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.
Showing posts with label cognitive scripts. Show all posts
Showing posts with label cognitive scripts. Show all posts
Sunday, December 21, 2008
Saturday, December 6, 2008
Breaking the Cycle of Stuckness
As I’ve written before, my clients often have highly maladaptive cognitive scripts, routinely utilizing one of three cognitive scripts. They act up, shut down, or use mood-altering substances. While these responses might not seem especially effective to someone with more adaptive cognitive scripts, they are predictable and therefore safe. Rose wrote that most youth with multiple life problems—as is the case with nearly all my clients— “seem to have dedicated and rigid strategies for dealing with problems and are disinclined to look at other possibilities" (p. 177).
Looking at other possibilities requires a willingness to try something new, to step outside your Comfort Zone, to take risks. For youth who have had lives filled with unpredictability, even the most painful known option can feel less risky than any unknown one. “Steve,” a former client, summed this up when he said, “What I like the most about drugs is that I know what to expect. I smoke. I get high. No surprises.” For youth like Steve, there is an inherent reinforcement in a life of “no surprises.” Unlike many of other aspects of his life, he knows what to expect when he uses. And, that predictability is appealing.
However, a life of "no surprises" can lead to a cycle of stuckness. A basic tenet of brain development is that what fires together wires together. Through repetition of the same behavior, neuronal connections are created and then reinforced. Just like tying shoes becomes easier over time as a result of neurons wiring together, cognitive scripts also become hard wired in the brain. In other words, the maladaptive scripts of acting up, shutting down and using become part of the individual’s brain structure.
This means that Steve, like many youth, is cognitively stuck. His brain is hard wired to respond to life in maladaptive ways. Facilitating for change requires helping these youth break this cycle of stuckness. Experiential learning provides an effective methodology for doing this, because it “challenge[s] participants to update, refine, and alter mental programs when they emerge” (Luckner & Nadler, p. 36).
This updating, refining and altering can occur thanks to neuroplasticity, “the brain’s ability to physically change in response to stimuli and activity” (Romer & Walker, p. 484). It is “the ability of neurons to change the way they behave and relate to one another as the brain adapts to the environment through time” (Cozolino, p. 75). Neuroplasticity allows us to create new cognitive scripts.
Paula Tallal of Rutgers University stated, “You create your brain from the input you get” (qtd. in Begley, p. 105). It seems to me that it logically follows that that if you change the input, you would change the brain. Therapy or counseling provides an effective methodology for changing the input in a controlled and intentional manner. Cozolino supports this conclusion by writing, “[T]he therapeutic context may enhance the brain’s ability to rewire through concurrent emotional and cognitive processing. Successful therapeutic techniques may be successful because of their very ability to change brain chemistry in a manner that enhances neural plasticity” (p. 300).
“An enriched environment is one that is characterized by a level of stimulation and complexity that enhances learning and growth… [E]nriched environments can include the kinds of challenging educational and experiential opportunities that encourage us to learn new skills and expand our knowledge” (Cozolino, p. 22-23). A study conducted by the University of British Columbia helps to support the conclusion by Priest and Gass.
In this study, mice that were provided exercise wheels developed neurons that were “dramatically different” from sedentary mice. These exercise wheels provided the mice a more enriched environment, and in response their neurons had more dendrites, which are responsible for receiving signals from other neurons. This means the thinking patterns of these mice was more complex, more able to solve problems, and more able to engage in lasting learning (Begley, p. 69).
Cozolino suggests that any therapeutic approach will provide the enriched environment he describes. It seems to me, though, that experiential learning is particularly well suited for enhancing neuroplasticity. Experiential learning takes the "talk therapy" of other methodologies and puts that learning into action. Experiential learning tests what other methodologies often leave as "inert ideas" (Whitehead, qtd. in Zull, p. 206). According to Zull, "Action forces our mental constructs out of our brains and into the reality of the physical world" ( p. 206). Without that active testing, these new ideas are unlikely to ever be integrated into new behaviors. Active testing, then, is what allows us to rehearse new cognitive scripts.
Neuroplasticity in Action
Priest and Gass outlined six characteristics of experiential learning: the participant is provided a direct and purposeful experience, the participant is appropriately challenged, the participant is presented with opportunities for synthesis and reflection, the experience provides for natural consequences, the experience emphasizes participant-driven change, and the experience has both present and future relevance (p. 146-147).
All six of these characteristics are important to assure the most beneficial learning experience possible. However, it seems to me that for facilitators of experiential learning in clinical settings, focusing on participant-driven change is especially relevant. “Challenges that force us to expand our awareness, learn new information, or push beyond assumed limits can all change our brains” (Cozolino, p. 291).
Experiential learning regularly utilizes activities intended to push participants beyond their assumed limits, or to step outside their Comfort Zone. This provides participants the opportunity to test their assumptions and reject those they discover to be faulty. Because this testing is participant-driven, it is more developmentally appropriate for teens than more prescriptive counseling methodologies.
Zull wrote, “When we test our ideas, we are changing the abstract into the concrete. We convert our mental ideas into physical events” (p. 208). Converting mental ideas into physical events is exactly why experiential learning is an especially effective methodology for ending the cycle of stuckness. I would add, though, that once a mental construct has been forced into the physical world and discovered to be faulty, it is likely to be abandoned.
Rehearsing Change
As we have seen, experiential learning provides an effective method for testing and rejecting. Experiential learning provides two additional methods for helping end the cycle of stuckness. First, this methodology provides participants an opportunity to practice alternative behavioral choices. When used effectively and chosen for their relevance to the clinical work at hand, experiential learning allows youth like Steve to alter their cognitive scripts by putting new learning into practice in ways that will be memorable and concrete. In other words, experiential learning provides an opportunity to rehearse new scripts.
Second, experiential learning provides participants the opportunity to engage in healthy risk taking. For youth like Steve who prefer a life of no surprises, acting up, shutting down and using are so germane to their maladaptive scripts that these behaviors have become normalized. Thus, they are no longer perceived as risky.
In the Stages of Change model, these youth are pre-contemplative. Part of the appeal of pre-contemplation is that it feels safe (Prochaska, Norcross & DiClemente, p. 74). These youth often exhibit significant cognitive dissonance, perceiving high-risk situations as risk-free. This is, perhaps, the ultimate maladaptive script and part of their stuckness is their inability to see it. Helping them become unstuck requires helping them to reframe this dissonance, so that they move through the Stages of Change. Helping them become unstuck requires that they come to see risky behavior as risky.
