Here's the handout from my workshop at Counselor Camp 2001. I'm presenting a very similar workshop (it even has the same title!) in November at the Association for Experiential Education's 2011 International Conference. That workshop will focus more specifically on integrating narrative therapy and experiential education with this population.
Overcoming the Stuckness
Six Keys to Facilitating Change with Substance Abusing Teens
Presented by David Flack • Counselor Camp 2011
Teens are teens. They aren’t adults and they aren’t children. That seems obvious, right? Obvious or not, though, it is essential to remember when working with this age group. Adolescence is a discrete developmental stage that focuses on the tasks of developing identity, autonomy, intimacy, sexuality, and achievement. With substance abusing teens we often see distorted, funhouse mirror versions of these normal developmental tasks. With co-occurring teens, that mirror can be even more distorted.
It is normal for teens to question, rebel against, and ultimately reject the plans of authority figures, including the most well intentioned drug counselors. That means our clients are doing exactly what they should be doing, just in maladaptive, problematic ways. Yet, we often label them non-compliant, oppositional, or treatment resistant.
What Else Do We Know About Our Clients?
• Teens rarely enter treatment by choice. Since establishing autonomy is an important task of adolescence, when teens are mandated or pressured to attend treatment, there is a predictable conflict that frequently results in reactance.
• Substance-abusing teens typically exhibit rigid thinking habits. If we use confrontational or directive approaches, we’ll stop being allies and become adversaries. This won’t be useful for anyone!
• Most of our clients have complicating factors. 80% of substance-abusing teens have a mental health challenge; 70% have a history of trauma. If not addressed, these challenges can become insurmountable obstacles to change.
With these points in mind, I’ve developed Six Keys for facilitating change with substance-abusing teens. These Keys are a “mash up” of motivational interviewing, stages-of-change, narrative therapy, and existential psychotherapy. I think of them as the “C” in CBT — a way to assist adolescent clients in overcoming rigid thinking, getting unstuck, and moving forward.
First Key: Everyone is motivated by something.
When starting treatment, teens often deny any problems related to alcohol, marijuana, or other drugs. When this happens, many helpers quickly label them as resistant. This can be a self-fulfilling prophecy. In other words, if you expect resistance then you’ll probably get it.
When given an opportunity, even the most reluctant clients are likely to identify something that motivates them to engage in treatment — often legal, school, or family problems. These may not be the motivators we want for our clients, but change requires meeting clients where they’re at, not where we want them to be.
Help clients find their “hook” by using the Five R’s of Motivational Interviewing:
• Relevance. Why is change important?
• Risks. What are the risks of changing? What are the risks of not changing?
• Rewards. What will you gain from change?
• Roadblocks. What are the obstacles to change?
• Repetition. Review these at each session.
Second Key: Change requires leaving your Comfort Zone.
Our clients are stuck in seemingly endless loops of maladaptive behaviors. Our task is to assist them in getting unstuck, not behave better, fulfill external mandates, or stop using. Hopefully those things happen, but they’re side effects of getting unstuck. When we start thinking about our task this way, we’re better able to help clients discover how to leave their Comfort Zones.
In the Zone
• Comfort Zone. Most people spend most of their time in their Comfort Zone, where risks and challenges are minimal, but so is change or learning.
• Challenge Zone. When you leave your Comfort Zone, you enter your Challenge Zone. This is where learning and change occurs.
• Crisis Zone. In the Crisis Zone, stress is too high for effective learning.
Risking Change
Leaving your Comfort Zone is risky. However, it is necessary if change is going to occur. Three ways to assist clients in taking this risk are:
• Acknowledge the risk. Increased awareness is one of the first steps to changing any behavior. Spend time talking with clients about the risks involved in change and ways to move forward anyway.
• Explore good risks vs. bad risks. Their behavior might suggest otherwise, but most substance-abusing teens are risk adverse. Bad risks have become commonplace in their lives, but they actively avoid taking good ones.
• Provide opportunities to practice safe risk taking. I’ve had clients try belly dancing, glass blowing, rock climbing, snowshoeing, and more. Adventure outings and other experiential activities also provide ways to practice risk taking.
Super-stuck Teens
This is a term I use for those clients who are simply unwilling to leave their Comfort Zone. For these teens, The Known — no matter how bad — is inherently better than The Unknown. Super-stuck teens are overwhelmed by existential anxiety. This can be defined as stress or anxiety rooted in our awareness of personal freedom and the responsibilities that accompany choices.
Teens with chaotic histories, unstable environments, and past traumas are most likely to become super-stuck. Super-stuckness can also occur with “timid” teens, clients who have poor self-esteem, and youth with traits of anxiety or depression, even if sub-clinical.
In my experience, super-stuck teens will likely spend a longer-than-usual time in the Contemplation and Preparation Stages of Change (see Third Key). They require extra patience, increased empathy, and counselors focused on relationships over compliance.
Third Key: Change is a process, not an event.
Even when it seems that change was instantaneous, we’re really seeing the end result of a process. The Stages of Change is a transtheoretical model that identifies five steps:
• Pre-contemplation. I don’t have a problem.
• Contemplation. Maybe I have a problem.
• Preparation. I have a problem and am thinking about what to do.
• Action. I’m doing something about my problem
• Maintenance. My new behavior has become habit.
It is important to remember that movement through these stages isn’t always linear. The most obvious example of this is Recycling (or Relapsing). When attempting any kind of change, relapse into old behaviors can be a necessary part of the process and a valuable teachable moment.
When relapse happens, we tend to blame a lack of skills, situational factors, or client unwillingness. These may be the extenuating circumstances, but I propose that relapse happens because we push our clients into Action too quickly. Recovery isn’t a race! We need to set our abstinence agendas aside and give our clients the time they need to move through all the Stages of Change.
Fourth Key: Expect ambivalence.
Ambivalence can be defined as simultaneously believing two seemingly contradictory ideas. In the case of substance-abusing teens: I want to fix my problem and I want to keep using. As we know, teens typically enter treatment because of legal, school, and family pressures, but don’t think they have a problem with alcohol, marijuana, or other drugs. Is it any surprise they’re ambivalent?
Helping clients resolve their ambivalence requires exploring both the pros and cons of using. However, drug counselors often focus solely on the problems. Our clients know they have a problem. They don’t need us telling them over and over. If anything, doing so may be invalidating and reaffirm their apparent inability to make change.
Resolving Ambivalence
As we know, substance-abusing teens have rigid thinking habits. These habits reinforce their ambivalence by keeping them stuck in extreme thinking. Resolving ambivalence requires them to think beyond the extremes. In addition to exploring the pros and cons of using, some strategies for helping with this are:
• Engage clients in activities and discussion on balance, the Middle Path, and similar concepts.
• Explore all-or-nothing thinking.
• Whenever possible, use continuums, spectrums, and scaling questions.
• Assist clients to develop critical thinking and mindfulness skills.
Fifth Key: Changed lives require changed stories.
The stories we tell about ourselves and our experiences define how we act, think, and feel. They determine how we make sense of our past, present, and future, how we interpret the information of our lives, and how we interact with the world.
Substance-abusing teens have lives filled with problem-saturated stories. These tales of stuckness, maladaptive behavior, and treatment failures have become the defining stories for their lives. These stories are constrictive, leaving our clients trapped in an ever-shrinking Comfort Zone, with fewer and fewer options. As helpers, we need to provide opportunities to create new, more hopeful stories.
Externalizing the Problem
• Instead of having a problem or being a problem, assist clients to view problems as existing outside themselves.
• Externalizing the problem removes pressures rooted in blame, shame, and defensiveness.
• We can take this even further by encouraging clients to think of their problems as characters in their stories.
• You can assist clients to externalize their ambivalence by presenting the idea of both an Addictive Voice and a Rational Voice.
Seek Exceptions
• Clients build and sustain problem-saturated narratives by ignoring times when The Problem wasn’t in control.
• Seeking exceptions involves assisting clients to identify those ignored times.
• Explore these exceptions in great detail. Much can be learned from them.
• Identifying exceptions assists clients to discover the skills they already possess but have been ignoring because The Problem was in control.
Re-authoring
• Once exceptions have been identified, clients can start re-authoring their problem-saturated stories.
• Re-authoring involves giving clients the opportunity to create new, more empowering stories.
• Anything that involves clients successfully leaving their Comfort Zone and experiencing exceptions to their problem-saturated narratives can provide useful material for these new stories.
Sixth Key: Maintain a playful approach.
I conceptualize the challenges faced by some adolescent clients as developmental debt. Various developmental theories exist, but most have some things in common. For example, most include stages of development that are linked to age ranges. Also, most include a task that needs to be accomplished in order to move to the next stage.
Traditional perspectives on development suggest that if a task isn’t successfully completed, then the person becomes stuck at that stage. While that may have been accurate when these developmental models were created, it seems to me this is no longer true. Instead, sociocultural and biological factors keep pushing individuals forward, even if developmental tasks are unresolved or only partially completed.
With every push forward, these individuals become less likely to successfully complete the next stage, resulting in an ever-growing developmental debt. Think of it like a credit card that never gets fully paid off. Not only will you always have a balance due, but you’ll also get further and further behind each month.
Maintaining a playful approach is one way to meet our “in debt” clients where they’re at both emotionally and cognitively. Also, play and playfulness creates an environment that allows these teens to start paying off some of that debt. In other words, a playful approach provides opportunities for our clients to go backwards in order to catch up.
Activities from the Workshop
The following activities and exercises were part of the workshop: Chiji Mingle, Endless Loop, Chiji Zones, Mega Jenga, Gutter Ball, Brainstorm Posters (The Good, the Bad, and the Ugly), and Whack 'Em.
Further Reading
• The Art of Changing the Brain, by James Zull
• Changing for Good, by James Prochaska, John Norcross & Carlo DiClemente
• Elusive Alliance, edited by David Castro-Blanco & Marc Karver
• Interviewing for Solutions, by Peter de Jong & Insoo Kim Berg
• Motivational Interviewing, by William Miller & Stephen Rollnick
• Motivational Interviewing with Adolescents & Young Adults, by Sylvie Naar-King & Mariann Suarez
• Pathways to Change, by Matthew Selekman
• The Primal Teen, by Barbara Strauch
• Real Boys, by William Pollack
• Reviving Ophelia, by Mary Pipher
• What is Narrative Therapy?, by Alice Miller
Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts
Monday, September 19, 2011
Sunday, May 17, 2009
Outside the Comfort Zone: Dissonance & Self-Efficacy as Mechanisms of Change
Beard and Wilson define experiential learning as “the sense-making process of active engagement between the inner world of the person and the outer world of the environment” (p. 19). It is during this sense-making process that a state of dissonance can develop and that change will most readily occur. However, change does not happen solely through experience. If an experience serves solely to confirm already held beliefs, it won’t serve as a catalyst of change. Instead, it will simply reinforce the individual’s current cognitive processes (Beard & Wilson, p. 20).
