successful and his childhood appears reasonably healthy. He went to private schools. He was successful and popular as a child, active in sports and other extracurricular activities. He doesn’t seem like a future meth addict. So what happened? I wondered that the entire time I was reading Beautiful Boy. I wondered that through much of Tweak.
Nic has a certain level of genetic predisposition, a grandfather who was an alcoholic. However, one grandparent who died before he was even born doesn’t seem enough to me, even though Nic wrote about his first using experience, with alcohol, “I drank some and then I just had to drink more until the whole glass was drained completely. I’m not sure why. Something was driving me that I couldn’t identify and still can’t comprehend” (p. 2).
Although this sounds very disease-like, I don’t believe in the disease model all that much, especially for adolescents. There must be more. There must be a missing puzzle piece. If Nic finds that missing puzzle piece, maybe he can get and stay clean. If I can help my clients find their missing pieces, maybe they can get and stay clean, too.
Maybe recovery is really about finding missing puzzle pieces.
In Beautiful Boy, this missing piece is not addressed. David is simply too helpless to look beyond the next crisis. In Tweak, though, it seemed obvious fairly quickly that Nic might have mental health issues. At first, I wondered if I was looking for this because of my work experience. After all, my clients all have co-occurring disorders, I’ve always worked with co-occurring clients, and I feel strongly that most adolescents with significant substance abuse issues probably have challenges in this area.
Much of Nic’s writing reflects a depressive state. At other times, though, he seems almost manic, even though it usually seems related to his use of meth. Nic wrote, “I… have an incredible anxiety socializing with people. I mean, if I’m at work, or I’m high, then that’s okay. But sober, going out with people my age, I am just really uncomfortable.” (p. 161). Eventually, after all his other treatment episodes, all the therapists he’s seen in his life, past diagnoses of depression and prescriptions for antidepressants that he simply abuses, and all the time spent high, Nic is given a diagnosis of bipolar disorder.
In my opinion, bipolar disorder is the new overly diagnosed condition. However, when accurately applied, I’ve seen treatment for this condition change lives dramatically. After two weeks on medications for bipolar disorder, Nic wrote, “Something has changed. And then it hits me—maybe it’s the medication… Sure, the change isn’t very dramatic. It’s no like shooting meth or something. But there is a slight difference. Keeping my head above water suddenly doesn’t seem so tiring. The blackness doesn’t swallow me up to such a horribly suffocating depth” (p. 204).
Both Beautiful Boy and Tweak can be grueling. David seems to often be lost in his helplessness and codependency, unable to live his life or even care for his other children. Indeed, David frequently wrote that he is addicted to Nic’s addiction. This is apparent throughout his book. This is also something I see frequently in the family members of clients.
Reading the relentless passages about using, crime, prostitution, and self-inflicted trauma is almost unbearable at times. After being diagnoses with bipolar disorder, Nic wrote, “How could I have spent my whole life battling so hard, not knowing what was wrong?” The better question, I think, is how could so many therapists, treatment centers, and other counselors have missed that puzzle piece?
With some of my clients, treatment is about learning skills to resist using. That's pretty simple. For other clients, though, there's much more. They know these skills. Heck, they could lead group sessions on triggers, relapse prevention, emotion regulation, and mindfulness. But, they still use. There's something missing in their recovery. They haven't found their puzzle piece. Yet.
Saturday, February 21, 2009
Riskier Risks
I’ve recently re-read The Primal Teen, by Barbara Strauch, to help me prepare for an upcoming workshop I’ll be presenting. In the book, Strauch presents findings from several studies showing that the human brain undergoes “dramatic changes around puberty and early adolescents” ( p. 15).
These changes include a thickening of the outer layer, which then thins suddenly and significantly. This thickening is thought to be the result of an “overproduction” of brain cells. Many scientists believe that during this overproduction, “the brain may be highly receptive to new information” (Strauch, p. 15).
While this overproduction is happening during adolescents, there is also a significant amount of synaptic pruning, explaining that sudden thinning. Strauch states that “some dendrite branches and their synapses develop and thrive simply because they’re used the most and grab the most neurochemical juice” (p. 17). On the other hand, less used or unused branches and synapses tend to get pruned.
Life experiences determine which synapses get used and which do not, thereby “impacting the brain’s essential architecture” (Strauch, p. 17). Siegel conceives of the mind as separate from the brain, stating, “The human mind emerges from the activity of the brain, whose structure and function are directly shaped by interpersonal experiences” (p. 1). He continued, “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).
However, while experience is shaping the brain during adolescence, “it remains more exposed, more easily wounded, perhaps much more susceptible to critical and long-lasting damage than most parents and educators or even most scientists had though” (Strauch, p. 21).
Taking Risks
It seems to me, based on my experience working with high-needs teen, that this critical time of brain development is also a time of risk-taking and impulsive behavior. In other words, while the brain is at most risk, the likelihood of risk taking is highest. Strauch states, that high impulsivity is “one of the world’s stereotypes about teenagers that just happens to be true” (p. 24). This is true, at least partly, because the frontal lobes, part of the brain that is used to resist impulses, is not yet fully developed in an adolescent’s brain (Strauch, p. 26).
So, all teens are impulsive. That’s not really news. However, this developmental appropriate impulsiveness can manifest itself in extremely different ways.
What is different between “Alex,” a seventeen year old neighbor kid who is on the soccer team, vice president of his class, and planning to attend UW next fall, and “Carl,” a seventeen year old client who has an extensive criminal record that includes auto theft and drug dealing, a history of unsuccessful chemical dependency counseling, and an alphabet soup listing of mental health diagnosis including ADHD, PTSD, and ODD?
Oh, if you saw Carl on the street, you’d think he was in his early 20s, not 17. If you talked to him, though, you’d think he was about 13. It is also important to know that when Carl was four years old, his family was living in their car when he witnessed the death by overdose of both parents. He’s spent most of his life being shuffled between group homes or on the run.
Is the differences between neighbor kid Alex and Carl a case of use-it-or-lose-it synaptic pruning? Carl’s past experiences have certainly had significant influence on his current multi-dimensional challenges, but it seems to me there must be more.
When asked, Carl describes his past risky behaviors—from stealing cars to having unprotected sex—by stating that such behavior “gives me a rush you just can’t believe.” Strauch cites several studies that suggest risk-taking in teens is developmentally necessary, a way to test boundaries and explore autonomy. In addition, adolescent risk taking involves “complex interactions across several brain systems of motivation and reward, including those that involve the neurotransmitter dopamine—one of the key brain chemicals that carry and influence the messages between nerve cells” (Dahl, qtd in Strauch, p. 92). However, not all teens steal cars, deal drugs, become meth addicts, and end up as my clients—even when they have pasts similar to Carl’s.
Could the answer be that Carl has an imbalance in dopamine that compels him to take riskier risks? Could the answer be that having physically matured earlier than his peers he has a particular vulnerability because his brain is “an engine without a driver” (Dahl, qtd in Strauch, p. 96). The answer to these questions would seemingly suggest very different treatment strategies.
If Carl has a chemical imbalance, medication would probably be an appropriate treatment approach. If he simply needs to mentally catch up with his physical development, perhaps he simply needs to be kept safe until this happens. That might suggest he needs a more structured environment, as his current home environment is clearly not preventing him from engaging in risky, even life-threatening, behavior. Or, maybe he just needs better choices of risky behavior. Could activities such as hang gliding, snow boarding, mountain climbing, and auto racing “cure” Carl?
Riskier Risks
All teens do not become chemically dependent car thieves. However, it does seem to me that, in general adolescents today take riskier risks than in the past. I hypothesize that there are three inter-related reasons for this. First, adolescence starts earlier than ever before, with the onset of puberty at eleven or twelve in many cases. That means youth are younger when physical development begins and their drive for autonomy surfaces. However, the onset of cognitive development, especially problem solving abilities, has remained consistent. This leads to physical maturity without cognitive maturity. I have certainly witnessed this with Carl and other clients.
Second, adolescence ends later, both physically and culturally, generally not ending until the early 20s (or even later). Combined, these factors have led to a significantly longer period of time spent within The Danger Gap, that space where physical development has raced significantly ahead of cognitive development.
Finally, there's the third reason: risks lurking within that Danger Gap are riskier today than ever before. A few examples: the THC levels in marijuana are now as high as 25-30%, making it more addictive than in the past; other substances of abuse, such as meth and crack, are highly addictive and readily available; youth are less supervised then ever before, and this lack of supervision starts at an earlier age.
Siegel wrote, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (p. 19). These processes that begin at birth continue into adolescence and beyond. Perhaps it is these early experiences that influence how a teen will respond to the ever-growing Danger Gap. Perhaps for Carl, his early life experiences have created synaptic connections that compel him to engage in the highest risk behaviors available to him.