Priest and Gass have cataloged significant affective gains from participation in experiential learning. These include new self-confidence, enhanced willingness to take good risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). These affective gains would be useful for anyone engaged in the change process, but they are particularly useful for someone stuck in pre-contemplation.
As illustrated, the use of experiential learning in clinical settings seems an obvious and valuable choice, leading to a “more enriched, complex, and potentially resilient brain” (Cozolino, p. 298). Experiential learning provides an excellent methodology for assuring this treatment outcome, by providing an “enriched environment to enhance brain development” (Cozolino, p. 291). These developments result in increased confidence and optimism regarding the ability to change. This is vital in helping assure that youth like Steve will actually utilize their new developed, more adaptive cognitive scripts.
“The concept of neuroplasticity suggests that the brain is highly malleable and is subject to continual change as a result of experience, so that new connections between neurons may be formed or even brand-new neurons generated” (The Dalai Lama, qtd. in Begley, p. 24). By providing rich opportunities to test assumptions, practice new behaviors, and engage in healthy risk taking, experiential learning inevitably enhances neuroplasticity, thereby leading to lasting changes in cognitive scripts. It is through this learning, rehearsing, and ultimate using of new, more adaptive cognitive scripts that youth like Steve can break their cycle of stuckness.
Works Cited
Begley, S. (2007). Train Your Mind, Change Your Brain. New York: Ballantine Books.
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S., & Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinestics.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Romer, D. & Walker, E. (2007). Adolescent Psychopathology and the Developing Brain. New York: Oxford University Press.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Looking at other possibilities requires a willingness to try something new, to step outside your Comfort Zone, to take risks. For youth who have had lives filled with unpredictability, even the most painful known option can feel less risky than any unknown one. “Steve,” a former client, summed this up when he said, “What I like the most about drugs is that I know what to expect. I smoke. I get high. No surprises.” For youth like Steve, there is an inherent reinforcement in a life of “no surprises.” Unlike many of other aspects of his life, he knows what to expect when he uses. And, that predictability is appealing.
However, a life of "no surprises" can lead to a cycle of stuckness. A basic tenet of brain development is that what fires together wires together. Through repetition of the same behavior, neuronal connections are created and then reinforced. Just like tying shoes becomes easier over time as a result of neurons wiring together, cognitive scripts also become hard wired in the brain. In other words, the maladaptive scripts of acting up, shutting down and using become part of the individual’s brain structure.
This means that Steve, like many youth, is cognitively stuck. His brain is hard wired to respond to life in maladaptive ways. Facilitating for change requires helping these youth break this cycle of stuckness. Experiential learning provides an effective methodology for doing this, because it “challenge[s] participants to update, refine, and alter mental programs when they emerge” (Luckner & Nadler, p. 36).
This updating, refining and altering can occur thanks to neuroplasticity, “the brain’s ability to physically change in response to stimuli and activity” (Romer & Walker, p. 484). It is “the ability of neurons to change the way they behave and relate to one another as the brain adapts to the environment through time” (Cozolino, p. 75). Neuroplasticity allows us to create new cognitive scripts.
Paula Tallal of Rutgers University stated, “You create your brain from the input you get” (qtd. in Begley, p. 105). It seems to me that it logically follows that that if you change the input, you would change the brain. Therapy or counseling provides an effective methodology for changing the input in a controlled and intentional manner. Cozolino supports this conclusion by writing, “[T]he therapeutic context may enhance the brain’s ability to rewire through concurrent emotional and cognitive processing. Successful therapeutic techniques may be successful because of their very ability to change brain chemistry in a manner that enhances neural plasticity” (p. 300).
“An enriched environment is one that is characterized by a level of stimulation and complexity that enhances learning and growth… [E]nriched environments can include the kinds of challenging educational and experiential opportunities that encourage us to learn new skills and expand our knowledge” (Cozolino, p. 22-23). A study conducted by the University of British Columbia helps to support the conclusion by Priest and Gass.
In this study, mice that were provided exercise wheels developed neurons that were “dramatically different” from sedentary mice. These exercise wheels provided the mice a more enriched environment, and in response their neurons had more dendrites, which are responsible for receiving signals from other neurons. This means the thinking patterns of these mice was more complex, more able to solve problems, and more able to engage in lasting learning (Begley, p. 69).
Cozolino suggests that any therapeutic approach will provide the enriched environment he describes. It seems to me, though, that experiential learning is particularly well suited for enhancing neuroplasticity. Experiential learning takes the "talk therapy" of other methodologies and puts that learning into action. Experiential learning tests what other methodologies often leave as "inert ideas" (Whitehead, qtd. in Zull, p. 206). According to Zull, "Action forces our mental constructs out of our brains and into the reality of the physical world" ( p. 206). Without that active testing, these new ideas are unlikely to ever be integrated into new behaviors. Active testing, then, is what allows us to rehearse new cognitive scripts.
Neuroplasticity in Action
Priest and Gass outlined six characteristics of experiential learning: the participant is provided a direct and purposeful experience, the participant is appropriately challenged, the participant is presented with opportunities for synthesis and reflection, the experience provides for natural consequences, the experience emphasizes participant-driven change, and the experience has both present and future relevance (p. 146-147).
All six of these characteristics are important to assure the most beneficial learning experience possible. However, it seems to me that for facilitators of experiential learning in clinical settings, focusing on participant-driven change is especially relevant. “Challenges that force us to expand our awareness, learn new information, or push beyond assumed limits can all change our brains” (Cozolino, p. 291).
Experiential learning regularly utilizes activities intended to push participants beyond their assumed limits, or to step outside their Comfort Zone. This provides participants the opportunity to test their assumptions and reject those they discover to be faulty. Because this testing is participant-driven, it is more developmentally appropriate for teens than more prescriptive counseling methodologies.
Zull wrote, “When we test our ideas, we are changing the abstract into the concrete. We convert our mental ideas into physical events” (p. 208). Converting mental ideas into physical events is exactly why experiential learning is an especially effective methodology for ending the cycle of stuckness. I would add, though, that once a mental construct has been forced into the physical world and discovered to be faulty, it is likely to be abandoned.
Rehearsing Change
As we have seen, experiential learning provides an effective method for testing and rejecting. Experiential learning provides two additional methods for helping end the cycle of stuckness. First, this methodology provides participants an opportunity to practice alternative behavioral choices. When used effectively and chosen for their relevance to the clinical work at hand, experiential learning allows youth like Steve to alter their cognitive scripts by putting new learning into practice in ways that will be memorable and concrete. In other words, experiential learning provides an opportunity to rehearse new scripts.