It seems to me that the facilitator’s goal during an experience should be to assure that learning opportunities occur during this sense-making process of active engagement. With this in mind, perhaps the facilitator must purposefully introduce a state of dissonance into the activity. Dissonance creates confusion, and “the act of restructuring or reordering to regain balance… is where change in feelings, thoughts, attitudes, and behavior patterns occur” (Luckner & Nadler, p. 23).
One way for a facilitator to create this dissonance is by holding the learning experience in an environment that is unfamiliar to the participants. This approach is commonly used in adventure programming, where the participants are placed outdoors in an unknown setting. In-patient treatment programs are also unknown settings, of course, so serve as another example of environmental dissonance being created.
This summer, I will again be leading a series of hikes with my clients. One goal of these hikes is to place them into unknown settings. Opportunities like summer hikes are often scare scarce or seasonal in many clinical settings. That means it is important to look for other ways to create dissonance. Presenting experiences with uncertain outcomes can do this.
Ropes courses and initiative activities are example of this, since participants are unsure if they will be able to successfully complete the challenge. In my experience, some clinicians only use activities that they know the participants will be able to successfully complete. I believe this is appropriate for some clinical applications of experiential learning, such as illustrating a concept or improving group cohesion (see my post “Experiential Activities in Clinical Settings,” November 2008).
However, I strongly believe doing this is a sort of codependency that is not in the best interest of the participants. For teens in treatment, failure is a real possibility and avoiding experiences with unknown outcomes is a disservice. In fact, I strongly believe that the greatest learning can come from a failed activity—as long as it is adequately and appropriately processed. In a treatment setting, it is easy to connect failed or uncompleted activities to relapse, but there are many other rich processing possibilities.
Presenting the Possibility of Success
Whatever the experience, it is the unknown aspects of the activity that force the participant to leave her Comfort Zone and enter into a state of dissonance (Priest & Gass, p. 146). Through successful completion of an activity, through going outside a position of comfort, the participant’s dissonance will decrease. For example, when on a challenging mountain hike, a timid or fearful participant is likely to expect a negative outcome. Perhaps he will fail at the activity, perhaps he will be injured, perhaps he will not be as good as his peers, or perhaps a wild animal will attack.
When none of these negative outcomes occur, the participant is confronted with a new indisputable possibility: perhaps he can be successful. As a result, he is presented an opportunity to alter his future expectations. If an opportunity is also presented to generalize this learning, these changed expectations may be extended to all dimensions of his life.
A former client, Marie, serves as a useful example. Although not fearful, she was extremely resistant to the weekly hikes that were part of her inpatient treatment program. On a couple occasions, she claimed to be sick in an effort to avoid them. Throughout the hike, she would make negative comments, stating she could not or would not go any further. One time, she actually sat down on the side of the trail and for nearly 30 minutes refused to continue. However, when we hiked Little Si, one of the most difficult hikes we made and one of her last outings while in treatment, she actually encouraged other clients by saying, “If you can complete this hike, you can stay clean!”
Priest and Gass wrote, “The mastery or competence produced by successfully resolving the adaptive dissonance presented by a situation motivates behavior change” (p. 152). This motivation to change her behavior can be seen in Marie. Through the weekly outings, not only did she come to believe that she was able to successfully complete even a challenging hike, she took on a leadership role by becoming a source of encouragement to her peers. Indeed she went a step further, connecting her ability to complete the hike to her ability to accomplish other difficult goals, such as staying clean.
Luckner and Nadler wrote that central to experiential education is the idea that “we encourage people to try things that they wouldn’t generally do on their own. In other words, they leave their safe, familiar, comfortable and predictable world for uncomfortable new territory” (p. 28). This is certainly true also for substance abuse treatment! With that in mind, I frequently talk with my clients about Growth Zones, a model common in experiential learning. In my version, these three concentric circles consist of the individual’s Comfort Zone in the middle, then the Change Zone as the middle ring, and the Crisis Zone as the outside ring.
By default, an individual’s Comfort Zone contains only what is already known, feels safe, and presents no challenges or distress. It is only when an individual leaves his Comfort Zone that learning and change can occur. By doing this, though, dissonance is created, and with the dissonance comes discomfort. By working to eliminate the discomfort caused by the dissonance experienced when leaving your Comfort Zone, the change process can occur. This is true even with resistant participants like Marie, who are initially unwilling to even consider leaving her Comfort Zone.
The Role of Self-Efficacy
Important to this change process is the idea of self-efficacy. Perceptions of self-efficacy have three dimensions: magnitude, strength, and generality. Magnitude refers to the level of certainty the individual has for success (Priest & Gass, p. 55). This is primarily influenced by the participant’s perceptions of risk, as well as the perceived difficulty of the experience. Many experiential learning activities are purposefully designed to present a high apparent risk level.
This perceived risk often includes both the risk of failure and physical risks. I have heard ropes course participants say, “We can’t do this” or “I’ll break my leg if I even try that!” As important as a perceived risk of possible failure or injury is the possibility of social risks, or looking inadequate or incapable in front of peers. With all three perceived risks, successful completion of an activity that initially seemed impossible has a high likelihood of increasing perceptions of self-efficacy. Marie perceived our weekly hikes as highly challenging in all three ways. As such, her repeated successes on these hikes dramatically increased the magnitude of her self-efficacy.
Strength reflects how long a person holds onto expectations of success despite contradictory information (Priest & Gass p. 55). A history of succeeding after multiple unsuccessful attempts can play an important role in building strength. Although Marie completed every hike she participated, she frequently reported, “I’m just not good at outdoor stuff. That’s why I hate nature.” Her past experiences clearly influenced her perceptions of her own ability. However, through her repeated successes on hikes while in treatment, she was able to move past her unusual self-limiting beliefs, thereby contributed to the strength of her self-efficacy.
Generality refers to the degree of an individual’s transfer of self-efficacy beliefs from one situation to another (Priest & Gass, p. 55). Transfer is the integration of learning from the adventure program into the participant’s life (Priest & Gass, p. 184). In clinical setting, I believe this is the most important concept of the three, and an area when strong facilitation skills are especially vital. To assure that change happens as a result of participation in an experience, transfer of learning must occur.
For Marie, successfully working through her own dissonance provided an important opportunity for her to increase her sense of self-efficacy. As this increased, her engagement in processing grew. Initially, she would say little during debriefing sessions, even when called on directly. Toward the end of her treatment, not only was she increasingly vocal during debriefings, during hikes she actively encouraged her struggling peers.
“When clients enter into adventure programs that focus on change, they may strongly resist [that] change… Adventure experiences often reduce such resistance by placing clients in situations that are new and unique, yet supportive” (Priest & Gass, p. 148). Marie’s initial resistance to change is clearly evident. She was taken out of her Comfort Zone, and repeatedly placed into new and unique situations that she considered risky. In her efforts to reduce the dissonance she felt, she was forced to reconsider her preconceived views. Through opportunities to process her experiences, she generalized her learning to other areas of her life and began to believe in her ability to accomplish other meaningful goals, such as staying clean after treatment.
Works Cited
Beard, C. & Gross, J. Experiential Learning: A Best Practice Handbook for Educators and Trainers. Philadelphia: Kogan Page, 2006.
Luckner, J. & Nadler, R. Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Co., 1997.
Priest, S. & Gross, M. Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics, 2005.
It seems to me that the facilitator’s goal during an experience should be to assure that learning opportunities occur during this sense-making process of active engagement. With this in mind, perhaps the facilitator must purposefully introduce a state of dissonance into the activity. Dissonance creates confusion, and “the act of restructuring or reordering to regain balance… is where change in feelings, thoughts, attitudes, and behavior patterns occur” (Luckner & Nadler, p. 23).
One way for a facilitator to create this dissonance is by holding the learning experience in an environment that is unfamiliar to the participants. This approach is commonly used in adventure programming, where the participants are placed outdoors in an unknown setting. In-patient treatment programs are also unknown settings, of course, so serve as another example of environmental dissonance being created.
This summer, I will again be leading a series of hikes with my clients. One goal of these hikes is to place them into unknown settings. Opportunities like summer hikes are often scare scarce or seasonal in many clinical settings. That means it is important to look for other ways to create dissonance. Presenting experiences with uncertain outcomes can do this.
Ropes courses and initiative activities are example of this, since participants are unsure if they will be able to successfully complete the challenge. In my experience, some clinicians only use activities that they know the participants will be able to successfully complete. I believe this is appropriate for some clinical applications of experiential learning, such as illustrating a concept or improving group cohesion (see my post “Experiential Activities in Clinical Settings,” November 2008).
However, I strongly believe doing this is a sort of codependency that is not in the best interest of the participants. For teens in treatment, failure is a real possibility and avoiding experiences with unknown outcomes is a disservice. In fact, I strongly believe that the greatest learning can come from a failed activity—as long as it is adequately and appropriately processed. In a treatment setting, it is easy to connect failed or uncompleted activities to relapse, but there are many other rich processing possibilities.
Presenting the Possibility of Success
Whatever the experience, it is the unknown aspects of the activity that force the participant to leave her Comfort Zone and enter into a state of dissonance (Priest & Gass, p. 146). Through successful completion of an activity, through going outside a position of comfort, the participant’s dissonance will decrease. For example, when on a challenging mountain hike, a timid or fearful participant is likely to expect a negative outcome. Perhaps he will fail at the activity, perhaps he will be injured, perhaps he will not be as good as his peers, or perhaps a wild animal will attack.
When none of these negative outcomes occur, the participant is confronted with a new indisputable possibility: perhaps he can be successful. As a result, he is presented an opportunity to alter his future expectations. If an opportunity is also presented to generalize this learning, these changed expectations may be extended to all dimensions of his life.