If this were the answer, it would seem a combination of treatment strategies is most appropriate. In other words, keep him out of danger while he continues to cognitively develop, encourage participation in “appropriate” risky behavior, but also expose him to experiences that allow new, more adaptive synaptic connections to be nurtured.
Works Cited
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Strauch, B. (2003). Primal Teen, The. New york: Anchor Books.
These changes include a thickening of the outer layer, which then thins suddenly and significantly. This thickening is thought to be the result of an “overproduction” of brain cells. Many scientists believe that during this overproduction, “the brain may be highly receptive to new information” (Strauch, p. 15).
While this overproduction is happening during adolescents, there is also a significant amount of synaptic pruning, explaining that sudden thinning. Strauch states that “some dendrite branches and their synapses develop and thrive simply because they’re used the most and grab the most neurochemical juice” (p. 17). On the other hand, less used or unused branches and synapses tend to get pruned.
Life experiences determine which synapses get used and which do not, thereby “impacting the brain’s essential architecture” (Strauch, p. 17). Siegel conceives of the mind as separate from the brain, stating, “The human mind emerges from the activity of the brain, whose structure and function are directly shaped by interpersonal experiences” (p. 1). He continued, “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).
However, while experience is shaping the brain during adolescence, “it remains more exposed, more easily wounded, perhaps much more susceptible to critical and long-lasting damage than most parents and educators or even most scientists had though” (Strauch, p. 21).
Taking Risks
It seems to me, based on my experience working with high-needs teen, that this critical time of brain development is also a time of risk-taking and impulsive behavior. In other words, while the brain is at most risk, the likelihood of risk taking is highest. Strauch states, that high impulsivity is “one of the world’s stereotypes about teenagers that just happens to be true” (p. 24). This is true, at least partly, because the frontal lobes, part of the brain that is used to resist impulses, is not yet fully developed in an adolescent’s brain (Strauch, p. 26).
So, all teens are impulsive. That’s not really news. However, this developmental appropriate impulsiveness can manifest itself in extremely different ways.
What is different between “Alex,” a seventeen year old neighbor kid who is on the soccer team, vice president of his class, and planning to attend UW next fall, and “Carl,” a seventeen year old client who has an extensive criminal record that includes auto theft and drug dealing, a history of unsuccessful chemical dependency counseling, and an alphabet soup listing of mental health diagnosis including ADHD, PTSD, and ODD?
Oh, if you saw Carl on the street, you’d think he was in his early 20s, not 17. If you talked to him, though, you’d think he was about 13. It is also important to know that when Carl was four years old, his family was living in their car when he witnessed the death by overdose of both parents. He’s spent most of his life being shuffled between group homes or on the run.
Is the differences between neighbor kid Alex and Carl a case of use-it-or-lose-it synaptic pruning? Carl’s past experiences have certainly had significant influence on his current multi-dimensional challenges, but it seems to me there must be more.
When asked, Carl describes his past risky behaviors—from stealing cars to having unprotected sex—by stating that such behavior “gives me a rush you just can’t believe.” Strauch cites several studies that suggest risk-taking in teens is developmentally necessary, a way to test boundaries and explore autonomy. In addition, adolescent risk taking involves “complex interactions across several brain systems of motivation and reward, including those that involve the neurotransmitter dopamine—one of the key brain chemicals that carry and influence the messages between nerve cells” (Dahl, qtd in Strauch, p. 92). However, not all teens steal cars, deal drugs, become meth addicts, and end up as my clients—even when they have pasts similar to Carl’s.
Could the answer be that Carl has an imbalance in dopamine that compels him to take riskier risks? Could the answer be that having physically matured earlier than his peers he has a particular vulnerability because his brain is “an engine without a driver” (Dahl, qtd in Strauch, p. 96). The answer to these questions would seemingly suggest very different treatment strategies.
If Carl has a chemical imbalance, medication would probably be an appropriate treatment approach. If he simply needs to mentally catch up with his physical development, perhaps he simply needs to be kept safe until this happens. That might suggest he needs a more structured environment, as his current home environment is clearly not preventing him from engaging in risky, even life-threatening, behavior. Or, maybe he just needs better choices of risky behavior. Could activities such as hang gliding, snow boarding, mountain climbing, and auto racing “cure” Carl?
Riskier Risks
All teens do not become chemically dependent car thieves. However, it does seem to me that, in general adolescents today take riskier risks than in the past. I hypothesize that there are three inter-related reasons for this. First, adolescence starts earlier than ever before, with the onset of puberty at eleven or twelve in many cases. That means youth are younger when physical development begins and their drive for autonomy surfaces. However, the onset of cognitive development, especially problem solving abilities, has remained consistent. This leads to physical maturity without cognitive maturity. I have certainly witnessed this with Carl and other clients.
Second, adolescence ends later, both physically and culturally, generally not ending until the early 20s (or even later). Combined, these factors have led to a significantly longer period of time spent within The Danger Gap, that space where physical development has raced significantly ahead of cognitive development.
Finally, there's the third reason: risks lurking within that Danger Gap are riskier today than ever before. A few examples: the THC levels in marijuana are now as high as 25-30%, making it more addictive than in the past; other substances of abuse, such as meth and crack, are highly addictive and readily available; youth are less supervised then ever before, and this lack of supervision starts at an earlier age.
Siegel wrote, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (p. 19). These processes that begin at birth continue into adolescence and beyond. Perhaps it is these early experiences that influence how a teen will respond to the ever-growing Danger Gap. Perhaps for Carl, his early life experiences have created synaptic connections that compel him to engage in the highest risk behaviors available to him.
If this were the answer, it would seem a combination of treatment strategies is most appropriate. In other words, keep him out of danger while he continues to cognitively develop, encourage participation in “appropriate” risky behavior, but also expose him to experiences that allow new, more adaptive synaptic connections to be nurtured.
Works Cited
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Strauch, B. (2003). Primal Teen, The. New york: Anchor Books.
Saturday, January 24, 2009
Fostering Resiliency with Experiential Activities
Children who grow up in troubled families often develop skills that help them cope with the adversity in their environment and grow emotionally stronger in the process. Wolin and Wolin refers to this ability to “spring back” as resiliency. They began researching resiliency in 1989, while they were interviewing adults who had grown up in families with parents suffering from chemical dependency, co-occurring disorders, and other family issues. To their surprise, none of their subjects exhibited characteristics typically associated with adult children of troubled families: fear of abandonment, a sense of isolation, co-dependency, and substance abuse. With this discovery, Wolin and Wolin began to focus their research efforts on how these subjects had become resilient.
Resiliency isn't a new concept. In 1955, Werner and Smith began a study that followed nearly 700 children born on the island of Kauai, Hawaii. All their subjects had come from families dealing with issues that included chemical dependency, mental illness, and economic difficulties. Thirty-four years later, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience. (Werner, 1989.)
In 1978, Bleuler, who spent thirty years studying schizophrenics and their families, wrote:
It is surprising to note that their [children of schizophrenics] spirit is not broken, even of children who have suffered severe adversity for many years. In studying a number of the family histories, one is even left with the impression that pain and suffering has a steeling – a hardening – effect on the personalities of some children. (Bleuler, 1978.)
Kagan stated that children should not be viewed as passive objects, but rather be considered active participants in their emotional lives. He goes on to propose that a child’s understanding of what occurs to him or her is more important than what actually happens. He wrote:
The effect of an emotionally significant experience – like a father’s prolonged absence or a bitter divorce – will depend on how the child interprets these events… Rarely will there be a fixed consequence of any single event – no matter how traumatic – or special set of family conditions. (Kagan, 1984.)
Felsman and Vaillant studied seventy-five inner-city American males, all from families that were impacted by chemical dependency, economically disadvantaged, or included a parent with mental illness. They wrote:
Our preliminary indications are that the successful men in our high-risk group are…not free from their difficult early memories. We would speculate that it is their style of remember and feeling that is important… Most do have access to their pasts and are able to bear that pain and sorrow, and in so doing, to draw upon it as a source of strength… [This ability] seems to inform that generative quality in the way they live. (Felsman & Vaillant, 1987.)
The Seven Resiliencies
According to Wolin and Wolin, resilient individuals exhibit specific behaviors, or competencies. They classified these competencies into what they call the Seven Resiliencies: insight, independence, relationships, initiative, creativity, humor, and morality. Each competency has three stages, which develop progressively: the childhood stage, the adolescent stage, and the adult stage. In children, competencies appear as unformed, non-goal oriented, intuitive behavior. In adolescents, these behaviors sharpen and become deliberate. In adults, the behaviors broaden and deepen, becoming a fully integrated part of the individual.