Second, experiential learning provides participants the opportunity to engage in healthy risk taking. For youth like Steve who prefer a life of no surprises, acting up, shutting down and using are so germane to their maladaptive scripts that these behaviors have become normalized. Thus, they are no longer perceived as risky.
In the Stages of Change model, these youth are pre-contemplative. Part of the appeal of pre-contemplation is that it feels safe (Prochaska, Norcross & DiClemente, p. 74). These youth often exhibit significant cognitive dissonance, perceiving high-risk situations as risk-free. This is, perhaps, the ultimate maladaptive script and part of their stuckness is their inability to see it. Helping them become unstuck requires helping them to reframe this dissonance, so that they move through the Stages of Change. Helping them become unstuck requires that they come to see risky behavior as risky.
Priest and Gass have cataloged significant affective gains from participation in experiential learning. These include new self-confidence, enhanced willingness to take good risks, improved self-concept, increased logical thinking, and greater reflective thinking (p. 19). These affective gains would be useful for anyone engaged in the change process, but they are particularly useful for someone stuck in pre-contemplation.
As illustrated, the use of experiential learning in clinical settings seems an obvious and valuable choice, leading to a “more enriched, complex, and potentially resilient brain” (Cozolino, p. 298). Experiential learning provides an excellent methodology for assuring this treatment outcome, by providing an “enriched environment to enhance brain development” (Cozolino, p. 291). These developments result in increased confidence and optimism regarding the ability to change. This is vital in helping assure that youth like Steve will actually utilize their new developed, more adaptive cognitive scripts.
“The concept of neuroplasticity suggests that the brain is highly malleable and is subject to continual change as a result of experience, so that new connections between neurons may be formed or even brand-new neurons generated” (The Dalai Lama, qtd. in Begley, p. 24). By providing rich opportunities to test assumptions, practice new behaviors, and engage in healthy risk taking, experiential learning inevitably enhances neuroplasticity, thereby leading to lasting changes in cognitive scripts. It is through this learning, rehearsing, and ultimate using of new, more adaptive cognitive scripts that youth like Steve can break their cycle of stuckness.
Works Cited
Begley, S. (2007). Train Your Mind, Change Your Brain. New York: Ballantine Books.
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S., & Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinestics.
Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for Good. New York: Harper Collins.
Romer, D. & Walker, E. (2007). Adolescent Psychopathology and the Developing Brain. New York: Oxford University Press.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Sunday, November 2, 2008
Experiential Activities In Clinical Settings
The more I explore ideas about facilitating change, the more I come to see my job as a substance abuse counselor as helping my clients become unstuck by providing them the opportunities to write new cognitive scripts, rather than simply getting them to stop using alcohol and other drugs. It seems to me that our job as counselors and therapists is not to eliminate those old cognitive scripts, but to help them discover new, more adaptive possibilities.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Saturday, October 25, 2008
Getting Unstuck
According to the Yale Medical School web site, cognitive script is "the term used for the themes that flow habitually through our thoughts. These cognitive scripts can influence both our emotions and our behavior. They have been described as the tapes we play repeatedly in our heads—those things we tell ourselves over and over again, often without conscious awareness."
In my experience, substance-abusing teens generally have three basic cognitive scripts: act up, shut down, and use. With such limited options, these youth are stuck continuously rerunning these same maladaptive scripts, perpetuating already internalized beliefs that they are ineffective, incapable, and unable to make more adaptive choices.
Every time a youth uses the same maladaptive script, it becomes more likely that he will use it again. This is basic neuroscience. Hebb wrote, “[A]ny two cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other" (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Cognitive scripts are learned. For an individual who experienced a positive childhood environment, her scripts will be adaptive and flexible. However, when a youth has only maladaptive scripts, eventually acting up, shutting down, and using can become so normalized that these scripts are no longer seen as problematic.
“Jennifer,” a former client, had a history of running away, shoplifting, and abusing marijuana. When I worked with her, she was on her third treatment episode. Jennifer lived in a group home with a drug testing policy and continued use would result in her losing her placement. Yet, she continued to use. Some drug counselors would say she was in denial or resistant to treatment. This seems overly simplistic to me. Jennifer couldn’t be successful because she had no mental model of success. All Jennifer knew was acting up, shutting down, and using. All Jennifer knew was being stuck.
If creating change in our clients is about helping them write new, more adaptive scripts, how do we make that happen? I’ve always believed the answer is not to provide endless didactic lectures. Rather, the answer is to present clients opportunities to try new behaviors. As they practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other words, they are starting to get unstuck.
Beyond the Comfort Zone
In my experience, substance-abusing teens and other at-risk youth continue to engage in maladaptive behaviors until they break their cycle of stuckness. If this is true, then it seems to me that the goal of substance abuse treatment should be to help clients create new, more adaptive cognitive scripts. It seems to me that the first step in this process is encouraging participants to risk going outside their Comfort Zones.
There's a paradox among many of my clients. While they have done things I consider extremely high risk—like getting high on drugs acquired from a stranger who is inherently a criminal, exchanging sex for drugs, or stealing to support their habit—they almost universally present as risk-adverse. I'm frequently perplexed by how to confront this Risk Dichotomy, which my clients are usually unable to recognize. It seems those things have become so normalized to them that they are no longer perceived as risky.
For these clients, staying stuck seems safe. Acting up, shutting down, and using are solidly within their Comfort Zones, so don't seem like risky behavior. This cycle keeps the youth stuck—and every time this cycle repeats itself, it becomes more likely the youth will stay stuck. What fires together wires together. That's basic neuroscience. And, every time that happens it becomes more likely to happen again.
Getting unstuck requires the individual to step outside her Comfort Zone and experiment with new behaviors. This is much riskier—not to mention harder—than sticking with rigid, predictable responses. However, it is only through trying new behaviors that the individual will have the opportunity to develop more adaptive cognitive scripts.
Through participation in experiences that move them outside their Comfort Zones, experiential learning provides substance-abusing teens an opportunity to test their assumptions and reject those they discover to be faulty. It seems to me that this testing and rejecting is vital for movement through the Stages of Change, especially those stages most likely to be encountered in a treatment setting—pre-contemplation, contemplation, and preparation.
For a pre-contemplative client, testing and rejecting “increases the likelihood of serious consideration of change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting fosters the likelihood of “a considered evaluation that leads to a decision to change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting increases self-efficacy and can result in “an action plan that will be implemented in the near term” (DiClemente, p. 27).