A former client, Marie, serves as a useful example. Although not fearful, she was extremely resistant to the weekly hikes that were part of her inpatient treatment program. On a couple occasions, she claimed to be sick in an effort to avoid them. Throughout the hike, she would make negative comments, stating she could not or would not go any further. One time, she actually sat down on the side of the trail and for nearly 30 minutes refused to continue. However, when we hiked Little Si, one of the most difficult hikes we made and one of her last outings while in treatment, she actually encouraged other clients by saying, “If you can complete this hike, you can stay clean!”
Priest and Gass wrote, “The mastery or competence produced by successfully resolving the adaptive dissonance presented by a situation motivates behavior change” (p. 152). This motivation to change her behavior can be seen in Marie. Through the weekly outings, not only did she come to believe that she was able to successfully complete even a challenging hike, she took on a leadership role by becoming a source of encouragement to her peers. Indeed she went a step further, connecting her ability to complete the hike to her ability to accomplish other difficult goals, such as staying clean.
Luckner and Nadler wrote that central to experiential education is the idea that “we encourage people to try things that they wouldn’t generally do on their own. In other words, they leave their safe, familiar, comfortable and predictable world for uncomfortable new territory” (p. 28). This is certainly true also for substance abuse treatment! With that in mind, I frequently talk with my clients about Growth Zones, a model common in experiential learning. In my version, these three concentric circles consist of the individual’s Comfort Zone in the middle, then the Change Zone as the middle ring, and the Crisis Zone as the outside ring.
By default, an individual’s Comfort Zone contains only what is already known, feels safe, and presents no challenges or distress. It is only when an individual leaves his Comfort Zone that learning and change can occur. By doing this, though, dissonance is created, and with the dissonance comes discomfort. By working to eliminate the discomfort caused by the dissonance experienced when leaving your Comfort Zone, the change process can occur. This is true even with resistant participants like Marie, who are initially unwilling to even consider leaving her Comfort Zone.
The Role of Self-Efficacy
Important to this change process is the idea of self-efficacy. Perceptions of self-efficacy have three dimensions: magnitude, strength, and generality. Magnitude refers to the level of certainty the individual has for success (Priest & Gass, p. 55). This is primarily influenced by the participant’s perceptions of risk, as well as the perceived difficulty of the experience. Many experiential learning activities are purposefully designed to present a high apparent risk level.
This perceived risk often includes both the risk of failure and physical risks. I have heard ropes course participants say, “We can’t do this” or “I’ll break my leg if I even try that!” As important as a perceived risk of possible failure or injury is the possibility of social risks, or looking inadequate or incapable in front of peers. With all three perceived risks, successful completion of an activity that initially seemed impossible has a high likelihood of increasing perceptions of self-efficacy. Marie perceived our weekly hikes as highly challenging in all three ways. As such, her repeated successes on these hikes dramatically increased the magnitude of her self-efficacy.
Strength reflects how long a person holds onto expectations of success despite contradictory information (Priest & Gass p. 55). A history of succeeding after multiple unsuccessful attempts can play an important role in building strength. Although Marie completed every hike she participated, she frequently reported, “I’m just not good at outdoor stuff. That’s why I hate nature.” Her past experiences clearly influenced her perceptions of her own ability. However, through her repeated successes on hikes while in treatment, she was able to move past her unusual self-limiting beliefs, thereby contributed to the strength of her self-efficacy.
Generality refers to the degree of an individual’s transfer of self-efficacy beliefs from one situation to another (Priest & Gass, p. 55). Transfer is the integration of learning from the adventure program into the participant’s life (Priest & Gass, p. 184). In clinical setting, I believe this is the most important concept of the three, and an area when strong facilitation skills are especially vital. To assure that change happens as a result of participation in an experience, transfer of learning must occur.
For Marie, successfully working through her own dissonance provided an important opportunity for her to increase her sense of self-efficacy. As this increased, her engagement in processing grew. Initially, she would say little during debriefing sessions, even when called on directly. Toward the end of her treatment, not only was she increasingly vocal during debriefings, during hikes she actively encouraged her struggling peers.
“When clients enter into adventure programs that focus on change, they may strongly resist [that] change… Adventure experiences often reduce such resistance by placing clients in situations that are new and unique, yet supportive” (Priest & Gass, p. 148). Marie’s initial resistance to change is clearly evident. She was taken out of her Comfort Zone, and repeatedly placed into new and unique situations that she considered risky. In her efforts to reduce the dissonance she felt, she was forced to reconsider her preconceived views. Through opportunities to process her experiences, she generalized her learning to other areas of her life and began to believe in her ability to accomplish other meaningful goals, such as staying clean after treatment.
Works Cited
Beard, C. & Gross, J. Experiential Learning: A Best Practice Handbook for Educators and Trainers. Philadelphia: Kogan Page, 2006.
Luckner, J. & Nadler, R. Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Co., 1997.
Priest, S. & Gross, M. Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics, 2005.
Saturday, April 25, 2009
It’s About The Climb, Not The Destination
In all forms of experiential education, transfer of learning is considered a vital part of the process. Necessary for fostering change, this transfer involves the integration of learning from the experience into the participant’s life (Priest & Gass), in order to allow for generalizing that experience to daily events. In other words, in clinical settings transfer of learning answers the question, “What does this have to do with recovery?”
To assure transfer of learning occurs, processing is an essential component of all experiential education programs (Luckner & Nadler, p. 8). In their book, The Processing Pinnacle, Simpson, Miller and Bocher identify a variety of goals when processing. I believe that most important of these in a clinical setting are assuring participants understand the lessons of the experience, analyzing and synthesizing the action, helping give the experience permanence, and transferring the learning to daily life (p. 19).
To help assure these goals are met, the authors present a model they call “the processing pinnacle,” an approach they initially present as a continuum and then later transform into a mountain. At one end is facilitator-centered processing with the leader retaining complete control of the processing. At the other end of the continuum is participant-centered processing, with all processing tasks relinquished by the leader (p. 59).
The authors identified four specific points along this continuum: facilitator frontloading, traditional question and answer, participant-directed processing, and independent reflection.
Facilitator Frontloading
Facilitator front-loading is farthest to the facilitator-centered side of the continuum. In this approach, the leader explicitly states the purpose of the activity before it even takes place, spelling out exactly what will be experienced and learned. When frontloading occurs, reflection generally happens throughout the activity, either during pauses for discussion or as the activity proceeds (p. 59).
As I initially read this book, facilitator frontloading seemed heavy-handed to me, and I didn’t think it fit at all with my personal facilitator style. However, I do frequently use metaphors as a way to frontload an activity, and that use often shapes the experience for the participants. In addition, I always do a lot of in-the-moment processing.
For example, I sometimes frame Trolleys, a common experiential activity, with recovery metaphors, giving participants the task of crossing the Sea of Relapse using the skills they have learned in treatment (the trolleys themselves) and arriving at the finish line, Long-Term Sobriety.
To me, this type of metaphor-rich framing isn’t necessarily as heavy handed as the authors’ definition initially seems. However, it certainly fulfills their definition. In discussing the use of metaphor in frontloading, they state, “The more ways and more times that a metaphor gets linked to everyday life, the more effective it will be” (p. 88). For example, during Trolleys-As-Recovery, I encourage participants to take things “one step at a time” and to not “future-trip” about getting to the end.
In some settings, this sort of predetermined shaping of the activity could clearly limit outcomes. However, when frontloading isn’t heavy-handed, it seems to me that this processing approach can be extremely appropriate within a clinical context where a specific goal has usually been determined in advance. Indeed, moving participants toward a specific goal is most often the point for doing an activity.
Traditional Q & A
The next on the continuum is traditional question and answer, in which the facilitator leads a discussion following the activity. This discussion includes input from both the facilitator and the participants, but is leader-driven. The leader chooses the questions, calls on specific participants, and guides the discussion in a predetermined direction (Simpson, Miller & Bocher, p. 60).
The authors state that this is the most common of all processing styles, but in clinical settings I attempt to avoid this traditional question and answer approach entirely. I’ve found that with youth in treatment, it is usually most effective to provide some structure to the processing. However, I want to do this in a way that isn’t facilitator-oriented. In my experience, participant-directed processing approaches work well for balancing these seemly contradictory goals.
Participant-Directed Processing
This third point on the continuum involves processing where “the direction of the discussion and reflection is determined by the participants, not the facilitator” (Simpson, Miller & Bocher, 2006, p. 61). One example of this approach is processing cards.
About a two year ago, I started using Chiji Processing Cards, a deck of 48 cards with different images on them such as a lighthouse, a compass, and a piece of shattered pottery. The most typical way to use these cards as a processing tool is to spread them out and ask participants to “pick a card that represents your role in the group today” or a similar prompt. I have found these cards to be a powerful processing tool, encouraging even the most reluctant participants to speak.
Teens in treatment can sometimes be challenging to get talking, and it seems to me that this approach helps that to happen. As such, I use a lot of other participant-directed and active processing approaches. I have another post on this blog -- Talking Despite Themselves -- that addresses this topic in more detail.
Independent Reflection
The final point on the processing continuum, independent reflection, is what the authors called “processing in the intentional absence of formal processing” (p. 60). In Outward Bound, this approach is common and frequently referred to as “letting the mountain speak for itself.” I feel there may be times, places, and participant populations were this approach is appropriate. However, it seems to me that not providing a formal processing opportunity of some type in a clinical setting would be therapeutically inappropriate.
Time for transfer of learning is a necessary part of the therapeutic process, and I believe some formal processing should always occur. However, authors wrote, “Even though it might be used rarely, [independent processing] is the appropriate processing methodology when a particular set of conditions has been met” (p. 125). They define these conditions as an appropriate setting, that participants have a strong commitment to the experience, that participants have the requisite knowledge to understand the significance of an experience, and that the group has prior training in processing.
I suppose that if these four conditions were all present in the entire participant population, it might be appropriate to have the group sit quietly on a mountain top watching a sunset and consider that a processing experience. Even then, though, the counselor in me would follow up the independent reflection time with a short group process of it.
Climbing the Mountain
I see processing as an important part of experiential learning. In fact, it may be the most important part, since it provides participants the opportunity to develop awareness, identify thinking patterns, and practice mindfulness—all skills I believe essential for recovery. In a clinical setting, it seems to me that the activity is often less important than the processing opportunities it provides. In other words, climbing a mountain is not about reaching the pinnacle, but about what happens along the way.
Early in the book, the authors wrote, “According to Chinese Tao thinking, action and reflection cannot exist without each other” (p. 18). I found this book interesting and practical in many ways, providing a comprehensive system for viewing various processing methodologies. Independent reflection is one extreme end of a spectrum, and fostering movement toward independent processing has obvious value. After all, a client will eventually no longer be a client, and the skills learned in a clinical context need to transfer to life.