• Insight
Insight is “the mental habit of asking searching questions and giving honest answers.” (Wolin & Wolin, 1993.) According to Wolin and Wolin, developing insight is an essential foundation for the other competencies, because it allows the individual to think objectively about her circumstance. Sensing, the initial stage of insight, occurs with a resilient child’s realization that her family is different than most, accompanied by an awareness of the antecedents for problems. In the next stage, knowing, a resilient teen develops awareness of the family’s underlying issues. Understanding, the adult stage, involves re-examining childhood memories, as well as developing practical strategies for dealing with a troubled past.
• Independence
Independence is the purposeful creation of both physical and emotional space between a resilient individual and the troubled family. The first stage of independence is straying. This happens when a resilient child starts to seek physical distance from his troubled family, perhaps by playing in unused corners of the house, spending time at neighbors, or going on secret adventures. Disengaging is the second stage of independence, and begins when a resilient teen starts to stray farther. Some examples of this include getting a job, participating in after-school activities, and spending time at the homes of friends and relatives. During this stage, a resilient teen will also begin to disengage emotionally. In the final stage, separating, a resilient adult establishes strategies to reduce and control interactions with his family, such as moving a significant distance, or limiting contact to phone calls or letters.
• Relationships
Relationships are “connections with other people based on sharing, mutual respect, and openness.” (Wolin & Desetta, 2000.) Connecting is the first stage. A resilient child enters this stage by making tentative steps to engage with non-family members, most frequently an adult neighbor or teacher. A resilient teen moves on to recruiting, the second stage, by actively applying the skills developed in the connecting stage to establish a meaningful relationship with an adult who can serve as a substitute parent. Resilient adults enter the final stage, attaching, by establishing relationships with partners from healthy families, and consciously choosing to not repeat past patterns.
• Initiative
Initiative is a determination to prevail over one’s troubled past experiences or present environment. The first stage is exploring. In this stage, through “conducting trial-and-error experiments that often succeed, resilient children find tangible rewards and achieve a sense of effectiveness.” (Wolin & Wolin, 1993.) In the second stage, working, resilient teens move from random experimentation to participating in focused, goal-oriented activities such as school, community service, and clubs. Having moved to the final stage, generating, a resilient adult exhibits leadership, strong practical skills, and an enthusiasm for planning.
• Creativity and Humor
Creativity and humor are closely related competencies. Both use imagination to relieve troubling emotions and environmental chaos. These two resiliencies also share the first two stages. Playing—the first stage for both—includes all the imaginative activities in which a resilient child engages to escape from real life difficulties. When a resilient adolescent moves to shaping—the second stage for both—playing evolves into the tentative creation of art. In the final stage of creativity, composing, a resilient adult engages in more skilled pursuits of the arts, possibly at a professional or semi-professional level. However, resilient adults are more likely to move into the final stage of humor, which is laughing. At this stage, having developed an awareness of a larger context, a resilient adult discovers the absurdity in situations that seem sad, embarrassing, or stressful.
• Morality
Morality, the final competency, is doing the right thing even when difficult, and striving to see the strength possible in human nature despite personal adversity. A resilient child enters the first stage of morality, judging, by distinguishing between right and wrong, even as it relates to her own family. A resilient adolescent moves to the second stage, valuing, by developing an understanding of concepts such as decency, compassion, and honesty. In this stage, resilient teens often attempt to apply this growing understanding at home and in the world. In the final stage, serving, a resilient adult is strongly committed to doing what’s right at home and work, and is frequently involved in community service and political causes.
My Adaptations of the Wolin Model
In my own resiliency-oriented work with substance abusing teens, I’ve adapted the Wolin Model in three ways. First, I consider humor a type of creativity. Since I work exclusively with teens and the Wolins define the child and adolescent stages of these competencies as the same, this seems appropriate. Also, humor can serve as an example of ways to be creative beyond the arts, inviting the exploration of of creativity as an approach and not an act.
The second way I’ve adapted the Wolin Model is by referring to the final competency as integrity, not morality. In my experience, the word morality can be highly charged for many people. (As you'll read below, reframing is an important concept in resiliency-work, and I'm well aware of the irony of me avoiding this particular reframing challenge. However, I believe that integrity is an equally valid name for this competency, and thus would rather avoid this clinical roadblock than spend precious treatment time working through it.)
The third way I’ve adapted the Wolin Model is by linking independence and relationships in the new competency of interdependence. I believe adding this competency is especially important with the population I work with because it reinforces key recovery concepts such as needing sober supports, working on family systems challenges, addressing peer group issues, and establishing appropriate boundaries.
Resiliency as a Strengths-Based Practice
Wolin and Wolin stated, “The most important part of a strength-based approach is believing that youth in trouble actually have strengths and can act on them” (Project Resilience, 2004). For youth who grow up in families impacted by chemical dependency or other problems—which is true for the vast majority of the clients I work with—some or all of the competencies often develop naturally. Helping clients identify, explore, and develop their natural competencies should be a part of any treatment strategy.
All youth have strengths or talents, but not all naturally develop resilience. When this is the case, the Wolin Model can provide an effective foundation for fostering resiliency. Wolin and Wolin have identified three closely related steps for doing this. The first step is reframing, or “viewing an old story from a new perspective.” (Wolin, Desetta & Hefner, 2000.) Derived from traditional family therapy practices and cognitive-behavioral theory, reframing focuses on the subjective nature of personal stories to uncover alternative, positive themes that will allow an individual to transform his thinking from that of a damaged victim to that of a survivor with strengths forged from adversity.
The second step identified by Wolin and Wolin is the assumption that everyone who grows up in a troubled family has some degree of natural resilience, even if an individual does not presently exhibit well-developed strengths in all, or even most, of the resiliency categories.
The final core concept is survivor’s pride, which Wolin and Wolin defined as “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity.” (Wolin & Wolin, 2004.) A mixture of pain and empowerment, survivor’s pride can be a powerful motivator, but often remains unacknowledged.
Fostering Resiliency
It seems to me that experiential learning methodologies inherently reinforce insight, independence, relationships, interdependence, initiative, creativity, and integrity. In other words, if you’re using experiential learning, you’re fostering resiliency. I suggest, though, that by becoming more intentional about integrating resiliency, we can increase the effectiveness of experiential learning to foster resilience in our clients.
One way to do this is by selecting activities that provide increased opportunities for the practice of the competencies, and then frame the activities to emphasize this. An example is the activity Pressure Pads. In this activity, participants must get from the Starting Line to the Finish Line without touching the ground. To do so, they're given carpet squares, polyspots, or something similar—generally fewer spots than total number of participants.
For me, Pressure Pads is an excellent metaphor for recovery: the task is harder than it initially seems, you start with limited resources, you'll only be successful if you have help from others, many people want to give up along the way. Several of these ideas easily connect to the competencies and the three Core Concepts, including the need for relationships and interdependence, creative problem solving, and reframing what initially might seem impossible. In addition, it is extremely easy to cheat during Pressure Pads, which provides rich opportunities for exploring integrity.
So much to talk about! In fact, it seems to me that when you integrate resiliency-work into any clinical application of experiential learning, you have the opportunityl to exponentially increase the outcome potentials. How can you possibly pass that up?
Here are a few other ideas to assist in being more intentional about integrating resiliency into experiential activities:
• Teach clients the basic concepts and vocabulary of resiliency.
• Use the basic concepts and vocabulary of resiliency when framing, doing, and processing activities.
• Help clients identify and develop competencies they already possess.
• Challenge clients to practice competencies they do not yet possess.
• Connect the competencies practiced during experiential activities to real world situations.
As we’ve seen, the Wolin Model is a method to understand strengths, identify weaknesses, and re-conceptualize a family past troubled by chemical dependency or other dysfunction. This model can also be taught to individuals who do not exhibit natural competencies and experiential learning provides an excellent fit for this. While the Wolin Model cannot change a troubled past, it can provide a source of personal pride and renewed strength to help assure a healthier future.
Works Cited
Project Resilience. (1999). http://www.projectresilience.com.
Wolin, S. & Desetta, A. (2000). The Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S., Desetta, A. & Hefner, K. (2000). The Leader’s Guide to the Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S.J. & Wolin, S. (1993). The Resilient Self. New York: Villard.
Resiliency isn't a new concept. In 1955, Werner and Smith began a study that followed nearly 700 children born on the island of Kauai, Hawaii. All their subjects had come from families dealing with issues that included chemical dependency, mental illness, and economic difficulties. Thirty-four years later, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience. (Werner, 1989.)
In 1978, Bleuler, who spent thirty years studying schizophrenics and their families, wrote:
It is surprising to note that their [children of schizophrenics] spirit is not broken, even of children who have suffered severe adversity for many years. In studying a number of the family histories, one is even left with the impression that pain and suffering has a steeling – a hardening – effect on the personalities of some children. (Bleuler, 1978.)