You’re Freaking Me Out!
If opportunities to test and reject assumptions are necessary for movement through the Stages of Change, so, too, is some discomfort. According to Cozolino, “[M]oderate stress triggers the release of neurohormones that enhance cortical reorganization and new learning” (p. 24). In addition, Zull wrote, “Plasticity in the brain probably depends more on signals from the emotional centers than it does on new sensory input” (p. 223).
In other words, it is emotions—especially stress—that make our brains learn and change. Experiential learning is an excellent methodology for creating this change environment. In most experiential activities, there is a high level of perceived risk. In some cases, such as white water rafting or high ropes activities, this perceived risk is physical. In other cases, this perceived risk could be emotional or social.
Whether physical, emotional, or social, the perception of risk in experiential activities will likely result in a sense of disequilibrium. According to Luckner and Nadler, “Disequilibrium refers to an individual’s awareness that a mismatch exists between old ways of thinking and new information” (p. 19). "Vincent," a former client, provided an example of disequilibrium during a group activity.
I talk about appropriate risk-taking frequently during group sessions, and often use an activity called Pass the Mousetraps to illustrate this idea. As the title suggests, this activity involves passing around set mousetraps. Actually, this activity also includes tripping mousetraps with hands.
Although completely safe when certain parameters are followed, this activity appears to be fairly risky. In fact, while sitting in a room filled with teens tripping mousetraps, Vincent, a former client, blurted, “You’re freaking me out!” and quickly left the room. For Vincent, the perceived risk was simply too high, even after my extremely detailed safety directions prior to the activity.
Watching his group-mates trip mousetraps with their hands created too strong of a mismatch for Vincent. He believed this to be extremely dangerous behavior, yet nobody was being injured. Unable to revise his thinking quickly enough to reflect the reality of the situation, Vincent had no choice but to flee. Later, Vincent stated, “I left because I was sure someone was going to get hurt. And I couldn’t figure out why that wasn’t happening.” Vincent wasn't worried someone might get hurt; he was upset because what he expected to happen didn't.
With all my clients, disequilibrium appears when acting up, shutting down, and using become no longer effective. When faced with this scenario, a participant is confronted with one of two choices: assimilation or accommodation. According to Piaget’s developmental theory, when presented with new information an individual tries to assimilate it, or fit it into his existing understanding of the world. If this is impossible, the individual is forced to accommodate the new information by altering his schema, or mental models (Kassin, p. 343). When presented with an experience that requires accommodation, an individual is forced to alter his cognitive scripts.
Experiential learning is rich in these opportunities. Marie—the client discussed in my earlier posting Reflecting on Reflection—and her experience on the hike is a good example. Marie was confronted with two choices. She could give up by sitting on the side of the mountain and refusing to continue the hike, or she could resume the hike even though it was difficult and clearly outside her Comfort Zone. When Marie chose to continue the hike, she was required to accommodate this new option and alter her cognitive scripts.
I believe that these opportunities are one of the major values of experiential learning in treatment setting. Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in many experiential activities], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18). It seems to me that by definition, insurmountable tasks only exist outside one’s Comfort Zone. Perhaps, then, taking the risk of tackling an insurmountable task means a participant will automatically be more open to becoming unstuck.
For Marie, an insurmountable task was accomplished and the change was almost immediate. In Vincent’s case, he never tripped a mousetrap with his bare hand, but he did confront a powerful mismatch. What he expected didn’t happen and to accommodate that new experience, he needed to alter his cognitive scripts.
So, what does being slightly less afraid of a mousetrap has to do with sobriety? As a result of his experience that day, Vincent discovered that mousetraps aren’t inherently dangerous after all. This new learning required him to rearrange information in ways that formed new neural networks based on actively testing and rejecting an outdated belief. And, perhaps, with that was born a new perspective: There are possibilities other than those you’ve always believed to be true. Experiential learning helps participants become unstuck by helping them create new, more adaptive cognitive scripts and helping them discover those other possibilities.
Works Cited
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
DiClemente, C. (2003). Addiction and Change. New York: Guilford Press.
Kassin, S. (2004). Essentials of Psychology. Upper Saddle River, NJ: Prentice-Hall.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Yale Medical School. (n.d.). Glossary. Retrieved October 22, 2008, from
http://info.med.yale.edu/psych/3s/glossary_items/cog_script.html
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
In my experience, substance-abusing teens generally have three basic cognitive scripts: act up, shut down, and use. With such limited options, these youth are stuck continuously rerunning these same maladaptive scripts, perpetuating already internalized beliefs that they are ineffective, incapable, and unable to make more adaptive choices.
Every time a youth uses the same maladaptive script, it becomes more likely that he will use it again. This is basic neuroscience. Hebb wrote, “[A]ny two cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other" (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Cognitive scripts are learned. For an individual who experienced a positive childhood environment, her scripts will be adaptive and flexible. However, when a youth has only maladaptive scripts, eventually acting up, shutting down, and using can become so normalized that these scripts are no longer seen as problematic.
“Jennifer,” a former client, had a history of running away, shoplifting, and abusing marijuana. When I worked with her, she was on her third treatment episode. Jennifer lived in a group home with a drug testing policy and continued use would result in her losing her placement. Yet, she continued to use. Some drug counselors would say she was in denial or resistant to treatment. This seems overly simplistic to me. Jennifer couldn’t be successful because she had no mental model of success. All Jennifer knew was acting up, shutting down, and using. All Jennifer knew was being stuck.
If creating change in our clients is about helping them write new, more adaptive scripts, how do we make that happen? I’ve always believed the answer is not to provide endless didactic lectures. Rather, the answer is to present clients opportunities to try new behaviors. As they practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other words, they are starting to get unstuck.
Beyond the Comfort Zone
In my experience, substance-abusing teens and other at-risk youth continue to engage in maladaptive behaviors until they break their cycle of stuckness. If this is true, then it seems to me that the goal of substance abuse treatment should be to help clients create new, more adaptive cognitive scripts. It seems to me that the first step in this process is encouraging participants to risk going outside their Comfort Zones.
There's a paradox among many of my clients. While they have done things I consider extremely high risk—like getting high on drugs acquired from a stranger who is inherently a criminal, exchanging sex for drugs, or stealing to support their habit—they almost universally present as risk-adverse. I'm frequently perplexed by how to confront this Risk Dichotomy, which my clients are usually unable to recognize. It seems those things have become so normalized to them that they are no longer perceived as risky.