That said, the authors failed to convince me that achieving independent reflection should be the ultimate goal of processing, at least within a clinical context. Getting to the pinnacle is not what’s important in a learning experience. Working toward the pinnacle is. Without a formal processing experience of some sort, it seems to me that this dialectic of action and reflection will not be assured, and transfer of learning may not occur.
Work Cited
Luckner, J., and Nadler, R. (1997). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Company.
Priest, S., and Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Simpson, S., Miller, D., and Bocher, B. (2006). The Processing Pinnacle. Oklahoma City, OK: Wood’n’Barnes.
To assure transfer of learning occurs, processing is an essential component of all experiential education programs (Luckner & Nadler, p. 8). In their book, The Processing Pinnacle, Simpson, Miller and Bocher identify a variety of goals when processing. I believe that most important of these in a clinical setting are assuring participants understand the lessons of the experience, analyzing and synthesizing the action, helping give the experience permanence, and transferring the learning to daily life (p. 19).
To help assure these goals are met, the authors present a model they call “the processing pinnacle,” an approach they initially present as a continuum and then later transform into a mountain. At one end is facilitator-centered processing with the leader retaining complete control of the processing. At the other end of the continuum is participant-centered processing, with all processing tasks relinquished by the leader (p. 59).
The authors identified four specific points along this continuum: facilitator frontloading, traditional question and answer, participant-directed processing, and independent reflection.
Facilitator Frontloading
Facilitator front-loading is farthest to the facilitator-centered side of the continuum. In this approach, the leader explicitly states the purpose of the activity before it even takes place, spelling out exactly what will be experienced and learned. When frontloading occurs, reflection generally happens throughout the activity, either during pauses for discussion or as the activity proceeds (p. 59).
As I initially read this book, facilitator frontloading seemed heavy-handed to me, and I didn’t think it fit at all with my personal facilitator style. However, I do frequently use metaphors as a way to frontload an activity, and that use often shapes the experience for the participants. In addition, I always do a lot of in-the-moment processing.
For example, I sometimes frame Trolleys, a common experiential activity, with recovery metaphors, giving participants the task of crossing the Sea of Relapse using the skills they have learned in treatment (the trolleys themselves) and arriving at the finish line, Long-Term Sobriety.
To me, this type of metaphor-rich framing isn’t necessarily as heavy handed as the authors’ definition initially seems. However, it certainly fulfills their definition. In discussing the use of metaphor in frontloading, they state, “The more ways and more times that a metaphor gets linked to everyday life, the more effective it will be” (p. 88). For example, during Trolleys-As-Recovery, I encourage participants to take things “one step at a time” and to not “future-trip” about getting to the end.
In some settings, this sort of predetermined shaping of the activity could clearly limit outcomes. However, when frontloading isn’t heavy-handed, it seems to me that this processing approach can be extremely appropriate within a clinical context where a specific goal has usually been determined in advance. Indeed, moving participants toward a specific goal is most often the point for doing an activity.
Traditional Q & A
The next on the continuum is traditional question and answer, in which the facilitator leads a discussion following the activity. This discussion includes input from both the facilitator and the participants, but is leader-driven. The leader chooses the questions, calls on specific participants, and guides the discussion in a predetermined direction (Simpson, Miller & Bocher, p. 60).
The authors state that this is the most common of all processing styles, but in clinical settings I attempt to avoid this traditional question and answer approach entirely. I’ve found that with youth in treatment, it is usually most effective to provide some structure to the processing. However, I want to do this in a way that isn’t facilitator-oriented. In my experience, participant-directed processing approaches work well for balancing these seemly contradictory goals.
Participant-Directed Processing
This third point on the continuum involves processing where “the direction of the discussion and reflection is determined by the participants, not the facilitator” (Simpson, Miller & Bocher, 2006, p. 61). One example of this approach is processing cards.
About a two year ago, I started using Chiji Processing Cards, a deck of 48 cards with different images on them such as a lighthouse, a compass, and a piece of shattered pottery. The most typical way to use these cards as a processing tool is to spread them out and ask participants to “pick a card that represents your role in the group today” or a similar prompt. I have found these cards to be a powerful processing tool, encouraging even the most reluctant participants to speak.
Teens in treatment can sometimes be challenging to get talking, and it seems to me that this approach helps that to happen. As such, I use a lot of other participant-directed and active processing approaches. I have another post on this blog -- Talking Despite Themselves -- that addresses this topic in more detail.
Independent Reflection
The final point on the processing continuum, independent reflection, is what the authors called “processing in the intentional absence of formal processing” (p. 60). In Outward Bound, this approach is common and frequently referred to as “letting the mountain speak for itself.” I feel there may be times, places, and participant populations were this approach is appropriate. However, it seems to me that not providing a formal processing opportunity of some type in a clinical setting would be therapeutically inappropriate.
Time for transfer of learning is a necessary part of the therapeutic process, and I believe some formal processing should always occur. However, authors wrote, “Even though it might be used rarely, [independent processing] is the appropriate processing methodology when a particular set of conditions has been met” (p. 125). They define these conditions as an appropriate setting, that participants have a strong commitment to the experience, that participants have the requisite knowledge to understand the significance of an experience, and that the group has prior training in processing.
I suppose that if these four conditions were all present in the entire participant population, it might be appropriate to have the group sit quietly on a mountain top watching a sunset and consider that a processing experience. Even then, though, the counselor in me would follow up the independent reflection time with a short group process of it.
Climbing the Mountain
I see processing as an important part of experiential learning. In fact, it may be the most important part, since it provides participants the opportunity to develop awareness, identify thinking patterns, and practice mindfulness—all skills I believe essential for recovery. In a clinical setting, it seems to me that the activity is often less important than the processing opportunities it provides. In other words, climbing a mountain is not about reaching the pinnacle, but about what happens along the way.
Early in the book, the authors wrote, “According to Chinese Tao thinking, action and reflection cannot exist without each other” (p. 18). I found this book interesting and practical in many ways, providing a comprehensive system for viewing various processing methodologies. Independent reflection is one extreme end of a spectrum, and fostering movement toward independent processing has obvious value. After all, a client will eventually no longer be a client, and the skills learned in a clinical context need to transfer to life.
That said, the authors failed to convince me that achieving independent reflection should be the ultimate goal of processing, at least within a clinical context. Getting to the pinnacle is not what’s important in a learning experience. Working toward the pinnacle is. Without a formal processing experience of some sort, it seems to me that this dialectic of action and reflection will not be assured, and transfer of learning may not occur.
Work Cited
Luckner, J., and Nadler, R. (1997). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing Company.
Priest, S., and Gross, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Simpson, S., Miller, D., and Bocher, B. (2006). The Processing Pinnacle. Oklahoma City, OK: Wood’n’Barnes.
Saturday, January 24, 2009
Fostering Resiliency with Experiential Activities
Children who grow up in troubled families often develop skills that help them cope with the adversity in their environment and grow emotionally stronger in the process. Wolin and Wolin refers to this ability to “spring back” as resiliency. They began researching resiliency in 1989, while they were interviewing adults who had grown up in families with parents suffering from chemical dependency, co-occurring disorders, and other family issues. To their surprise, none of their subjects exhibited characteristics typically associated with adult children of troubled families: fear of abandonment, a sense of isolation, co-dependency, and substance abuse. With this discovery, Wolin and Wolin began to focus their research efforts on how these subjects had become resilient.
Resiliency isn't a new concept. In 1955, Werner and Smith began a study that followed nearly 700 children born on the island of Kauai, Hawaii. All their subjects had come from families dealing with issues that included chemical dependency, mental illness, and economic difficulties. Thirty-four years later, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience. (Werner, 1989.)
In 1978, Bleuler, who spent thirty years studying schizophrenics and their families, wrote:
It is surprising to note that their [children of schizophrenics] spirit is not broken, even of children who have suffered severe adversity for many years. In studying a number of the family histories, one is even left with the impression that pain and suffering has a steeling – a hardening – effect on the personalities of some children. (Bleuler, 1978.)
Kagan stated that children should not be viewed as passive objects, but rather be considered active participants in their emotional lives. He goes on to propose that a child’s understanding of what occurs to him or her is more important than what actually happens. He wrote:
The effect of an emotionally significant experience – like a father’s prolonged absence or a bitter divorce – will depend on how the child interprets these events… Rarely will there be a fixed consequence of any single event – no matter how traumatic – or special set of family conditions. (Kagan, 1984.)
Felsman and Vaillant studied seventy-five inner-city American males, all from families that were impacted by chemical dependency, economically disadvantaged, or included a parent with mental illness. They wrote:
Our preliminary indications are that the successful men in our high-risk group are…not free from their difficult early memories. We would speculate that it is their style of remember and feeling that is important… Most do have access to their pasts and are able to bear that pain and sorrow, and in so doing, to draw upon it as a source of strength… [This ability] seems to inform that generative quality in the way they live. (Felsman & Vaillant, 1987.)
The Seven Resiliencies
According to Wolin and Wolin, resilient individuals exhibit specific behaviors, or competencies. They classified these competencies into what they call the Seven Resiliencies: insight, independence, relationships, initiative, creativity, humor, and morality. Each competency has three stages, which develop progressively: the childhood stage, the adolescent stage, and the adult stage. In children, competencies appear as unformed, non-goal oriented, intuitive behavior. In adolescents, these behaviors sharpen and become deliberate. In adults, the behaviors broaden and deepen, becoming a fully integrated part of the individual.
• Insight
Insight is “the mental habit of asking searching questions and giving honest answers.” (Wolin & Wolin, 1993.) According to Wolin and Wolin, developing insight is an essential foundation for the other competencies, because it allows the individual to think objectively about her circumstance. Sensing, the initial stage of insight, occurs with a resilient child’s realization that her family is different than most, accompanied by an awareness of the antecedents for problems. In the next stage, knowing, a resilient teen develops awareness of the family’s underlying issues. Understanding, the adult stage, involves re-examining childhood memories, as well as developing practical strategies for dealing with a troubled past.