Kagan stated that children should not be viewed as passive objects, but rather be considered active participants in their emotional lives. He goes on to propose that a child’s understanding of what occurs to him or her is more important than what actually happens. He wrote:
The effect of an emotionally significant experience – like a father’s prolonged absence or a bitter divorce – will depend on how the child interprets these events… Rarely will there be a fixed consequence of any single event – no matter how traumatic – or special set of family conditions. (Kagan, 1984.)
Felsman and Vaillant studied seventy-five inner-city American males, all from families that were impacted by chemical dependency, economically disadvantaged, or included a parent with mental illness. They wrote:
Our preliminary indications are that the successful men in our high-risk group are…not free from their difficult early memories. We would speculate that it is their style of remember and feeling that is important… Most do have access to their pasts and are able to bear that pain and sorrow, and in so doing, to draw upon it as a source of strength… [This ability] seems to inform that generative quality in the way they live. (Felsman & Vaillant, 1987.)
The Seven Resiliencies
According to Wolin and Wolin, resilient individuals exhibit specific behaviors, or competencies. They classified these competencies into what they call the Seven Resiliencies: insight, independence, relationships, initiative, creativity, humor, and morality. Each competency has three stages, which develop progressively: the childhood stage, the adolescent stage, and the adult stage. In children, competencies appear as unformed, non-goal oriented, intuitive behavior. In adolescents, these behaviors sharpen and become deliberate. In adults, the behaviors broaden and deepen, becoming a fully integrated part of the individual.
• Insight
Insight is “the mental habit of asking searching questions and giving honest answers.” (Wolin & Wolin, 1993.) According to Wolin and Wolin, developing insight is an essential foundation for the other competencies, because it allows the individual to think objectively about her circumstance. Sensing, the initial stage of insight, occurs with a resilient child’s realization that her family is different than most, accompanied by an awareness of the antecedents for problems. In the next stage, knowing, a resilient teen develops awareness of the family’s underlying issues. Understanding, the adult stage, involves re-examining childhood memories, as well as developing practical strategies for dealing with a troubled past.
• Independence
Independence is the purposeful creation of both physical and emotional space between a resilient individual and the troubled family. The first stage of independence is straying. This happens when a resilient child starts to seek physical distance from his troubled family, perhaps by playing in unused corners of the house, spending time at neighbors, or going on secret adventures. Disengaging is the second stage of independence, and begins when a resilient teen starts to stray farther. Some examples of this include getting a job, participating in after-school activities, and spending time at the homes of friends and relatives. During this stage, a resilient teen will also begin to disengage emotionally. In the final stage, separating, a resilient adult establishes strategies to reduce and control interactions with his family, such as moving a significant distance, or limiting contact to phone calls or letters.
• Relationships
Relationships are “connections with other people based on sharing, mutual respect, and openness.” (Wolin & Desetta, 2000.) Connecting is the first stage. A resilient child enters this stage by making tentative steps to engage with non-family members, most frequently an adult neighbor or teacher. A resilient teen moves on to recruiting, the second stage, by actively applying the skills developed in the connecting stage to establish a meaningful relationship with an adult who can serve as a substitute parent. Resilient adults enter the final stage, attaching, by establishing relationships with partners from healthy families, and consciously choosing to not repeat past patterns.
• Initiative
Initiative is a determination to prevail over one’s troubled past experiences or present environment. The first stage is exploring. In this stage, through “conducting trial-and-error experiments that often succeed, resilient children find tangible rewards and achieve a sense of effectiveness.” (Wolin & Wolin, 1993.) In the second stage, working, resilient teens move from random experimentation to participating in focused, goal-oriented activities such as school, community service, and clubs. Having moved to the final stage, generating, a resilient adult exhibits leadership, strong practical skills, and an enthusiasm for planning.
• Creativity and Humor
Creativity and humor are closely related competencies. Both use imagination to relieve troubling emotions and environmental chaos. These two resiliencies also share the first two stages. Playing—the first stage for both—includes all the imaginative activities in which a resilient child engages to escape from real life difficulties. When a resilient adolescent moves to shaping—the second stage for both—playing evolves into the tentative creation of art. In the final stage of creativity, composing, a resilient adult engages in more skilled pursuits of the arts, possibly at a professional or semi-professional level. However, resilient adults are more likely to move into the final stage of humor, which is laughing. At this stage, having developed an awareness of a larger context, a resilient adult discovers the absurdity in situations that seem sad, embarrassing, or stressful.
• Morality
Morality, the final competency, is doing the right thing even when difficult, and striving to see the strength possible in human nature despite personal adversity. A resilient child enters the first stage of morality, judging, by distinguishing between right and wrong, even as it relates to her own family. A resilient adolescent moves to the second stage, valuing, by developing an understanding of concepts such as decency, compassion, and honesty. In this stage, resilient teens often attempt to apply this growing understanding at home and in the world. In the final stage, serving, a resilient adult is strongly committed to doing what’s right at home and work, and is frequently involved in community service and political causes.
My Adaptations of the Wolin Model
In my own resiliency-oriented work with substance abusing teens, I’ve adapted the Wolin Model in three ways. First, I consider humor a type of creativity. Since I work exclusively with teens and the Wolins define the child and adolescent stages of these competencies as the same, this seems appropriate. Also, humor can serve as an example of ways to be creative beyond the arts, inviting the exploration of of creativity as an approach and not an act.
The second way I’ve adapted the Wolin Model is by referring to the final competency as integrity, not morality. In my experience, the word morality can be highly charged for many people. (As you'll read below, reframing is an important concept in resiliency-work, and I'm well aware of the irony of me avoiding this particular reframing challenge. However, I believe that integrity is an equally valid name for this competency, and thus would rather avoid this clinical roadblock than spend precious treatment time working through it.)
The third way I’ve adapted the Wolin Model is by linking independence and relationships in the new competency of interdependence. I believe adding this competency is especially important with the population I work with because it reinforces key recovery concepts such as needing sober supports, working on family systems challenges, addressing peer group issues, and establishing appropriate boundaries.
Resiliency as a Strengths-Based Practice
Wolin and Wolin stated, “The most important part of a strength-based approach is believing that youth in trouble actually have strengths and can act on them” (Project Resilience, 2004). For youth who grow up in families impacted by chemical dependency or other problems—which is true for the vast majority of the clients I work with—some or all of the competencies often develop naturally. Helping clients identify, explore, and develop their natural competencies should be a part of any treatment strategy.
All youth have strengths or talents, but not all naturally develop resilience. When this is the case, the Wolin Model can provide an effective foundation for fostering resiliency. Wolin and Wolin have identified three closely related steps for doing this. The first step is reframing, or “viewing an old story from a new perspective.” (Wolin, Desetta & Hefner, 2000.) Derived from traditional family therapy practices and cognitive-behavioral theory, reframing focuses on the subjective nature of personal stories to uncover alternative, positive themes that will allow an individual to transform his thinking from that of a damaged victim to that of a survivor with strengths forged from adversity.
The second step identified by Wolin and Wolin is the assumption that everyone who grows up in a troubled family has some degree of natural resilience, even if an individual does not presently exhibit well-developed strengths in all, or even most, of the resiliency categories.
The final core concept is survivor’s pride, which Wolin and Wolin defined as “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity.” (Wolin & Wolin, 2004.) A mixture of pain and empowerment, survivor’s pride can be a powerful motivator, but often remains unacknowledged.
Fostering Resiliency
It seems to me that experiential learning methodologies inherently reinforce insight, independence, relationships, interdependence, initiative, creativity, and integrity. In other words, if you’re using experiential learning, you’re fostering resiliency. I suggest, though, that by becoming more intentional about integrating resiliency, we can increase the effectiveness of experiential learning to foster resilience in our clients.
One way to do this is by selecting activities that provide increased opportunities for the practice of the competencies, and then frame the activities to emphasize this. An example is the activity Pressure Pads. In this activity, participants must get from the Starting Line to the Finish Line without touching the ground. To do so, they're given carpet squares, polyspots, or something similar—generally fewer spots than total number of participants.
For me, Pressure Pads is an excellent metaphor for recovery: the task is harder than it initially seems, you start with limited resources, you'll only be successful if you have help from others, many people want to give up along the way. Several of these ideas easily connect to the competencies and the three Core Concepts, including the need for relationships and interdependence, creative problem solving, and reframing what initially might seem impossible. In addition, it is extremely easy to cheat during Pressure Pads, which provides rich opportunities for exploring integrity.
So much to talk about! In fact, it seems to me that when you integrate resiliency-work into any clinical application of experiential learning, you have the opportunityl to exponentially increase the outcome potentials. How can you possibly pass that up?