For these clients, staying stuck seems safe. Acting up, shutting down, and using are solidly within their Comfort Zones, so don't seem like risky behavior. This cycle keeps the youth stuck—and every time this cycle repeats itself, it becomes more likely the youth will stay stuck. What fires together wires together. That's basic neuroscience. And, every time that happens it becomes more likely to happen again.
Getting unstuck requires the individual to step outside her Comfort Zone and experiment with new behaviors. This is much riskier—not to mention harder—than sticking with rigid, predictable responses. However, it is only through trying new behaviors that the individual will have the opportunity to develop more adaptive cognitive scripts.
Through participation in experiences that move them outside their Comfort Zones, experiential learning provides substance-abusing teens an opportunity to test their assumptions and reject those they discover to be faulty. It seems to me that this testing and rejecting is vital for movement through the Stages of Change, especially those stages most likely to be encountered in a treatment setting—pre-contemplation, contemplation, and preparation.
For a pre-contemplative client, testing and rejecting “increases the likelihood of serious consideration of change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting fosters the likelihood of “a considered evaluation that leads to a decision to change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting increases self-efficacy and can result in “an action plan that will be implemented in the near term” (DiClemente, p. 27).
You’re Freaking Me Out!
If opportunities to test and reject assumptions are necessary for movement through the Stages of Change, so, too, is some discomfort. According to Cozolino, “[M]oderate stress triggers the release of neurohormones that enhance cortical reorganization and new learning” (p. 24). In addition, Zull wrote, “Plasticity in the brain probably depends more on signals from the emotional centers than it does on new sensory input” (p. 223).
In other words, it is emotions—especially stress—that make our brains learn and change. Experiential learning is an excellent methodology for creating this change environment. In most experiential activities, there is a high level of perceived risk. In some cases, such as white water rafting or high ropes activities, this perceived risk is physical. In other cases, this perceived risk could be emotional or social.
Whether physical, emotional, or social, the perception of risk in experiential activities will likely result in a sense of disequilibrium. According to Luckner and Nadler, “Disequilibrium refers to an individual’s awareness that a mismatch exists between old ways of thinking and new information” (p. 19). "Vincent," a former client, provided an example of disequilibrium during a group activity.
I talk about appropriate risk-taking frequently during group sessions, and often use an activity called Pass the Mousetraps to illustrate this idea. As the title suggests, this activity involves passing around set mousetraps. Actually, this activity also includes tripping mousetraps with hands.
Although completely safe when certain parameters are followed, this activity appears to be fairly risky. In fact, while sitting in a room filled with teens tripping mousetraps, Vincent, a former client, blurted, “You’re freaking me out!” and quickly left the room. For Vincent, the perceived risk was simply too high, even after my extremely detailed safety directions prior to the activity.
Watching his group-mates trip mousetraps with their hands created too strong of a mismatch for Vincent. He believed this to be extremely dangerous behavior, yet nobody was being injured. Unable to revise his thinking quickly enough to reflect the reality of the situation, Vincent had no choice but to flee. Later, Vincent stated, “I left because I was sure someone was going to get hurt. And I couldn’t figure out why that wasn’t happening.” Vincent wasn't worried someone might get hurt; he was upset because what he expected to happen didn't.
With all my clients, disequilibrium appears when acting up, shutting down, and using become no longer effective. When faced with this scenario, a participant is confronted with one of two choices: assimilation or accommodation. According to Piaget’s developmental theory, when presented with new information an individual tries to assimilate it, or fit it into his existing understanding of the world. If this is impossible, the individual is forced to accommodate the new information by altering his schema, or mental models (Kassin, p. 343). When presented with an experience that requires accommodation, an individual is forced to alter his cognitive scripts.
Experiential learning is rich in these opportunities. Marie—the client discussed in my earlier posting Reflecting on Reflection—and her experience on the hike is a good example. Marie was confronted with two choices. She could give up by sitting on the side of the mountain and refusing to continue the hike, or she could resume the hike even though it was difficult and clearly outside her Comfort Zone. When Marie chose to continue the hike, she was required to accommodate this new option and alter her cognitive scripts.
I believe that these opportunities are one of the major values of experiential learning in treatment setting. Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in many experiential activities], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18). It seems to me that by definition, insurmountable tasks only exist outside one’s Comfort Zone. Perhaps, then, taking the risk of tackling an insurmountable task means a participant will automatically be more open to becoming unstuck.
For Marie, an insurmountable task was accomplished and the change was almost immediate. In Vincent’s case, he never tripped a mousetrap with his bare hand, but he did confront a powerful mismatch. What he expected didn’t happen and to accommodate that new experience, he needed to alter his cognitive scripts.
So, what does being slightly less afraid of a mousetrap has to do with sobriety? As a result of his experience that day, Vincent discovered that mousetraps aren’t inherently dangerous after all. This new learning required him to rearrange information in ways that formed new neural networks based on actively testing and rejecting an outdated belief. And, perhaps, with that was born a new perspective: There are possibilities other than those you’ve always believed to be true. Experiential learning helps participants become unstuck by helping them create new, more adaptive cognitive scripts and helping them discover those other possibilities.
Works Cited
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
DiClemente, C. (2003). Addiction and Change. New York: Guilford Press.
Kassin, S. (2004). Essentials of Psychology. Upper Saddle River, NJ: Prentice-Hall.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Yale Medical School. (n.d.). Glossary. Retrieved October 22, 2008, from
http://info.med.yale.edu/psych/3s/glossary_items/cog_script.html
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Saturday, September 20, 2008
Here I Go!
I've recently finished The Art of Changing the Brain, by James Zull. This book is packed full of interesting information on the biology of learning. The author did an excellent job of providing the information needed to understand this potentially challenging topic, so even if you have little understanding, you should be able to jump right in.
Zull wrote, “The main message [of this book] is that learning is change. It is change in ourselves, because it is change in the brain. Thus the art of teaching must be the art of changing the brain” (p. xivv). Zull builds on this statement throughout the book, exploring ways to use what is known about neuroscience in the process of teaching, and more important to my focus here, in facilitating for change.
Although the book is focused on teaching, the material presented is equally relevant to counseling and group facilitation. Over the last couple years I’ve started viewing myself more as a facilitator than a counselor. To me a counselor is someone who gives advice, and I try to avoid that most of the time!