• Independence
Independence is the purposeful creation of both physical and emotional space between a resilient individual and the troubled family. The first stage of independence is straying. This happens when a resilient child starts to seek physical distance from his troubled family, perhaps by playing in unused corners of the house, spending time at neighbors, or going on secret adventures. Disengaging is the second stage of independence, and begins when a resilient teen starts to stray farther. Some examples of this include getting a job, participating in after-school activities, and spending time at the homes of friends and relatives. During this stage, a resilient teen will also begin to disengage emotionally. In the final stage, separating, a resilient adult establishes strategies to reduce and control interactions with his family, such as moving a significant distance, or limiting contact to phone calls or letters.
• Relationships
Relationships are “connections with other people based on sharing, mutual respect, and openness.” (Wolin & Desetta, 2000.) Connecting is the first stage. A resilient child enters this stage by making tentative steps to engage with non-family members, most frequently an adult neighbor or teacher. A resilient teen moves on to recruiting, the second stage, by actively applying the skills developed in the connecting stage to establish a meaningful relationship with an adult who can serve as a substitute parent. Resilient adults enter the final stage, attaching, by establishing relationships with partners from healthy families, and consciously choosing to not repeat past patterns.
• Initiative
Initiative is a determination to prevail over one’s troubled past experiences or present environment. The first stage is exploring. In this stage, through “conducting trial-and-error experiments that often succeed, resilient children find tangible rewards and achieve a sense of effectiveness.” (Wolin & Wolin, 1993.) In the second stage, working, resilient teens move from random experimentation to participating in focused, goal-oriented activities such as school, community service, and clubs. Having moved to the final stage, generating, a resilient adult exhibits leadership, strong practical skills, and an enthusiasm for planning.
• Creativity and Humor
Creativity and humor are closely related competencies. Both use imagination to relieve troubling emotions and environmental chaos. These two resiliencies also share the first two stages. Playing—the first stage for both—includes all the imaginative activities in which a resilient child engages to escape from real life difficulties. When a resilient adolescent moves to shaping—the second stage for both—playing evolves into the tentative creation of art. In the final stage of creativity, composing, a resilient adult engages in more skilled pursuits of the arts, possibly at a professional or semi-professional level. However, resilient adults are more likely to move into the final stage of humor, which is laughing. At this stage, having developed an awareness of a larger context, a resilient adult discovers the absurdity in situations that seem sad, embarrassing, or stressful.
• Morality
Morality, the final competency, is doing the right thing even when difficult, and striving to see the strength possible in human nature despite personal adversity. A resilient child enters the first stage of morality, judging, by distinguishing between right and wrong, even as it relates to her own family. A resilient adolescent moves to the second stage, valuing, by developing an understanding of concepts such as decency, compassion, and honesty. In this stage, resilient teens often attempt to apply this growing understanding at home and in the world. In the final stage, serving, a resilient adult is strongly committed to doing what’s right at home and work, and is frequently involved in community service and political causes.
My Adaptations of the Wolin Model
In my own resiliency-oriented work with substance abusing teens, I’ve adapted the Wolin Model in three ways. First, I consider humor a type of creativity. Since I work exclusively with teens and the Wolins define the child and adolescent stages of these competencies as the same, this seems appropriate. Also, humor can serve as an example of ways to be creative beyond the arts, inviting the exploration of of creativity as an approach and not an act.
The second way I’ve adapted the Wolin Model is by referring to the final competency as integrity, not morality. In my experience, the word morality can be highly charged for many people. (As you'll read below, reframing is an important concept in resiliency-work, and I'm well aware of the irony of me avoiding this particular reframing challenge. However, I believe that integrity is an equally valid name for this competency, and thus would rather avoid this clinical roadblock than spend precious treatment time working through it.)
The third way I’ve adapted the Wolin Model is by linking independence and relationships in the new competency of interdependence. I believe adding this competency is especially important with the population I work with because it reinforces key recovery concepts such as needing sober supports, working on family systems challenges, addressing peer group issues, and establishing appropriate boundaries.
Resiliency as a Strengths-Based Practice
Wolin and Wolin stated, “The most important part of a strength-based approach is believing that youth in trouble actually have strengths and can act on them” (Project Resilience, 2004). For youth who grow up in families impacted by chemical dependency or other problems—which is true for the vast majority of the clients I work with—some or all of the competencies often develop naturally. Helping clients identify, explore, and develop their natural competencies should be a part of any treatment strategy.
All youth have strengths or talents, but not all naturally develop resilience. When this is the case, the Wolin Model can provide an effective foundation for fostering resiliency. Wolin and Wolin have identified three closely related steps for doing this. The first step is reframing, or “viewing an old story from a new perspective.” (Wolin, Desetta & Hefner, 2000.) Derived from traditional family therapy practices and cognitive-behavioral theory, reframing focuses on the subjective nature of personal stories to uncover alternative, positive themes that will allow an individual to transform his thinking from that of a damaged victim to that of a survivor with strengths forged from adversity.
The second step identified by Wolin and Wolin is the assumption that everyone who grows up in a troubled family has some degree of natural resilience, even if an individual does not presently exhibit well-developed strengths in all, or even most, of the resiliency categories.
The final core concept is survivor’s pride, which Wolin and Wolin defined as “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity.” (Wolin & Wolin, 2004.) A mixture of pain and empowerment, survivor’s pride can be a powerful motivator, but often remains unacknowledged.
Fostering Resiliency
It seems to me that experiential learning methodologies inherently reinforce insight, independence, relationships, interdependence, initiative, creativity, and integrity. In other words, if you’re using experiential learning, you’re fostering resiliency. I suggest, though, that by becoming more intentional about integrating resiliency, we can increase the effectiveness of experiential learning to foster resilience in our clients.
One way to do this is by selecting activities that provide increased opportunities for the practice of the competencies, and then frame the activities to emphasize this. An example is the activity Pressure Pads. In this activity, participants must get from the Starting Line to the Finish Line without touching the ground. To do so, they're given carpet squares, polyspots, or something similar—generally fewer spots than total number of participants.
For me, Pressure Pads is an excellent metaphor for recovery: the task is harder than it initially seems, you start with limited resources, you'll only be successful if you have help from others, many people want to give up along the way. Several of these ideas easily connect to the competencies and the three Core Concepts, including the need for relationships and interdependence, creative problem solving, and reframing what initially might seem impossible. In addition, it is extremely easy to cheat during Pressure Pads, which provides rich opportunities for exploring integrity.
So much to talk about! In fact, it seems to me that when you integrate resiliency-work into any clinical application of experiential learning, you have the opportunityl to exponentially increase the outcome potentials. How can you possibly pass that up?
Here are a few other ideas to assist in being more intentional about integrating resiliency into experiential activities:
• Teach clients the basic concepts and vocabulary of resiliency.
• Use the basic concepts and vocabulary of resiliency when framing, doing, and processing activities.
• Help clients identify and develop competencies they already possess.
• Challenge clients to practice competencies they do not yet possess.
• Connect the competencies practiced during experiential activities to real world situations.
As we’ve seen, the Wolin Model is a method to understand strengths, identify weaknesses, and re-conceptualize a family past troubled by chemical dependency or other dysfunction. This model can also be taught to individuals who do not exhibit natural competencies and experiential learning provides an excellent fit for this. While the Wolin Model cannot change a troubled past, it can provide a source of personal pride and renewed strength to help assure a healthier future.
Works Cited
Project Resilience. (1999). http://www.projectresilience.com.
Wolin, S. & Desetta, A. (2000). The Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S., Desetta, A. & Hefner, K. (2000). The Leader’s Guide to the Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S.J. & Wolin, S. (1993). The Resilient Self. New York: Villard.
Resiliency isn't a new concept. In 1955, Werner and Smith began a study that followed nearly 700 children born on the island of Kauai, Hawaii. All their subjects had come from families dealing with issues that included chemical dependency, mental illness, and economic difficulties. Thirty-four years later, Werner wrote:
Risk factors and stressful environments do not inevitably lead to poor adaptation. It seems clear that, at each stage in an individual’s development from birth to maturity, there is a shifting balance between stressful events that heighten vulnerability and protective factors that enhance resilience. (Werner, 1989.)
In 1978, Bleuler, who spent thirty years studying schizophrenics and their families, wrote:
It is surprising to note that their [children of schizophrenics] spirit is not broken, even of children who have suffered severe adversity for many years. In studying a number of the family histories, one is even left with the impression that pain and suffering has a steeling – a hardening – effect on the personalities of some children. (Bleuler, 1978.)
Kagan stated that children should not be viewed as passive objects, but rather be considered active participants in their emotional lives. He goes on to propose that a child’s understanding of what occurs to him or her is more important than what actually happens. He wrote:
The effect of an emotionally significant experience – like a father’s prolonged absence or a bitter divorce – will depend on how the child interprets these events… Rarely will there be a fixed consequence of any single event – no matter how traumatic – or special set of family conditions. (Kagan, 1984.)
Felsman and Vaillant studied seventy-five inner-city American males, all from families that were impacted by chemical dependency, economically disadvantaged, or included a parent with mental illness. They wrote:
Our preliminary indications are that the successful men in our high-risk group are…not free from their difficult early memories. We would speculate that it is their style of remember and feeling that is important… Most do have access to their pasts and are able to bear that pain and sorrow, and in so doing, to draw upon it as a source of strength… [This ability] seems to inform that generative quality in the way they live. (Felsman & Vaillant, 1987.)
The Seven Resiliencies
According to Wolin and Wolin, resilient individuals exhibit specific behaviors, or competencies. They classified these competencies into what they call the Seven Resiliencies: insight, independence, relationships, initiative, creativity, humor, and morality. Each competency has three stages, which develop progressively: the childhood stage, the adolescent stage, and the adult stage. In children, competencies appear as unformed, non-goal oriented, intuitive behavior. In adolescents, these behaviors sharpen and become deliberate. In adults, the behaviors broaden and deepen, becoming a fully integrated part of the individual.
• Insight
Insight is “the mental habit of asking searching questions and giving honest answers.” (Wolin & Wolin, 1993.) According to Wolin and Wolin, developing insight is an essential foundation for the other competencies, because it allows the individual to think objectively about her circumstance. Sensing, the initial stage of insight, occurs with a resilient child’s realization that her family is different than most, accompanied by an awareness of the antecedents for problems. In the next stage, knowing, a resilient teen develops awareness of the family’s underlying issues. Understanding, the adult stage, involves re-examining childhood memories, as well as developing practical strategies for dealing with a troubled past.