Here are a few other ideas to assist in being more intentional about integrating resiliency into experiential activities:
• Teach clients the basic concepts and vocabulary of resiliency.
• Use the basic concepts and vocabulary of resiliency when framing, doing, and processing activities.
• Help clients identify and develop competencies they already possess.
• Challenge clients to practice competencies they do not yet possess.
• Connect the competencies practiced during experiential activities to real world situations.
As we’ve seen, the Wolin Model is a method to understand strengths, identify weaknesses, and re-conceptualize a family past troubled by chemical dependency or other dysfunction. This model can also be taught to individuals who do not exhibit natural competencies and experiential learning provides an excellent fit for this. While the Wolin Model cannot change a troubled past, it can provide a source of personal pride and renewed strength to help assure a healthier future.
Works Cited
Project Resilience. (1999). http://www.projectresilience.com.
Wolin, S. & Desetta, A. (2000). The Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S., Desetta, A. & Hefner, K. (2000). The Leader’s Guide to the Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S.J. & Wolin, S. (1993). The Resilient Self. New York: Villard.
Sunday, January 11, 2009
Adventure Programming with GLBT Youth
(NOTE: Most of my posts on this blog are "new writing" based on my current reading, preparation for workshops, and so on. Periodically, though, I'll post "old writing" such as this paper written about two years ago in support of a grant proposal. Although not specific to clinical uses of experiential learning, I believe it is relevant. Hopefully you agree.)
A Chinese proverb states, "Tell me and I will forget. Show me and I may remember. Involve me and I will understand." The primary objective of adventure programming is to do just that, involve clients in a physically engaging manner so that they come to understand. In this paper, I will present evidence that supports the use of this physically engaging manner as an effective methodology to reduce at-risk behaviors in gay, lesbian, bisexual, and transgender (GLBT) youth by decreasing the likelihood of alienation, fostering resiliency, and countering internalized homophobia.
First, though, a deeper exploration of adventure programming and its goals is warranted. According to the Association of Experiential Education, adventure programming, like all types of experiential learning, is “a philosophy and methodology in which educators purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills, and clarify values” (AEE, p. 1).
Any form of experiential learning has two critical steps: doing and processing. The doing step is the activity. Common activities for the doing step are hikes, kayaking, initiative games, and ropes courses. In the processing step, participants talk about the experience of doing, with the facilitator helping them to review the activity and generalize the learning to other areas of their lives (Luckner & Nadler, p. 10).
In his groundbreaking work, Kolb presented a model for the experiential learning cycle that expanded beyond this basic doing then processing model. Kolb identifies four components: concrete experience, reflective observation, abstract conceptualization, and active experimentation (Webb, p. 2). In this model, a concrete experience provides an opportunity for reflection, which is then integrated by the participant and abstracted or generalized in a way that can be actively tested in other areas of the individual’s life.
All models for adventure programming, as well as most other types of experiential learning, include a core belief that learning occurs most readily when the participant is “confronted with a balance between stress and comfort” (Webb, p. 3). Through “activities that provide compelling tasks to accomplish” (Priest & Gass, p. 17), adventure programming provides this balance in three inter-related ways. First, adventure programming strives to create an uncertain outcome. Second, adventure programming most often contains a high level of perceived physical, emotional, or social risk. Finally, adventure programming typically occurs outdoors or in an environment unfamiliar to the participant (Coons, p. 1).
Adventure programming and other types of experiential education “are a major strategy for accomplishing holistic development outcomes” (Bernard & Marshall, p. 1). Priest and Gass have cataloged significant affective gains from participation in adventure programming, both intrapersonal and interpersonal. Intrapersonal improvements include new confidence in oneself, increased willingness to take risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). Interpersonal improvements include enhanced cooperation, more effective communication, greater trust in others, increased sharing of decision-making, new ways of resolving problems, and enhanced leadership skills (p. 20).
A meta-analysis conducted by Hattie, March, Neill, and Richards reviewed results from 96 studies on adventure programs. These studies had a combined participation of over 12,000 at-risk youth and identified a wide variety of positive outcomes. The most significant outcomes were improvements in self-control, such as increased autonomy, confidence, self-efficacy, self-understanding, decision-making, and assertiveness. Other notable outcomes were increased interpersonal skills, improvements in mathematics and other academic areas involving critical thinking or problem solving, and significant gains in self-esteem (qtd. in Bernard & Marshall, p. 3). Another noteworthy finding, unlike outcomes from most interventions, was that these areas of improvements were maintained and even continued to increase over time (Bernard & Marshall, p. 4).
While outcomes for GLBT youth were not specifically addressed by Hattie’s meta-analysis, it was determined that there were no outcome differences attributable to ethnicity, socioeconomic status, or prior academic achievement (Bernard & Marshall, p. 4). As such, the results of Hattie’s meta-analysis support the use of adventure programming as an effective methodology to prevent at-risk behavior with all adolescent populations, including GLBT youth.
GLBT Youth As Inherently At-Risk
Almost no research focusing specifically on the efficacy of adventure programming with GLBT could be found during research for this paper. However, Hattie’s meta-analysis and several other studies report positive results from incorporating adventure programming into both therapeutic and developmental work with at-risk youth. Kallisky defined the term at-risk to include all adolescents who “live in a negative environment and/or lack the skills and values that help them become responsible members of society” (qtd. in Cross, p. 2).
A disproportionate number of at-risk youth are GLBT (Berger, p. 2). GLBT youth are particularly at-risk for suicidal ideation and attempts, parasuicidal behavior, verbal and physical harassment, substance abuse, sexually transmitted diseases, engagement in prostitution or truancy, and declining school performance (Mufioz-Plaza, et al, p. 3; Berger, p. 2). Additionally, the National Network of Runaway and Youth Services has reported that up to forty percent of all youth who experience homelessness identify as GLBT (qtd. in Berger, p. 2).
In response to the stressors noted above, the American Academy of Pediatrics has stated:
The psychosocial problems of gay and lesbian adolescents are primarily the result of societal stigma, hostility, hatred and isolation…These youth are severely hindered by societal stigmatization and prejudice, limited knowledge of human sexuality, a need for secrecy, a lack of opportunities for open socialization, and limited communication with healthy role models… [This] may lead to isolation, runaway behavior, homelessness, domestic violence, depression, suicide, substance abuse and school or job failure…Pediatricians should be aware of these risks (qtd. in Ryan and Futterman, p. 23).
As this evidence supports, all GLBT youth should be considered inherently at-risk. Further, one can assume that research supporting the efficacy of adventure programming with at-risk adolescents in general can be applied to GLBT youth specifically.
Ripples of Disruption
Understanding how at-risk behavior develops, in all adolescent populations, is key. Bronfenbrenner identified four dimensions of influence upon adolescents: family, school, peers, and work or play (qtd in Cross, p. 2). Subsequent research suggested that alienation, a significant element in at-risk behavior in adolescents, is the result of disruptions in these dimensions. Calabrese stated, “Trouble comes when an adolescent experiences alienation in more than one world at a time, or finds no solace in their other worlds” (qtd. in Cross, p. 2). When an adolescent does experience disruption in one dimension, a ripple effect is likely to occur with negative impacts in the other dimensions.
GLBT youth are likely to confront these negative ripples in all of Bronfenbrenner’s dimensions, especially school. Many schools condone or tolerate homophobia (Owen, p. 84). Kevin Jennings, executive director of the Gay, Lesbian and Straight Education Network, or GLSEN, said, “Anti-LGBT bullying and harassment remain commonplace in America's schools" (GLSEN, p. 1). In fact, a 2005 study conducted by GLSEN found that over 75% of high school students who identified as LGBT regularly heard derogatory remarks such as "faggot" or "dyke." Additionally, over 35% of these students suffered harassment at school due to their sexual orientation; and almost 20% of them had been physically assaulted (GLSEN, p. 1).
School experiences play a particularly important role in determining how adolescents define their place in the larger community (Cross, p. 2). As such, negative experiences such as those reported in the GLSEN study are highly likely to create a negative ripple effect throughout all other dimensions. Since these ripples are frequent for GLBT youth, concerns regarding alienation and the probability of at-risk behaviors are especially heightened for this population.
While Bronfenbrenner identified four dimensions of influence, Dean states that alienation is the result of three factors: powerlessness, or feeling unable to influence one’s own choices; normlessness, or feeling one’s value system is inconsistent with that of society; and isolation, or feeling acute loneliness or separation (qtd. in Cross, p. 2). Dean’s three factors of powerlessness, normlessness, and isolation are exacerbated for nearly all GLBT youth. Mercier and Berger point to the lack of social supports for LGBT youth, again giving particular attention to the school environment, as the cause of isolation for LGBT youth (qtd. in Mufioz-Plaza, et al, p. 4). Ryan and Futterman wrote, “The need for support is particularly critical to avoid isolation when adolescents begin to question their sexual identity” (p. 10). It is at this time that adventure programming would be a particularly effective strategy for this population to decrease alienation, foster resiliency, and counter internalized homophobia.