In my experience, teens just aren’t much for advice taking. More importantly, though, I have come to believe that treatment is inherently an experiential learning process and hope to help clients reach their own decisions, building whatever necessary skills as we go. If I’m doing good work, what I’m really doing is facilitating the process of change, not providing advice. Like any facilitator, what I'm doing is providing opportunities.
As I started reading Zull and realized how teacher-focused it was, I had a bit of a challenge accepting that the material could apply to me. I don’t even like being called a counselor; I certainly don’t want to consider myself a teacher! Teachers provide new information and I operate on the assumption that my clients already know what they need. Sure, they're likely missing certain skills and frequently don’t have some factual information, but if treatment is an experiential process, than doesn't being effective in my work means not giving advice (at least not too often) and not teaching new information (at least not too much)? Isn't that what a facilitator does?
Having finished the book, I’ve altered my take on this a bit. It seems to me there’s really not much difference between teaching, counseling and facilitating—at least when they are done well. I still see myself as a facilitator, because that fits best with my approaches to counseling and fostering change, and I like how that role name fits. However, the distinctions between the three seem less relevant to me.
Prior Knowledge
One idea from Zull that has especially impacted me is the importance of prior knowledge. Zull wrote, “[P]rior knowledge is the beginning of new knowledge” (p. 93). He expanded on that with this statement: “When we speak of prior knowledge, we are speaking of something physical. It builds as brains physically change, and it is held in place by physical connections” (p. 94).
According to Zull, that physical something consists of all the neuronal networks that exist in our brains. “Whatever the neuronal networks are in the student brain, a teacher cannot remove them” (p. 101). So, rather than try to eliminate these neuronal networks, which won’t be effective anyway, it is more effective to build upon them. Taking this idea a small step further, it seems to me that prior knowledge actually provides a foundation that allows the teacher/facilitator/counselor to start in progress with the process of change. Prior knowledge, even if not entirely accurate, gives you a head start in facilitating change.
With that in mind, it seems only reasonable to have this first blog entry address what I already believe about that work I do. Core to my counseling approach is that everyone has cognitive scripts. Simply put, cognitive scripts are learned responses to situations. They are habits of both though and behavior. Like any habit, if I do something enough times it becomes automatic. This idea has roots in basic brain development. What wires together fires together. If someone is wired for adaptive cognitive scripts, that person is unlikely to have major problems in life. However, if someone is wired for maladaptive scripts, that person is stuck.
My clients are stuck. They have brains wired to make bad choices. In some cases, that wiring results from their environment. In other cases, it is due to genetic predisposition. In most cases, it seems to me that the maladaptive scripts result from a combination of these factors. Regardless of the causation, though, the cognitive scripts of my clients are usually limited to three options: acting up, shutting down, and using.
For my clients, acting up, shutting down, and using are solutions that have been effective in the past. Of course, effective doesn't necessarily mean adaptive. Rather, it means the behavior helped the individual meet her/his needs at that time. Since her/his needs were met by the behavior, it was repeated and became hardwired. This is basic behaviorist stuff. Do something, like the outcome, do it again.
Helping my clients move forward requires helping them get unstuck from this behaviorist loop, and that means helping them develop new, more adaptive cognitive scripts.
Zull's concept of prior learning would imply that my goal as a facilitator/counselor/teacher should not be to eliminate these maladaptive scripts, and that seems somewhat revolutionary to me. Instead, Zull suggested that it would be more effective to start with them. This bit of neuroscience would seem to support motivational interviewing, an "evidence-based approach to overcoming the ambivalence that keeps many people from making desired changes in their lives" (Miller & Rollnick, dust jacket), takes this approach also. More to come on that in the future!
Growth Zones
Getting unstuck means making changes and that’s hard. There are many reasons that change is hard, but I believe there are two factors that are especially relevant. The first is that brains are lazy. More accurately, brains are efficient and will automatically default to what is already known—those neurons that have fired together over and over in the past, those well rehearsed cognitive scripts whether they’re adaptive or not. The second factor that makes getting unstuck hard is that change is risky because it requires stepping outside your Comfort Zone.
A popular model in the experiential learning field is Growth Zones. I use this model with my clients regularly, and have found it to be useful for them in conceptualizing the process of change. Imagine an archery target with three rings. The innermost ring is an individual’s Comfort Zone. Here there are no challenges and no risks, but also no learning or change.
Most people spend most of their time in their Comfort Zone, and that's reasonable and appropriate. However, it is only when you move outside your Comfort Zone and enter your Change Zone, the middle ring, that you have the opportunity for growth or new learning. With this opportunity comes risk, though, because the outcome is uncertain. Should you go too far from your Comfort Zone, straying past your Change Zone and into the outermost ring, you'll end up in your Crisis Zone. At this point, you’re no longer learning or growing.
Comfort, Change, and Crisis are my names for these three zones. I like the alliteration and I like that it reinforces the idea of change. Most versions of this model call the three zones Comfort, Learning, and Panic.
Risking Change
Since making changes means taking risks, I believe success in the work I do requires the intentional creation of an environment where taking risks feels less risky. Doing that requires acknowledging that change is risky, exploring good risks versus bad risks, and providing opportunities to practice safe risk-taking. I believe that one of the best ways to provide opportunities to practice safe risk-taking is through experiential activities.
Experiential learning provides opportunities for participants to:
1. Test their pre-existing assumptions and reject what they no longer find effective;
2. Practice alternate behaviors; and,
3. Engage in healthy risk taking.
For many of my clients, risk-taking is something of a paradox. They’ve regularly engaged in behaviors that most people would considered extremely high risk—illicit drug use, illegal activities and so on. However, when it comes to making changes they are often extremely risk-adverse. They would often rather continue engaging in maladaptive, no longer effective behaviors than even consider doing anything different. At least that’s what they say and that’s what they do.
In fact, I believe most of my clients actually have more complex feelings about changing their behaviors, initially presenting with a certain amount of cognitive dissonance apparent in their words and actions. However, this risk-taking paradox is definitely a barrier to becoming unstuck for my clients.
It seems to me that this paradox is rooted in one simple fact: the Known, which is always inside someone's Comfort Zone, is safer than the Unknown, which is outside someone's Comfort Zone. For many of my clients, high-risk behavior is Very Much Known. Or at least the chaos created by the high-risk behavior is Very Much Known.
Nearly all of my clients have histories of trauma, abuse, neglect, or (at the very least) dysfunctional family systems. The cognitive scripts of these clients include chaos. It is hard-wired in their brains. In addition, stress releases neurochemicals that act on the brain’s reward center in the same way that meth, cocaine and other stimulants do. What a double whammy!