• Independence
Independence is the purposeful creation of both physical and emotional space between a resilient individual and the troubled family. The first stage of independence is straying. This happens when a resilient child starts to seek physical distance from his troubled family, perhaps by playing in unused corners of the house, spending time at neighbors, or going on secret adventures. Disengaging is the second stage of independence, and begins when a resilient teen starts to stray farther. Some examples of this include getting a job, participating in after-school activities, and spending time at the homes of friends and relatives. During this stage, a resilient teen will also begin to disengage emotionally. In the final stage, separating, a resilient adult establishes strategies to reduce and control interactions with his family, such as moving a significant distance, or limiting contact to phone calls or letters.
• Relationships
Relationships are “connections with other people based on sharing, mutual respect, and openness.” (Wolin & Desetta, 2000.) Connecting is the first stage. A resilient child enters this stage by making tentative steps to engage with non-family members, most frequently an adult neighbor or teacher. A resilient teen moves on to recruiting, the second stage, by actively applying the skills developed in the connecting stage to establish a meaningful relationship with an adult who can serve as a substitute parent. Resilient adults enter the final stage, attaching, by establishing relationships with partners from healthy families, and consciously choosing to not repeat past patterns.
• Initiative
Initiative is a determination to prevail over one’s troubled past experiences or present environment. The first stage is exploring. In this stage, through “conducting trial-and-error experiments that often succeed, resilient children find tangible rewards and achieve a sense of effectiveness.” (Wolin & Wolin, 1993.) In the second stage, working, resilient teens move from random experimentation to participating in focused, goal-oriented activities such as school, community service, and clubs. Having moved to the final stage, generating, a resilient adult exhibits leadership, strong practical skills, and an enthusiasm for planning.
• Creativity and Humor
Creativity and humor are closely related competencies. Both use imagination to relieve troubling emotions and environmental chaos. These two resiliencies also share the first two stages. Playing—the first stage for both—includes all the imaginative activities in which a resilient child engages to escape from real life difficulties. When a resilient adolescent moves to shaping—the second stage for both—playing evolves into the tentative creation of art. In the final stage of creativity, composing, a resilient adult engages in more skilled pursuits of the arts, possibly at a professional or semi-professional level. However, resilient adults are more likely to move into the final stage of humor, which is laughing. At this stage, having developed an awareness of a larger context, a resilient adult discovers the absurdity in situations that seem sad, embarrassing, or stressful.
• Morality
Morality, the final competency, is doing the right thing even when difficult, and striving to see the strength possible in human nature despite personal adversity. A resilient child enters the first stage of morality, judging, by distinguishing between right and wrong, even as it relates to her own family. A resilient adolescent moves to the second stage, valuing, by developing an understanding of concepts such as decency, compassion, and honesty. In this stage, resilient teens often attempt to apply this growing understanding at home and in the world. In the final stage, serving, a resilient adult is strongly committed to doing what’s right at home and work, and is frequently involved in community service and political causes.
My Adaptations of the Wolin Model
In my own resiliency-oriented work with substance abusing teens, I’ve adapted the Wolin Model in three ways. First, I consider humor a type of creativity. Since I work exclusively with teens and the Wolins define the child and adolescent stages of these competencies as the same, this seems appropriate. Also, humor can serve as an example of ways to be creative beyond the arts, inviting the exploration of of creativity as an approach and not an act.
The second way I’ve adapted the Wolin Model is by referring to the final competency as integrity, not morality. In my experience, the word morality can be highly charged for many people. (As you'll read below, reframing is an important concept in resiliency-work, and I'm well aware of the irony of me avoiding this particular reframing challenge. However, I believe that integrity is an equally valid name for this competency, and thus would rather avoid this clinical roadblock than spend precious treatment time working through it.)
The third way I’ve adapted the Wolin Model is by linking independence and relationships in the new competency of interdependence. I believe adding this competency is especially important with the population I work with because it reinforces key recovery concepts such as needing sober supports, working on family systems challenges, addressing peer group issues, and establishing appropriate boundaries.
Resiliency as a Strengths-Based Practice
Wolin and Wolin stated, “The most important part of a strength-based approach is believing that youth in trouble actually have strengths and can act on them” (Project Resilience, 2004). For youth who grow up in families impacted by chemical dependency or other problems—which is true for the vast majority of the clients I work with—some or all of the competencies often develop naturally. Helping clients identify, explore, and develop their natural competencies should be a part of any treatment strategy.
All youth have strengths or talents, but not all naturally develop resilience. When this is the case, the Wolin Model can provide an effective foundation for fostering resiliency. Wolin and Wolin have identified three closely related steps for doing this. The first step is reframing, or “viewing an old story from a new perspective.” (Wolin, Desetta & Hefner, 2000.) Derived from traditional family therapy practices and cognitive-behavioral theory, reframing focuses on the subjective nature of personal stories to uncover alternative, positive themes that will allow an individual to transform his thinking from that of a damaged victim to that of a survivor with strengths forged from adversity.
The second step identified by Wolin and Wolin is the assumption that everyone who grows up in a troubled family has some degree of natural resilience, even if an individual does not presently exhibit well-developed strengths in all, or even most, of the resiliency categories.
The final core concept is survivor’s pride, which Wolin and Wolin defined as “the well-deserved feeling of accomplishment that results from persisting in the face of hardship or adversity.” (Wolin & Wolin, 2004.) A mixture of pain and empowerment, survivor’s pride can be a powerful motivator, but often remains unacknowledged.
Fostering Resiliency
It seems to me that experiential learning methodologies inherently reinforce insight, independence, relationships, interdependence, initiative, creativity, and integrity. In other words, if you’re using experiential learning, you’re fostering resiliency. I suggest, though, that by becoming more intentional about integrating resiliency, we can increase the effectiveness of experiential learning to foster resilience in our clients.
One way to do this is by selecting activities that provide increased opportunities for the practice of the competencies, and then frame the activities to emphasize this. An example is the activity Pressure Pads. In this activity, participants must get from the Starting Line to the Finish Line without touching the ground. To do so, they're given carpet squares, polyspots, or something similar—generally fewer spots than total number of participants.
For me, Pressure Pads is an excellent metaphor for recovery: the task is harder than it initially seems, you start with limited resources, you'll only be successful if you have help from others, many people want to give up along the way. Several of these ideas easily connect to the competencies and the three Core Concepts, including the need for relationships and interdependence, creative problem solving, and reframing what initially might seem impossible. In addition, it is extremely easy to cheat during Pressure Pads, which provides rich opportunities for exploring integrity.
So much to talk about! In fact, it seems to me that when you integrate resiliency-work into any clinical application of experiential learning, you have the opportunityl to exponentially increase the outcome potentials. How can you possibly pass that up?
Here are a few other ideas to assist in being more intentional about integrating resiliency into experiential activities:
• Teach clients the basic concepts and vocabulary of resiliency.
• Use the basic concepts and vocabulary of resiliency when framing, doing, and processing activities.
• Help clients identify and develop competencies they already possess.
• Challenge clients to practice competencies they do not yet possess.
• Connect the competencies practiced during experiential activities to real world situations.
As we’ve seen, the Wolin Model is a method to understand strengths, identify weaknesses, and re-conceptualize a family past troubled by chemical dependency or other dysfunction. This model can also be taught to individuals who do not exhibit natural competencies and experiential learning provides an excellent fit for this. While the Wolin Model cannot change a troubled past, it can provide a source of personal pride and renewed strength to help assure a healthier future.
Works Cited
Project Resilience. (1999). http://www.projectresilience.com.
Wolin, S. & Desetta, A. (2000). The Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S., Desetta, A. & Hefner, K. (2000). The Leader’s Guide to the Struggle to Be Strong. Minneapolis, MN: Free Spirit Publishing.
Wolin, S.J. & Wolin, S. (1993). The Resilient Self. New York: Villard.
Saturday, November 15, 2008
Beyond Resistance
It is common in substance abuse treatment to hear clinicians label clients as resistant, meaning the individual is unmotivated to participate in the treatment process. Over the last year of so, I’ve been thinking a lot about the idea of resistance within teens. The more I think about this, the more I've come to believe that resistance is extremely rare in teens, if not in all client populations.
It seems to me that resistance is an easy answer to explain away non-engagement by clients, providing an easy excuse to not make further efforts at engagement. Selekman wrote, “The traditional psychotherapeutic concept of resistance is an unhelpful idea that has handicapped therapists” (p. 32). Motivational interviewing provides many useful ideas for moving beyond the easy excuse provided by labeling a client as resistant. According to Miller and Rollnick, motivational interviewing is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (p. 25).
In my experience, most teens are not resistant. They are ambivalent. Indeed, most of the clients I’ve worked with have held as absolute fact two seemingly incongruent thoughts: 1.) I have a problem; and, 2.) I don’t want to do anything about my problem. Its worth noting that my clients rarely define their problems the way I do, at least not initially, but that doesn't mean they believe themselves to be problem-less. It also doesn't mean they are resistant.
From my perspective as a clinician, my clients have problems stemming from drug use, truancy, illegal behavior, mental health challenges, and family dysfunction. Rarely are these the problems my clients initially identify, though. Many of my clients reluctantly enter treatment with only one self-identified problem, being on probation or an at-risk youth petition, and only one self-identified goal, avoiding detention. It would be easy to dismiss these youth as resistant. After all, they don't agree with me, the professional. In fact, though, not agreeing with me probably shouldn’t be considered pathological.
Miller and Rollnick wrote, “Understanding the dynamics of ambivalence… provides an alternative to thinking of people as (and blaming them for being) ‘unmotivated.’ People are always motivated for something” (p. 18). Avoiding detention—the sole initial motivation with many of my clients—is an extremely concrete goal and an excellent place to begin. It is easy to develop discrepancy with these youth, a key principle of motivational interviewing (Miller & Rollnick, p. 37). This principle requires that the helper “create and amplify, from the client’s perspective, a discrepancy between present behavior and his or her broader goals and values” (Miller & Rollnick, p. 38).
“If we want to help people learn, we should not worry about how we can motivate them but try to identify what already is motivating them” (Zull, p. 53). For teens on probation or an at-risk youth petition, continued use of alcohol and other drugs will lead to a violation that could send them to detention. Staying out of detention—their self-defined goal—requires clean UAs and attendance at treatment. When I talk about this with a client, I’m not telling him to stop using alcohol and other drugs. Instead, I’m being collaborative and helping him solve his problem as he defined it. Sure, the client is doing what I hoped for, but he's doing he for his reasons, not mine.