Use of Adventure Programming To Decrease Alienation In GLBT Youth
Cross conducted a study to determine the effects of adventure programming program on perceptions of alienation and personal control among at-risk adolescents. Cross’ study had two hypotheses: (1) “At-risk adolescents who participate in an outdoor intervention program will demonstrate significantly lower perceptions of alienation [than] their counterparts who receive no such program”; and, (2) “At-risk adolescents who participate in an outdoor intervention program will demonstrate significantly greater perceptions of personal control…as compared to their counterparts who receive no such program” (Cross, p. 3).
Cross’ study included 34 at-risk adolescents. Half the group served as controls, and the other half participated in a five-day intensive rock climbing experience designed to be a typical example of adventure programming. It included the following fundamental components: the participants were placed in a novel setting; a cooperative, caring, and trusting environment was created; unique problem solving opportunities were presented; opportunities for success and accomplishment were provided; and daily opportunities for processing the experience were given (Luckner & Nadler, p. 257).
Both the treatment group and the control group completed pre- and post-tests to measure alienation and perceptions of control. After participation in the rock-climbing program, the experimental group was less alienated and exhibited higher perceptions of control than the study participants who did not participate (Cross, p. 8). Cross’s study included only thirty-four subjects, all of whom attended the same alternative high school, with the majority of the participants being male, Caucasian, and of lower socioeconomic status. Due to the small size and lack of diversity among the participants, the results cannot be considered conclusive. However, the study results do suggest that adventure programming has the potential to positively effect perceptions of alienation in at-risk youth, including GLBT adolescents.
Use of Adventure Programming To Foster Resiliency In GLBT Youth
“Resiliency is the ability to thrive in spite of risk or adversity” (Brendtro & Longhurst, p. 2). In 1955, Werner and Smith began a longitudinal study of nearly 700 children, all born on the island of Kauai, Hawaii and all from families dealing with issues such as chemical dependency, mental illness, and economic difficulties. After following the subjects for thirty-four years, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience (qtd. in Wolin & Wolin, p. 19).
Resilience is a combination of inner strengths and external supports (Brendtro & Longhurst, p. 2). Those external supports can come from within any of Bronfenbrenner’s dimensions. When provided this supportive environment, adolescents are able to develop their own natural resiliencies. However, as previously stated, school is often particularly difficult for GLBT youth. Hyman wrote that the “most dangerous schools are those with negative climates of disrespect among peers and adults” (qtd. in Brendtro & Longhurst, p. 2). When lacking support in any of Bronfenbrenner’s dimensions, adventure programming can provide an effective methodology for fostering resilience.
Fostering resiliency in adolescents has three primary goals. The first goal is assisting the individual to reframe his or her life experiences. Reframing, or “viewing an old story from a new perspective” (Wolin, Desetta & Hefner, p. 4), is derived from basic cognitive-behavioral theory and focuses on the subjective nature of personal stories to uncover alternative, positive themes (Wolin & Wolin, p. 21). The second goal in fostering resiliency is helping the individual to acknowledge untapped survivor’s pride, “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity” (Wolin & Wolin, p. 11). The final goal in fostering resiliency is facilitating the individual to identify current strengths or competencies while developing weaker areas.
Wolin and Wolin have identified seven specific areas of competence exhibited by resilient individuals: insight, independence, relationships, initiative, creativity, humor, and morality. Green conducted a study to examine the effects of adventure programming on the development of these competencies in at-risk youth. For the study, twenty-five minority youth age ten to sixteen participated in a six week ropes course program consisting of one four-hour session each week. A group of over 150 other minority youth served as a control. All subjects were pre- and post-tested. The results from Green’s study indicated that protective factors related to these competencies improved significantly within the treatment group (p. 1).
Green’s study focuses on at-risk low-income minority youth. However, his results suggest that adventure programming delivered to GLBT youth has the potential to provide significant gains in resiliency for this population. Hattie’s meta-analysis supports this conclusion. Bernard and Marshall wrote that adventure programming not only fosters resiliency, but also provides “a powerful prevention strategy” for at-risk youth (p. 1).
Use of Adventure Programming to Counter Internalized Homophobia
All adolescents face the psychosocial challenges of developing identity, autonomy, intimacy, sexuality, and achievement (Steinberg, p. 12). GLBT youth have the additional challenge of learning to manage a stigmatized identity (Ryan & Futterman, p. xii). Based on their own study, Mufioz-Plaza, et al, wrote, “Confronted with their own sense of alienation and confusion, as well as the overwhelmingly negative messages about homosexuality…respondents described their sexual identity formation as a process characterized by varying degrees of denial and acceptance” (p. 2).
Ryan and Futterman stated, “Unlike their heterosexual peers, lesbian and gay youth consolidate identity against a backdrop of social disapproval” (p. 21). In their study of GLBT youth ages 14-17, they found an overwhelming acceptance of negative stereotypes, including beliefs that all gay men were effeminate, all lesbians were masculine, that all homosexuals were unhappy, and that all lesbians hated men (Ryan & Futterman, p. 73).
Common reactions to such internalized homophobia include adjustment problems, impaired psychosocial development, family alienation, inadequate interpersonal relationships, alcohol and drug abuse, depression, suicidal ideation, and sexual acting out (Ryan & Futterman, p. 29). These reactions can be effectively countered through participation in adventure programming.
As stated earlier, learning occurs most readily when an individual is “outside a position of comfort” (Priest & Gass, p. 146). Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in typical adventure programming], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18), such as those created by internalized homophobia.
Through involvement in experiences that move the individual outside a position of comfort, adventure programming provides GLBT youth an opportunity to test their own assumptions and reject those they discover to be faulty. In doing so, adventure programming provides an effective treatment strategy for GLBT youth who need to change behaviors and move beyond self-defined limits.
Discussion
As I have presented in this paper, adventure programming is a process of “learning by doing with reflection’ (Priest and Gass, p. 16). This dynamic process provides participants unique opportunities to try new behaviors, to improve self-esteem, and to see one’s self in ways that move beyond personal or societal expectations (Bradish, p. 92), outcomes that positively impact at-risk participants. GLBT youth face unique social and emotional stressors resulting from a stigmatized identity. These stressors increase their risks for a wide range of physical and mental health concerns (Ryan & Futterman, p. 5). As such, all GLBT youth can be considered inherently at-risk. Studies that support adventure programming as an effective treatment modality for at-risk adolescents can therefore be generalized to GLBT youth.
Adventure programming specifically targeted to GLBT youth provides a safe alternative to the negative environment and experiences encountered at school and within Bronfenbrenner’s other dimensions. By providing powerful learning experiences that move participants beyond their personal positions of comfort, adventure programming presents opportunities to develop beneficial resiliencies, decrease the likelihood of alienation, and counter internalized homophobia. As such, adventure programming can be considered an effective methodology for use with GLBT youth.
Works Cited
Association for Experiential Education. What Is Experiential Education?. 21 January 2007.
Beard, C. & Gross, J. Experiential Learning: A Best Practice Handbook for Educators and Trainers. Philadelphia: Kogan Page, 2006.
Berger, C. “What becomes of at-risk gay youth?” Gay and Lesbian Review Worldwide. November/December 2005: 24-27. ProQuest. 8 February 2007.
Bernard, B. & Marshall, K. Adventure Education: Making A Lasting Difference. 8 February 2007.
Bradish, C. “Therapeutic programming for gay and lesbian youth: How experiential education can support an at-risk population.” Journal of Experiential Education. Aug. 1995: 91-94.
Brendtro, L. & Longhurst, J. “The resilient brain.” Reclaiming Children and Youth. Spring 2005: 52-60. ProQuest. 8 February 2007.
Coons, V. “Advantages of adventure therapy for adolescents.” Counselor. April 2004: 42-44. ProQuest. 25 February 2007.
Cross, R. “The effects of an adventure education program on perceptions of alienation and personal control among at-risk adolescents.” Journal of Experiential Education. Spring 2002: 247-254. ProQuest. 22 January 2007.
Gay, Lesbian and Straight Education Network. GLSEN's 2005 National School Climate
Survey Sheds New Light on Experiences of Lesbian, Gay, Bisexual and Transgender (LGBT) Students. 25 February 2007.
Luckner, J. & Nadler, R. Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Co., 1997.
Mufioz-Plaza, C., et al. “Lesbian, gay, bisexual and transgender students: Perceived
social support in the high school environment.” High School Journal. April/May 2002: 52-64. ProQuest. 8 December 2007.