For these youth, high-risk behavior has become normalized. It exists inside their Comfort Zones and so no longer seems risky. In addition, when they engage in high-risk behavior, the behavior is reinforced because they get high. Perhaps there is no paradox here. Perhaps this behavior is completely understandable.
Another way to conceptualize this paradox occurred to me as I wrote this blog post: For these chaos junkie youth, maybe high-risk behavior isn't really in their Comfort Zone. After all, they generally do exhibit cognitive dissonance and generally are able to identify problems related to their behavior (not always the problems I've identified, but problems nonetheless).
I wonder if this cognitive dissonance means that the high-risk behaviors of these youth are, in fact, not in their Comfort Zone. I wonder if maybe these youth are stuck in their Crisis Zone.
Most treatment strategies for these youth are about trying new behaviors. In other words, most treatment strategies for these youth involve getting them to leave their Comfort Zones. However, they can't leave if they aren't even there. Maybe this treatment approach is backward. Maybe what should be happening is these youth should be nudged back into their Comfort Zone. Hummm...
Stages of Change
Another model of change I utilize frequently is the Stages of Change. This model states that any change requires progression through a series of stages. These stages include Pre-contemplation, Contemplation, Preparation, Action and Maintenance. Without progressing through all stages, lasting change won't happen.
In the past, most chemical dependency treatment was focused entirely on Action. Upon entering treatment, the client was expected to immediately stop all using. If that didn’t happen, the client was consider in denial or resistant to treatment and was often discharged. Not very effective. Would an M.D. discharge a cancer patient because the cancer didn't go away immediately? I hope not.
Alternatively, the client was perhaps compliant, attending all group sessions and having nothing but clean UAs. In this case, the client would be rewarded for her/his success. However, compliance has nothing to do with change, at least to in my opinion. Compliant clients are relapses waiting to happen.
The Stages of Change model suggests that you meet the client where she/he is and work on facilitating movement to the next stage. Discovering the motivation to move is the key to progressing through the Stages of Change.
There’s also the Recycle or Relapse stage, which is an important part of this theoretical model. In the Recycle stage, the individual cycles back through some of the earlier stages. When working with clients attempting to create any kind of change, I believe it is important to remember that relapse is not a sign of failure. Instead, relapse is a vital part of the change process and an important learning opportunity.
Relapse is experiential learning. It allows the client to test her/his pre-existing assumptions and reject what they no longer find effective, practice alternate behaviors, and engage in some healthy risk taking by learning something new. What didn’t work? What do you need to do differently? How can you move forward now, better prepared and with greater understanding of your personal challenges for staying clean?
Recently, I’ve been thinking about how an individual’s Stage of Change is their Comfort Zone. It seems to me there must be some interesting dynamic between these two models, but I don’t yet know what. It also seems to me that there is likely much more to discover in the crevasse between facilitating change and traumatic stress. I’m ready to go explore!
Works Cited
Zull, James. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Zull wrote, “The main message [of this book] is that learning is change. It is change in ourselves, because it is change in the brain. Thus the art of teaching must be the art of changing the brain” (p. xivv). Zull builds on this statement throughout the book, exploring ways to use what is known about neuroscience in the process of teaching, and more important to my focus here, in facilitating for change.
Although the book is focused on teaching, the material presented is equally relevant to counseling and group facilitation. Over the last couple years I’ve started viewing myself more as a facilitator than a counselor. To me a counselor is someone who gives advice, and I try to avoid that most of the time!
In my experience, teens just aren’t much for advice taking. More importantly, though, I have come to believe that treatment is inherently an experiential learning process and hope to help clients reach their own decisions, building whatever necessary skills as we go. If I’m doing good work, what I’m really doing is facilitating the process of change, not providing advice. Like any facilitator, what I'm doing is providing opportunities.
As I started reading Zull and realized how teacher-focused it was, I had a bit of a challenge accepting that the material could apply to me. I don’t even like being called a counselor; I certainly don’t want to consider myself a teacher! Teachers provide new information and I operate on the assumption that my clients already know what they need. Sure, they're likely missing certain skills and frequently don’t have some factual information, but if treatment is an experiential process, than doesn't being effective in my work means not giving advice (at least not too often) and not teaching new information (at least not too much)? Isn't that what a facilitator does?
Having finished the book, I’ve altered my take on this a bit. It seems to me there’s really not much difference between teaching, counseling and facilitating—at least when they are done well. I still see myself as a facilitator, because that fits best with my approaches to counseling and fostering change, and I like how that role name fits. However, the distinctions between the three seem less relevant to me.
Prior Knowledge
One idea from Zull that has especially impacted me is the importance of prior knowledge. Zull wrote, “[P]rior knowledge is the beginning of new knowledge” (p. 93). He expanded on that with this statement: “When we speak of prior knowledge, we are speaking of something physical. It builds as brains physically change, and it is held in place by physical connections” (p. 94).
According to Zull, that physical something consists of all the neuronal networks that exist in our brains. “Whatever the neuronal networks are in the student brain, a teacher cannot remove them” (p. 101). So, rather than try to eliminate these neuronal networks, which won’t be effective anyway, it is more effective to build upon them. Taking this idea a small step further, it seems to me that prior knowledge actually provides a foundation that allows the teacher/facilitator/counselor to start in progress with the process of change. Prior knowledge, even if not entirely accurate, gives you a head start in facilitating change.
With that in mind, it seems only reasonable to have this first blog entry address what I already believe about that work I do. Core to my counseling approach is that everyone has cognitive scripts. Simply put, cognitive scripts are learned responses to situations. They are habits of both though and behavior. Like any habit, if I do something enough times it becomes automatic. This idea has roots in basic brain development. What wires together fires together. If someone is wired for adaptive cognitive scripts, that person is unlikely to have major problems in life. However, if someone is wired for maladaptive scripts, that person is stuck.
My clients are stuck. They have brains wired to make bad choices. In some cases, that wiring results from their environment. In other cases, it is due to genetic predisposition. In most cases, it seems to me that the maladaptive scripts result from a combination of these factors. Regardless of the causation, though, the cognitive scripts of my clients are usually limited to three options: acting up, shutting down, and using.
For my clients, acting up, shutting down, and using are solutions that have been effective in the past. Of course, effective doesn't necessarily mean adaptive. Rather, it means the behavior helped the individual meet her/his needs at that time. Since her/his needs were met by the behavior, it was repeated and became hardwired. This is basic behaviorist stuff. Do something, like the outcome, do it again.