The threat of detention may not motivate a youth to change her behavior, but it is usually sufficiently motivating to start the process. Once this process has begun, “the overall goal is to increase intrinsic motivation, so that change arises from within rather than being imposed from without and so that change serves the person’s own goals and values” (Miller & Rollnick, p. 34).
Mental Logjams
Many of my clients are adequately motivated by extrinsic rewards to start the change process. However, for a client who simultaneously hold as true “I have a problem” and “I don’t want to do anything about my problem,” the mental logjam created from these incongruent beliefs can serve to reinforce his maladaptive cognitive scripts, encouraging him to remain stuck. After all, resolving this discrepancy will be hard and brains are lazy. They’d rather continue to use the same ol’ well-rehearsed scripts. Those brains would rather continue to Act Up, Shut Down, or Use.
When lazy brains do what lazy brains do, it may appear to be resistance or a lack of motivation. However, it seems to me that this is really just basic neuroscience in action. What fires together wires together, and then wants to keep firing that way. Getting unstuck requires getting lazy brains to do something different; that requires overcoming an apparent lack of motivation. Miller and Rollnick wrote that lack of motivation “can be thought of as unresolved ambivalence. To explore ambivalence is to work at the heart of the problem of being stuck” (p. 14).
In my experience, professional helpers often do their work only on the “I have a problem” side of ambivalence. I believe this is ineffective for two reasons. First, as discussed above, my clients already know they have a problem. They don’t need me to repeatedly tell them that. If anything, doing so is invalidating and reaffirms their apparent inability to be effective or make change. In fact, it would seem to me that repeatedly telling a client she has a problem contributes to keeping her stuck.
The second reason working on the “I have a problem” side is ineffective is that it is developmentally inappropriate with adolescents. Lectures don’t persuade teens. Neither does forcing compliance to a pre-determined solution they had no input on. Adolescents are supposed to question, rebel against, and ultimately resist the plans authority figures. Most professional helpers may be reluctant to view themselves as authority figures, but our clients never forget it.
“The theory of psychological reactance predicts an increase in the rate and attractiveness of a ‘problem’ behavior if a person perceives that his or her personal freedom is being infringed or challenged” (Miller & Rollnick, p. 18). If I tell my clients to stop using alcohol and other drugs, I may be increasing the likelihood of them continuing their use! That's true for any client, child, adolescent, or adult. However, as an unavoidably authoritarian figure working with adolescents who are supposed to rebel against what I say, this is magnified. So, not only does telling a client he has a problem contributes to keeping him stuck, so does telling him what to do about his problem.
Reframing Resistance
I started this post by stating that resistance meant that the individual is not amiable to treatment. Miller and Rollnick propose a different definition for resistance, “movement away from change” (p.47). Forced compliance doesn’t lead to change, but as we’ve seen above it may lead to movement away from change.
With mandated clients, I could create a pressure cooker situation that forced them into compliance, and I’ve seen counselors, parents, and probation officers take this approach. However, it is vital to avoid this sort of taking sides. “If the counselor argues for one side of the conflict, it is natural for the client to give voice to the other side… Hearing themselves vigorously arguing that they don’t have a problem and don’t need to change, they become convinced” (p. 56-57).
One way to avoid taking sides is to externalize the problem (Selekman, p. 93). This therapeutic strategy involves talking about the problem as if it was a separate being from the client, complete with sentience and decision-making abilities. About two years ago, when I initially read Selekman, I started externalizing ambivalence when working with reluctant clients. Inspired by a treatment-oriented board game, I began talking about Addictive Voices and Rational Voices. I’ve integrated the Voices throughout my groups—including role plays, art activities, the board game, and experiential activities—and I’ve found my clients readily embrace this concept.
In both individual and group sessions, I often assume the role of a client’s Addictive Voice, leaving the Rational Voice to the client. According to Miller and Rollnick, “If taking up one side of the argument causes an ambivalent person to defend the other, then the process ought to work both ways… By the nature of ambivalence, when the counselor raises only one side the client is inclined to explore the other” (p. 107).
In my experience, even the most ambivalent client is able to effectively speak for her Rational Voice. According to Miller and Rollnick, this is exactly the goal of motivational interviewing—for the client to “present the arguments for change” (p. 76). In doing so, the client can begin the process of breaking through the mental logjam caused by ambivalence.
Mandates may bring clients into treatment, but they don’t lead to lasting change. Motivational interviewing “focuses on intrinsic motivation for change, even with those who initially come for counseling as a direct result of extrinsic pressure” (Miller & Rollnick, p. 26). Looking beyond the simple answer of resistance is vital if this process is to occur.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
It seems to me that resistance is an easy answer to explain away non-engagement by clients, providing an easy excuse to not make further efforts at engagement. Selekman wrote, “The traditional psychotherapeutic concept of resistance is an unhelpful idea that has handicapped therapists” (p. 32). Motivational interviewing provides many useful ideas for moving beyond the easy excuse provided by labeling a client as resistant. According to Miller and Rollnick, motivational interviewing is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (p. 25).
In my experience, most teens are not resistant. They are ambivalent. Indeed, most of the clients I’ve worked with have held as absolute fact two seemingly incongruent thoughts: 1.) I have a problem; and, 2.) I don’t want to do anything about my problem. Its worth noting that my clients rarely define their problems the way I do, at least not initially, but that doesn't mean they believe themselves to be problem-less. It also doesn't mean they are resistant.
From my perspective as a clinician, my clients have problems stemming from drug use, truancy, illegal behavior, mental health challenges, and family dysfunction. Rarely are these the problems my clients initially identify, though. Many of my clients reluctantly enter treatment with only one self-identified problem, being on probation or an at-risk youth petition, and only one self-identified goal, avoiding detention. It would be easy to dismiss these youth as resistant. After all, they don't agree with me, the professional. In fact, though, not agreeing with me probably shouldn’t be considered pathological.
Miller and Rollnick wrote, “Understanding the dynamics of ambivalence… provides an alternative to thinking of people as (and blaming them for being) ‘unmotivated.’ People are always motivated for something” (p. 18). Avoiding detention—the sole initial motivation with many of my clients—is an extremely concrete goal and an excellent place to begin. It is easy to develop discrepancy with these youth, a key principle of motivational interviewing (Miller & Rollnick, p. 37). This principle requires that the helper “create and amplify, from the client’s perspective, a discrepancy between present behavior and his or her broader goals and values” (Miller & Rollnick, p. 38).
“If we want to help people learn, we should not worry about how we can motivate them but try to identify what already is motivating them” (Zull, p. 53). For teens on probation or an at-risk youth petition, continued use of alcohol and other drugs will lead to a violation that could send them to detention. Staying out of detention—their self-defined goal—requires clean UAs and attendance at treatment. When I talk about this with a client, I’m not telling him to stop using alcohol and other drugs. Instead, I’m being collaborative and helping him solve his problem as he defined it. Sure, the client is doing what I hoped for, but he's doing he for his reasons, not mine.
The threat of detention may not motivate a youth to change her behavior, but it is usually sufficiently motivating to start the process. Once this process has begun, “the overall goal is to increase intrinsic motivation, so that change arises from within rather than being imposed from without and so that change serves the person’s own goals and values” (Miller & Rollnick, p. 34).
Mental Logjams
Many of my clients are adequately motivated by extrinsic rewards to start the change process. However, for a client who simultaneously hold as true “I have a problem” and “I don’t want to do anything about my problem,” the mental logjam created from these incongruent beliefs can serve to reinforce his maladaptive cognitive scripts, encouraging him to remain stuck. After all, resolving this discrepancy will be hard and brains are lazy. They’d rather continue to use the same ol’ well-rehearsed scripts. Those brains would rather continue to Act Up, Shut Down, or Use.
When lazy brains do what lazy brains do, it may appear to be resistance or a lack of motivation. However, it seems to me that this is really just basic neuroscience in action. What fires together wires together, and then wants to keep firing that way. Getting unstuck requires getting lazy brains to do something different; that requires overcoming an apparent lack of motivation. Miller and Rollnick wrote that lack of motivation “can be thought of as unresolved ambivalence. To explore ambivalence is to work at the heart of the problem of being stuck” (p. 14).
In my experience, professional helpers often do their work only on the “I have a problem” side of ambivalence. I believe this is ineffective for two reasons. First, as discussed above, my clients already know they have a problem. They don’t need me to repeatedly tell them that. If anything, doing so is invalidating and reaffirms their apparent inability to be effective or make change. In fact, it would seem to me that repeatedly telling a client she has a problem contributes to keeping her stuck.
The second reason working on the “I have a problem” side is ineffective is that it is developmentally inappropriate with adolescents. Lectures don’t persuade teens. Neither does forcing compliance to a pre-determined solution they had no input on. Adolescents are supposed to question, rebel against, and ultimately resist the plans authority figures. Most professional helpers may be reluctant to view themselves as authority figures, but our clients never forget it.
“The theory of psychological reactance predicts an increase in the rate and attractiveness of a ‘problem’ behavior if a person perceives that his or her personal freedom is being infringed or challenged” (Miller & Rollnick, p. 18). If I tell my clients to stop using alcohol and other drugs, I may be increasing the likelihood of them continuing their use! That's true for any client, child, adolescent, or adult. However, as an unavoidably authoritarian figure working with adolescents who are supposed to rebel against what I say, this is magnified. So, not only does telling a client he has a problem contributes to keeping him stuck, so does telling him what to do about his problem.
Reframing Resistance
I started this post by stating that resistance meant that the individual is not amiable to treatment. Miller and Rollnick propose a different definition for resistance, “movement away from change” (p.47). Forced compliance doesn’t lead to change, but as we’ve seen above it may lead to movement away from change.
With mandated clients, I could create a pressure cooker situation that forced them into compliance, and I’ve seen counselors, parents, and probation officers take this approach. However, it is vital to avoid this sort of taking sides. “If the counselor argues for one side of the conflict, it is natural for the client to give voice to the other side… Hearing themselves vigorously arguing that they don’t have a problem and don’t need to change, they become convinced” (p. 56-57).
One way to avoid taking sides is to externalize the problem (Selekman, p. 93). This therapeutic strategy involves talking about the problem as if it was a separate being from the client, complete with sentience and decision-making abilities. About two years ago, when I initially read Selekman, I started externalizing ambivalence when working with reluctant clients. Inspired by a treatment-oriented board game, I began talking about Addictive Voices and Rational Voices. I’ve integrated the Voices throughout my groups—including role plays, art activities, the board game, and experiential activities—and I’ve found my clients readily embrace this concept.