Owens, Jr., R. Queer Kids. New York: Haworth Press, 1998.
Priest, S. & Gross, M. Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics, 2005.
Ryan, C. & Futterman, D. Lesbian and Gay Youth: Care and Counseling. New York: Columbia University Press, 1998.
Webb, L. “Learning by doing.” Training Journal. March 2006: 36-41. ProQuest. 11 February 2007.
Wolin, S. & Wolin, S. Resilient Self, The. New York: Random House, 1993.
Wolin, S., Desetta, A. & Hefner, K. Leader’s Guide to the Struggle to Be Strong, The. Minneapolis, MN: Free Spirit Publishing, 2000.
A Chinese proverb states, "Tell me and I will forget. Show me and I may remember. Involve me and I will understand." The primary objective of adventure programming is to do just that, involve clients in a physically engaging manner so that they come to understand. In this paper, I will present evidence that supports the use of this physically engaging manner as an effective methodology to reduce at-risk behaviors in gay, lesbian, bisexual, and transgender (GLBT) youth by decreasing the likelihood of alienation, fostering resiliency, and countering internalized homophobia.
First, though, a deeper exploration of adventure programming and its goals is warranted. According to the Association of Experiential Education, adventure programming, like all types of experiential learning, is “a philosophy and methodology in which educators purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills, and clarify values” (AEE, p. 1).
Any form of experiential learning has two critical steps: doing and processing. The doing step is the activity. Common activities for the doing step are hikes, kayaking, initiative games, and ropes courses. In the processing step, participants talk about the experience of doing, with the facilitator helping them to review the activity and generalize the learning to other areas of their lives (Luckner & Nadler, p. 10).
In his groundbreaking work, Kolb presented a model for the experiential learning cycle that expanded beyond this basic doing then processing model. Kolb identifies four components: concrete experience, reflective observation, abstract conceptualization, and active experimentation (Webb, p. 2). In this model, a concrete experience provides an opportunity for reflection, which is then integrated by the participant and abstracted or generalized in a way that can be actively tested in other areas of the individual’s life.
All models for adventure programming, as well as most other types of experiential learning, include a core belief that learning occurs most readily when the participant is “confronted with a balance between stress and comfort” (Webb, p. 3). Through “activities that provide compelling tasks to accomplish” (Priest & Gass, p. 17), adventure programming provides this balance in three inter-related ways. First, adventure programming strives to create an uncertain outcome. Second, adventure programming most often contains a high level of perceived physical, emotional, or social risk. Finally, adventure programming typically occurs outdoors or in an environment unfamiliar to the participant (Coons, p. 1).
Adventure programming and other types of experiential education “are a major strategy for accomplishing holistic development outcomes” (Bernard & Marshall, p. 1). Priest and Gass have cataloged significant affective gains from participation in adventure programming, both intrapersonal and interpersonal. Intrapersonal improvements include new confidence in oneself, increased willingness to take risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). Interpersonal improvements include enhanced cooperation, more effective communication, greater trust in others, increased sharing of decision-making, new ways of resolving problems, and enhanced leadership skills (p. 20).
A meta-analysis conducted by Hattie, March, Neill, and Richards reviewed results from 96 studies on adventure programs. These studies had a combined participation of over 12,000 at-risk youth and identified a wide variety of positive outcomes. The most significant outcomes were improvements in self-control, such as increased autonomy, confidence, self-efficacy, self-understanding, decision-making, and assertiveness. Other notable outcomes were increased interpersonal skills, improvements in mathematics and other academic areas involving critical thinking or problem solving, and significant gains in self-esteem (qtd. in Bernard & Marshall, p. 3). Another noteworthy finding, unlike outcomes from most interventions, was that these areas of improvements were maintained and even continued to increase over time (Bernard & Marshall, p. 4).
While outcomes for GLBT youth were not specifically addressed by Hattie’s meta-analysis, it was determined that there were no outcome differences attributable to ethnicity, socioeconomic status, or prior academic achievement (Bernard & Marshall, p. 4). As such, the results of Hattie’s meta-analysis support the use of adventure programming as an effective methodology to prevent at-risk behavior with all adolescent populations, including GLBT youth.
GLBT Youth As Inherently At-Risk
Almost no research focusing specifically on the efficacy of adventure programming with GLBT could be found during research for this paper. However, Hattie’s meta-analysis and several other studies report positive results from incorporating adventure programming into both therapeutic and developmental work with at-risk youth. Kallisky defined the term at-risk to include all adolescents who “live in a negative environment and/or lack the skills and values that help them become responsible members of society” (qtd. in Cross, p. 2).
A disproportionate number of at-risk youth are GLBT (Berger, p. 2). GLBT youth are particularly at-risk for suicidal ideation and attempts, parasuicidal behavior, verbal and physical harassment, substance abuse, sexually transmitted diseases, engagement in prostitution or truancy, and declining school performance (Mufioz-Plaza, et al, p. 3; Berger, p. 2). Additionally, the National Network of Runaway and Youth Services has reported that up to forty percent of all youth who experience homelessness identify as GLBT (qtd. in Berger, p. 2).
In response to the stressors noted above, the American Academy of Pediatrics has stated:
The psychosocial problems of gay and lesbian adolescents are primarily the result of societal stigma, hostility, hatred and isolation…These youth are severely hindered by societal stigmatization and prejudice, limited knowledge of human sexuality, a need for secrecy, a lack of opportunities for open socialization, and limited communication with healthy role models… [This] may lead to isolation, runaway behavior, homelessness, domestic violence, depression, suicide, substance abuse and school or job failure…Pediatricians should be aware of these risks (qtd. in Ryan and Futterman, p. 23).
As this evidence supports, all GLBT youth should be considered inherently at-risk. Further, one can assume that research supporting the efficacy of adventure programming with at-risk adolescents in general can be applied to GLBT youth specifically.
Ripples of Disruption
Understanding how at-risk behavior develops, in all adolescent populations, is key. Bronfenbrenner identified four dimensions of influence upon adolescents: family, school, peers, and work or play (qtd in Cross, p. 2). Subsequent research suggested that alienation, a significant element in at-risk behavior in adolescents, is the result of disruptions in these dimensions. Calabrese stated, “Trouble comes when an adolescent experiences alienation in more than one world at a time, or finds no solace in their other worlds” (qtd. in Cross, p. 2). When an adolescent does experience disruption in one dimension, a ripple effect is likely to occur with negative impacts in the other dimensions.
GLBT youth are likely to confront these negative ripples in all of Bronfenbrenner’s dimensions, especially school. Many schools condone or tolerate homophobia (Owen, p. 84). Kevin Jennings, executive director of the Gay, Lesbian and Straight Education Network, or GLSEN, said, “Anti-LGBT bullying and harassment remain commonplace in America's schools" (GLSEN, p. 1). In fact, a 2005 study conducted by GLSEN found that over 75% of high school students who identified as LGBT regularly heard derogatory remarks such as "faggot" or "dyke." Additionally, over 35% of these students suffered harassment at school due to their sexual orientation; and almost 20% of them had been physically assaulted (GLSEN, p. 1).
School experiences play a particularly important role in determining how adolescents define their place in the larger community (Cross, p. 2). As such, negative experiences such as those reported in the GLSEN study are highly likely to create a negative ripple effect throughout all other dimensions. Since these ripples are frequent for GLBT youth, concerns regarding alienation and the probability of at-risk behaviors are especially heightened for this population.
While Bronfenbrenner identified four dimensions of influence, Dean states that alienation is the result of three factors: powerlessness, or feeling unable to influence one’s own choices; normlessness, or feeling one’s value system is inconsistent with that of society; and isolation, or feeling acute loneliness or separation (qtd. in Cross, p. 2). Dean’s three factors of powerlessness, normlessness, and isolation are exacerbated for nearly all GLBT youth. Mercier and Berger point to the lack of social supports for LGBT youth, again giving particular attention to the school environment, as the cause of isolation for LGBT youth (qtd. in Mufioz-Plaza, et al, p. 4). Ryan and Futterman wrote, “The need for support is particularly critical to avoid isolation when adolescents begin to question their sexual identity” (p. 10). It is at this time that adventure programming would be a particularly effective strategy for this population to decrease alienation, foster resiliency, and counter internalized homophobia.
Use of Adventure Programming To Decrease Alienation In GLBT Youth
Cross conducted a study to determine the effects of adventure programming program on perceptions of alienation and personal control among at-risk adolescents. Cross’ study had two hypotheses: (1) “At-risk adolescents who participate in an outdoor intervention program will demonstrate significantly lower perceptions of alienation [than] their counterparts who receive no such program”; and, (2) “At-risk adolescents who participate in an outdoor intervention program will demonstrate significantly greater perceptions of personal control…as compared to their counterparts who receive no such program” (Cross, p. 3).