Helping my clients move forward requires helping them get unstuck from this behaviorist loop, and that means helping them develop new, more adaptive cognitive scripts.
Zull's concept of prior learning would imply that my goal as a facilitator/counselor/teacher should not be to eliminate these maladaptive scripts, and that seems somewhat revolutionary to me. Instead, Zull suggested that it would be more effective to start with them. This bit of neuroscience would seem to support motivational interviewing, an "evidence-based approach to overcoming the ambivalence that keeps many people from making desired changes in their lives" (Miller & Rollnick, dust jacket), takes this approach also. More to come on that in the future!
Growth Zones
Getting unstuck means making changes and that’s hard. There are many reasons that change is hard, but I believe there are two factors that are especially relevant. The first is that brains are lazy. More accurately, brains are efficient and will automatically default to what is already known—those neurons that have fired together over and over in the past, those well rehearsed cognitive scripts whether they’re adaptive or not. The second factor that makes getting unstuck hard is that change is risky because it requires stepping outside your Comfort Zone.
A popular model in the experiential learning field is Growth Zones. I use this model with my clients regularly, and have found it to be useful for them in conceptualizing the process of change. Imagine an archery target with three rings. The innermost ring is an individual’s Comfort Zone. Here there are no challenges and no risks, but also no learning or change.
Most people spend most of their time in their Comfort Zone, and that's reasonable and appropriate. However, it is only when you move outside your Comfort Zone and enter your Change Zone, the middle ring, that you have the opportunity for growth or new learning. With this opportunity comes risk, though, because the outcome is uncertain. Should you go too far from your Comfort Zone, straying past your Change Zone and into the outermost ring, you'll end up in your Crisis Zone. At this point, you’re no longer learning or growing.
Comfort, Change, and Crisis are my names for these three zones. I like the alliteration and I like that it reinforces the idea of change. Most versions of this model call the three zones Comfort, Learning, and Panic.
Risking Change
Since making changes means taking risks, I believe success in the work I do requires the intentional creation of an environment where taking risks feels less risky. Doing that requires acknowledging that change is risky, exploring good risks versus bad risks, and providing opportunities to practice safe risk-taking. I believe that one of the best ways to provide opportunities to practice safe risk-taking is through experiential activities.
Experiential learning provides opportunities for participants to:
1. Test their pre-existing assumptions and reject what they no longer find effective;
2. Practice alternate behaviors; and,
3. Engage in healthy risk taking.
For many of my clients, risk-taking is something of a paradox. They’ve regularly engaged in behaviors that most people would considered extremely high risk—illicit drug use, illegal activities and so on. However, when it comes to making changes they are often extremely risk-adverse. They would often rather continue engaging in maladaptive, no longer effective behaviors than even consider doing anything different. At least that’s what they say and that’s what they do.
In fact, I believe most of my clients actually have more complex feelings about changing their behaviors, initially presenting with a certain amount of cognitive dissonance apparent in their words and actions. However, this risk-taking paradox is definitely a barrier to becoming unstuck for my clients.
It seems to me that this paradox is rooted in one simple fact: the Known, which is always inside someone's Comfort Zone, is safer than the Unknown, which is outside someone's Comfort Zone. For many of my clients, high-risk behavior is Very Much Known. Or at least the chaos created by the high-risk behavior is Very Much Known.
Nearly all of my clients have histories of trauma, abuse, neglect, or (at the very least) dysfunctional family systems. The cognitive scripts of these clients include chaos. It is hard-wired in their brains. In addition, stress releases neurochemicals that act on the brain’s reward center in the same way that meth, cocaine and other stimulants do. What a double whammy!
For these youth, high-risk behavior has become normalized. It exists inside their Comfort Zones and so no longer seems risky. In addition, when they engage in high-risk behavior, the behavior is reinforced because they get high. Perhaps there is no paradox here. Perhaps this behavior is completely understandable.
Another way to conceptualize this paradox occurred to me as I wrote this blog post: For these chaos junkie youth, maybe high-risk behavior isn't really in their Comfort Zone. After all, they generally do exhibit cognitive dissonance and generally are able to identify problems related to their behavior (not always the problems I've identified, but problems nonetheless).
I wonder if this cognitive dissonance means that the high-risk behaviors of these youth are, in fact, not in their Comfort Zone. I wonder if maybe these youth are stuck in their Crisis Zone.
Most treatment strategies for these youth are about trying new behaviors. In other words, most treatment strategies for these youth involve getting them to leave their Comfort Zones. However, they can't leave if they aren't even there. Maybe this treatment approach is backward. Maybe what should be happening is these youth should be nudged back into their Comfort Zone. Hummm...
Stages of Change
Another model of change I utilize frequently is the Stages of Change. This model states that any change requires progression through a series of stages. These stages include Pre-contemplation, Contemplation, Preparation, Action and Maintenance. Without progressing through all stages, lasting change won't happen.
In the past, most chemical dependency treatment was focused entirely on Action. Upon entering treatment, the client was expected to immediately stop all using. If that didn’t happen, the client was consider in denial or resistant to treatment and was often discharged. Not very effective. Would an M.D. discharge a cancer patient because the cancer didn't go away immediately? I hope not.
Alternatively, the client was perhaps compliant, attending all group sessions and having nothing but clean UAs. In this case, the client would be rewarded for her/his success. However, compliance has nothing to do with change, at least to in my opinion. Compliant clients are relapses waiting to happen.
The Stages of Change model suggests that you meet the client where she/he is and work on facilitating movement to the next stage. Discovering the motivation to move is the key to progressing through the Stages of Change.
There’s also the Recycle or Relapse stage, which is an important part of this theoretical model. In the Recycle stage, the individual cycles back through some of the earlier stages. When working with clients attempting to create any kind of change, I believe it is important to remember that relapse is not a sign of failure. Instead, relapse is a vital part of the change process and an important learning opportunity.
Relapse is experiential learning. It allows the client to test her/his pre-existing assumptions and reject what they no longer find effective, practice alternate behaviors, and engage in some healthy risk taking by learning something new. What didn’t work? What do you need to do differently? How can you move forward now, better prepared and with greater understanding of your personal challenges for staying clean?
Recently, I’ve been thinking about how an individual’s Stage of Change is their Comfort Zone. It seems to me there must be some interesting dynamic between these two models, but I don’t yet know what. It also seems to me that there is likely much more to discover in the crevasse between facilitating change and traumatic stress. I’m ready to go explore!
Works Cited
Zull, James. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
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