In both individual and group sessions, I often assume the role of a client’s Addictive Voice, leaving the Rational Voice to the client. According to Miller and Rollnick, “If taking up one side of the argument causes an ambivalent person to defend the other, then the process ought to work both ways… By the nature of ambivalence, when the counselor raises only one side the client is inclined to explore the other” (p. 107).
In my experience, even the most ambivalent client is able to effectively speak for her Rational Voice. According to Miller and Rollnick, this is exactly the goal of motivational interviewing—for the client to “present the arguments for change” (p. 76). In doing so, the client can begin the process of breaking through the mental logjam caused by ambivalence.
Mandates may bring clients into treatment, but they don’t lead to lasting change. Motivational interviewing “focuses on intrinsic motivation for change, even with those who initially come for counseling as a direct result of extrinsic pressure” (Miller & Rollnick, p. 26). Looking beyond the simple answer of resistance is vital if this process is to occur.
Works Cited
Miller, W., & Rollnick, S. (2002). Motivational Interviewing. New York: Guilford Press.
Selekman, M. (2005). Pathways to Change. New York: Guilford Press.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Sunday, November 2, 2008
Experiential Activities In Clinical Settings
The more I explore ideas about facilitating change, the more I come to see my job as a substance abuse counselor as helping my clients become unstuck by providing them the opportunities to write new cognitive scripts, rather than simply getting them to stop using alcohol and other drugs. It seems to me that our job as counselors and therapists is not to eliminate those old cognitive scripts, but to help them discover new, more adaptive possibilities.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
As our clients utilize these new, more adaptive possibilities, those old scripts will just fade away from neglect. Neuroscience tells us that what wires together fires together, but the opposite is true as well. What no longer fires together becomes unwired. If we help our clients write new, more effective scripts, and help our clients integrate these scripts into their daily lives, the neuronal networks that have hardwired those old, less effective scripts become like a forgotten path overgrown after years of no use. It seems to me that experiential activities are especially useful in achieving this.
In my last post, I discussed using experiential learning as a way to create disequilibrium for the sake of exploring that disequilibrium. In my experience, teens in treatment often lack motivation to change because they perceive their lives as being in balance. Brains like this misperception. It allows the brain to remain lazy, continuing to use those same old, all-purpose maladaptive scripts of Act Up, Shut Down, or Use, continuing to go down that same well-trodden path.
More accurately, of course, brains are exactly lazy. They're efficient, and the known response is more efficient. It takes less energy. It maintains a sense of balance. Experiential activities can be effectively used to disrupt this sense of balance, thereby creating disequilibrium. However, that is not the only use for experiential activities in a clinical setting. Experiential learning can also be used for illustrating concepts, practicing new skills, and improving group cohesion.
Illustrate Concepts
Zull wrote that we are most likely to trust sensory input from experiences. “One of the most important and powerful aspects of experiential learning is that the images in our brains come from the experience itself” (p. 145). Simply put, the use of an activity to illustrate a new concept helps it come to life in a way that makes it more memorable. In other words, the brain remembers what the body does. By framing activities as interactive metaphors, perhaps we can increase the likelihood that our clients will remember new information, thereby integrating it into their lives and creating lasting change.
An example of an activity that illustrates a concept is Journey to Recovery. This activity is more commonly referred to as Minefield, but I prefer my title for clinical settings. Use lengths of rope or webbing to establish start and finish lines, then scatter various items between the two ropes to create an obstacle course. I use polyspots, beach balls, Koosh balls, hackeysacks, stuffed animals, rubber chickens, a plastic pig, and so on.
The goal of Journey to Recovery is for a blindfolded participant to make it from the start to the finish without touching any of the obstacles. This will, of course, require the assistance of other participants. I usually start with one person going through the obstacle course. After a round or two of this, I have two participants go simultaneously, starting from different sides. Eventually I may move obstacles around to increase the challenge level.
Different obstacles can stand for different recovery-related concepts. For example, should a participant touch a polyspot, she would be given a relapse scenario and be required to share her likely response. If other clients decide her response is effective, she can continue. However, if other clients decide her response is ineffective, she must start over. I also use beach balls to represent using friends, hackeysacks can be triggers, and so on.
Practice New Skills
Ross and Bernstein stated, “[G]ames and activities offer youth a workshop for discovering and developing new ways to manage obstacles” (qtd. in Rose, p. 24). I believe experiential activities do this by only providing the opportunity to try new behaviors, and to practice those new behaviors in a safe, supportive environment. As clients practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other works, they are getting unstuck.
This work of getting unstuck happens by presenting clients with new, more adaptive possibilities and opportunities for practicing them. Experiential activities serve this treatment goal well, especially when such activities are presented in ways that reinforce trying alternate behaviors. Requiring the group’s “natural leaders” to follow, framing activities so that they are symbolic of real life, using metaphor-rich language throughout activities, and spending as much time debriefing as doing are a few ways I strive to reinforce the practice of alternate behaviors during experiential activities.
In addition, the use of experiential activities provide opportunities for clients to increase their problem-solving skills, sense of self-efficacy, and openness to taking good risks, so that the are more willing to implement their newly developed, more adaptive scripts.
An example of an activity that provides opportunities to practice a new skill is Fill the Crate. I’ve encountered several variations of this activity. This is how I generally present it in clinical settings. Use a long rope or piece of webbing to create a large perimeter circle on the floor or ground. In the middle of the circle, place a milk crate. Scatter tossable items on the outside of the circle.
The goal of Fill the Crate is for the group to get all the tossable items into the milk crate without stepping into the circle, moving the rope, or talking. A few ways to adjust the challenge level to meet a specific group’s needs is to vary the size of the circle, use tossable items of different sizes and weights, blindfold some participants, and give a time limit for accomplishing the task.
Improve Group Cohesion
Experiential activities can certainly be effective for team-building as part of employee retreats, during corporate trainings, or with sport teams. However, it seems to me this application isn’t especially relevant to clinical settings. When a client leaves an experience—be it a group session, an extended adventure outing, or graduating from an ongoing treatment program—he will likely not be part of a real world team with his group-mates. As such, it seems to me that team-building isn’t particularly relevant in a clinical setting.
What is relevant, though, is group cohesiveness. Luckner and Nadler defines group cohesiveness as “the sense of connection and good feelings when the group works together” (p. 49). Group cohesiveness helps assure the best possible treatment outcomes by assuring that the group collectively and individually is functioning at the highest level possible.
An important aspect of group cohesiveness, especially in a clinical setting, is trust. “Individuals are often less willing to share and participate fully in groups that have not built a trustworthy community” (Stanchfield, p. 14). If a participant doesn’t trust the other group members or the facilitator, it is only reasonable that she would be reluctant to engage in a meaningful way.
Increased group cohesion is a secondary benefit of nearly an experiential activity. However, there is also value in intentionally addressing this issue. In fact, I believe this is so important for effectively working in a group that I address cohesiveness in some manner nearly every time a treatment group meets. An example of an activity that helps improve group cohesion is The Trust Walk. For this activity, the participants will pair off, with one partner being the Guide and the other partner being blindfolded.
Once blindfolded, this participant is spun around a few times to create a sense of disorientation and the Guide then takes over, leading the blindfolded participant around the area. When doing this activity inside my agency’s building, we leave the group room, which gives us access to several long, narrow halls, various public spaces, and a stairway, as well as exterior spaces. I’ve also conducted this activity in a nearby, heavily wooden park, which worked quite well. After about fifteen minutes, have the participants switch roles.
Based on the overall functioning level of the group, you can allow the participants to choose their partners or you can use randomly assignment them to pairs. Allowing them to choose their own partners gives them some control and will reduce the sense of risk inherent in the activity. You can also increase or decrease the sense of challenge by either silencing the Guide or banning physical contact.
Framing the Experience
Framing refers to the manner in which it is presented to the participants. Three types of framing are possible. I call these Nuts-N-Bolts, StoryTime, and Metaphorical. Nuts-n-Bolts framing involves simply providing the basic rules and goals. A Nut-n-Bolts framing of Journey to Recovery might go like this: “In this activity, you’re goal is to get from the starting line to the finish line without touching any of the obstacles.” A StoryTime presentation might start like this: “You are on a great quest. There are many obstacles on your quest, obstacles which you must avoid.” The version described above would be a Metaphorical framing of the activity.
Pressure Pads, one of my favorite experiential activities, provides another example of Metaphorical framing. Use lengths of rope or webbing to establish a start and finish lines. Then, explain to the participants that their objective is to get from the starting point here in Treatment to the finish line over there, Long-Term Sobriety. They must do so without touching the Sea of Relapse. To do this, they would be given several polyspots that represented the skills they’d learned in treatment.
Once the group has been handed the polyspots, someone must remain in physical contact with each spot. If contact with a spot is lost, if a spot is slid on the floor (or ground), or if anyone touches the Sea of Relapse, the group is given a setback. I try to use setbacks as a way to adjust the challenge of the activity to the functioning level of a group. Setbacks can include answering recovery-oriented questions, requiring a participant to start over, or even loosing a spot. Another way to adjust the challenge level of the activity is by the distance the group must travel to cross the Sea of Relapse.
Pressure Pads requires the group to effectively work together to utilize their limited resources to solve the problem. As such, it has clear value for promoting critical thinking skills. More importantly, from a clinical standpoint, the activity includes a long learning curve, frequent false starts, and is harder than it seems. That sounds like treatment and recovery to me.
I believe framing helps makes experiential activities therapeutic and processing assures transfer of learning. Without framing to make the activity relevant to the clinical setting, the full value of these activities may be lost. Without processing, this generalizing of the activity to the real world wouldn’t happen. Processing the activity and finding the connections between it and the real world are important parts of the experience. I believe that is true anytime experiential learning is utilized, but especially in clinical settings.
Siegel wrote, “Experience can shape not only what information enters the mind, but the way in which the mind develops the ability to process that information” (p. 16). Perhaps the effectiveness of experiential learning—in a clinical setting or elsewhere—is that it changes the way information is processed. If so, then Pressure Pads isn’t really about crossing the room without touching the floor. It is about replacing previous maladaptive cognitive scripts with more adaptive ones.
Works Cited
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt
Publishing.
Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Stanchfield, J. (2007). Tips & Tools: The Art of Experiential Group Facilitation. Oklahoma City,
OK: Wood ‘N’ Barnes.
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
Subscribe to:
Posts (Atom)