Cross’ study included 34 at-risk adolescents. Half the group served as controls, and the other half participated in a five-day intensive rock climbing experience designed to be a typical example of adventure programming. It included the following fundamental components: the participants were placed in a novel setting; a cooperative, caring, and trusting environment was created; unique problem solving opportunities were presented; opportunities for success and accomplishment were provided; and daily opportunities for processing the experience were given (Luckner & Nadler, p. 257).
Both the treatment group and the control group completed pre- and post-tests to measure alienation and perceptions of control. After participation in the rock-climbing program, the experimental group was less alienated and exhibited higher perceptions of control than the study participants who did not participate (Cross, p. 8). Cross’s study included only thirty-four subjects, all of whom attended the same alternative high school, with the majority of the participants being male, Caucasian, and of lower socioeconomic status. Due to the small size and lack of diversity among the participants, the results cannot be considered conclusive. However, the study results do suggest that adventure programming has the potential to positively effect perceptions of alienation in at-risk youth, including GLBT adolescents.
Use of Adventure Programming To Foster Resiliency In GLBT Youth
“Resiliency is the ability to thrive in spite of risk or adversity” (Brendtro & Longhurst, p. 2). In 1955, Werner and Smith began a longitudinal study of nearly 700 children, all born on the island of Kauai, Hawaii and all from families dealing with issues such as chemical dependency, mental illness, and economic difficulties. After following the subjects for thirty-four years, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience (qtd. in Wolin & Wolin, p. 19).
Resilience is a combination of inner strengths and external supports (Brendtro & Longhurst, p. 2). Those external supports can come from within any of Bronfenbrenner’s dimensions. When provided this supportive environment, adolescents are able to develop their own natural resiliencies. However, as previously stated, school is often particularly difficult for GLBT youth. Hyman wrote that the “most dangerous schools are those with negative climates of disrespect among peers and adults” (qtd. in Brendtro & Longhurst, p. 2). When lacking support in any of Bronfenbrenner’s dimensions, adventure programming can provide an effective methodology for fostering resilience.
Fostering resiliency in adolescents has three primary goals. The first goal is assisting the individual to reframe his or her life experiences. Reframing, or “viewing an old story from a new perspective” (Wolin, Desetta & Hefner, p. 4), is derived from basic cognitive-behavioral theory and focuses on the subjective nature of personal stories to uncover alternative, positive themes (Wolin & Wolin, p. 21). The second goal in fostering resiliency is helping the individual to acknowledge untapped survivor’s pride, “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity” (Wolin & Wolin, p. 11). The final goal in fostering resiliency is facilitating the individual to identify current strengths or competencies while developing weaker areas.
Wolin and Wolin have identified seven specific areas of competence exhibited by resilient individuals: insight, independence, relationships, initiative, creativity, humor, and morality. Green conducted a study to examine the effects of adventure programming on the development of these competencies in at-risk youth. For the study, twenty-five minority youth age ten to sixteen participated in a six week ropes course program consisting of one four-hour session each week. A group of over 150 other minority youth served as a control. All subjects were pre- and post-tested. The results from Green’s study indicated that protective factors related to these competencies improved significantly within the treatment group (p. 1).
Green’s study focuses on at-risk low-income minority youth. However, his results suggest that adventure programming delivered to GLBT youth has the potential to provide significant gains in resiliency for this population. Hattie’s meta-analysis supports this conclusion. Bernard and Marshall wrote that adventure programming not only fosters resiliency, but also provides “a powerful prevention strategy” for at-risk youth (p. 1).
Use of Adventure Programming to Counter Internalized Homophobia
All adolescents face the psychosocial challenges of developing identity, autonomy, intimacy, sexuality, and achievement (Steinberg, p. 12). GLBT youth have the additional challenge of learning to manage a stigmatized identity (Ryan & Futterman, p. xii). Based on their own study, Mufioz-Plaza, et al, wrote, “Confronted with their own sense of alienation and confusion, as well as the overwhelmingly negative messages about homosexuality…respondents described their sexual identity formation as a process characterized by varying degrees of denial and acceptance” (p. 2).
Ryan and Futterman stated, “Unlike their heterosexual peers, lesbian and gay youth consolidate identity against a backdrop of social disapproval” (p. 21). In their study of GLBT youth ages 14-17, they found an overwhelming acceptance of negative stereotypes, including beliefs that all gay men were effeminate, all lesbians were masculine, that all homosexuals were unhappy, and that all lesbians hated men (Ryan & Futterman, p. 73).
Common reactions to such internalized homophobia include adjustment problems, impaired psychosocial development, family alienation, inadequate interpersonal relationships, alcohol and drug abuse, depression, suicidal ideation, and sexual acting out (Ryan & Futterman, p. 29). These reactions can be effectively countered through participation in adventure programming.
As stated earlier, learning occurs most readily when an individual is “outside a position of comfort” (Priest & Gass, p. 146). Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in typical adventure programming], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18), such as those created by internalized homophobia.
Through involvement in experiences that move the individual outside a position of comfort, adventure programming provides GLBT youth an opportunity to test their own assumptions and reject those they discover to be faulty. In doing so, adventure programming provides an effective treatment strategy for GLBT youth who need to change behaviors and move beyond self-defined limits.
Discussion
As I have presented in this paper, adventure programming is a process of “learning by doing with reflection’ (Priest and Gass, p. 16). This dynamic process provides participants unique opportunities to try new behaviors, to improve self-esteem, and to see one’s self in ways that move beyond personal or societal expectations (Bradish, p. 92), outcomes that positively impact at-risk participants. GLBT youth face unique social and emotional stressors resulting from a stigmatized identity. These stressors increase their risks for a wide range of physical and mental health concerns (Ryan & Futterman, p. 5). As such, all GLBT youth can be considered inherently at-risk. Studies that support adventure programming as an effective treatment modality for at-risk adolescents can therefore be generalized to GLBT youth.
Adventure programming specifically targeted to GLBT youth provides a safe alternative to the negative environment and experiences encountered at school and within Bronfenbrenner’s other dimensions. By providing powerful learning experiences that move participants beyond their personal positions of comfort, adventure programming presents opportunities to develop beneficial resiliencies, decrease the likelihood of alienation, and counter internalized homophobia. As such, adventure programming can be considered an effective methodology for use with GLBT youth.
Works Cited
Association for Experiential Education. What Is Experiential Education?. 21 January 2007
Beard, C. & Gross, J. Experiential Learning: A Best Practice Handbook for Educators and Trainers. Philadelphia: Kogan Page, 2006.
Berger, C. “What becomes of at-risk gay youth?” Gay and Lesbian Review Worldwide. November/December 2005: 24-27. ProQuest. 8 February 2007
Bernard, B. & Marshall, K. Adventure Education: Making A Lasting Difference. 8 February 2007
Bradish, C. “Therapeutic programming for gay and lesbian youth: How experiential education can support an at-risk population.” Journal of Experiential Education. Aug. 1995: 91-94.
Brendtro, L. & Longhurst, J. “The resilient brain.” Reclaiming Children and Youth. Spring 2005: 52-60. ProQuest. 8 February 2007
Coons, V. “Advantages of adventure therapy for adolescents.” Counselor. April 2004: 42-44. ProQuest. 25 February 2007
Cross, R. “The effects of an adventure education program on perceptions of alienation and personal control among at-risk adolescents.” Journal of Experiential Education. Spring 2002: 247-254. ProQuest. 22 January 2007
Gay, Lesbian and Straight Education Network. GLSEN's 2005 National School Climate
Survey Sheds New Light on Experiences of Lesbian, Gay, Bisexual and Transgender (LGBT) Students. 25 February 2007
Luckner, J. & Nadler, R. Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Co., 1997.
Mufioz-Plaza, C., et al. “Lesbian, gay, bisexual and transgender students: Perceived
social support in the high school environment.” High School Journal. April/May 2002: 52-64. ProQuest. 8 December 2007
Owens, Jr., R. Queer Kids. New York: Haworth Press, 1998.
Priest, S. & Gross, M. Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics, 2005.
Ryan, C. & Futterman, D. Lesbian and Gay Youth: Care and Counseling. New York: Columbia University Press, 1998.
Webb, L. “Learning by doing.” Training Journal. March 2006: 36-41. ProQuest. 11 February 2007
Wolin, S. & Wolin, S. Resilient Self, The. New York: Random House, 1993.
Wolin, S., Desetta, A. & Hefner, K. Leader’s Guide to the Struggle to Be Strong, The. Minneapolis, MN: Free Spirit Publishing, 2000.
Sunday, December 21, 2008
Cascades of Chaos
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.
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.
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.
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