Keeping Choices in the Client`s Hands

Clients who enter substance abuse treatment usually have made some really bad choices. It is not surprising that some programs and self-help groups ask substance abusers to abandon their own decision-making process in favor of following a set of guidelines demonstrated to be helpful to maintaining sobriety. But this can prove to be a very big mistake.


Nicholas A. Roes, PhD

Counselors need to help clients develop, rather than abandon, their own decision-making process. This is much more supportive of long-term sobriety than blind obedience to a counselor's advice, a program's policies, or any particular interpretation of the 12 Steps. It's an approach more likely to be successful for a number of reasons:

• It makes relapse less likely. Some relapse results from clients being able to follow instructions while in treatment but not being able to apply principles to their posttreatment life. When a client is applying external guidelines, there is a much greater likelihood of abandoning them. When the principles of living are developed through the client's own internal decision-making process, the likelihood of sticking with them is much greater.

• It automatically adjusts to individual differences among clients. A one-size-fits-all solution cannot possibly work for everyone. No matter how helpful a set of rules for quality sobriety might be, insisting that they are the only way to quality sobriety offers a recipe for failure.

• It increases self-efficacy. The bigger the role the client has in making decisions, the healthier the client's self-esteem becomes. Some clients have a tendency to give too much credit to the program or counselor, and not enough to themselves. This creates a relapse risk by undermining self-confidence. Our biggest successes happen when clients leave treatment in full touch with their unique talents and abilities. It is much less helpful when clients end treatment thinking that their program or counselor was the greatest.

• It helps prevent “cloning.” Without consciously knowing it, all of us operate within our own value systems. If the full extent of treatment is only the giving of advice, this leaves open the possibility of counselors creating clients who think exactly as they do. We all have passionate beliefs that make it difficult for us to be objective when a client is deciding on some issues, such as engaging in recreational alcohol use or remaining with an abusive spouse. A focus on the process of making a decision protects clients from being bullied into the same decision the counselor might make in a similar situation.

• It decreases the likelihood of going from the frying pan into the fire. Too strong a focus on getting out of the current situation leads to the possibility of jumping into an even worse one.

• It helps clients handle not just their current presenting problem, but also helps them resolve future problems and achieve goals.

Problem-solving techniques

There are many tools and techniques that clients can learn to make better decisions for themselves and to solve their own problems. Cognitive therapists are especially fond of focusing on process, and often meet with success by teaching clients how to change their thoughts.

Many texts and workbooks explain the use of such techniques. One such technique is the D-I-E-D-E-P model.1 It is a very simple, very effective way to equip clients for handling current and future problems.

The first “D” stands for Data— the objective facts of the situation. For example, you lose out on a promising job opportunity because a background check turned up a DWI, and company policy prohibits the employer from hiring you. Different Interpretations (“I”s) of the data create different Emotions (“E”s). If your interpretation of these Data is “Nobody will ever hire me, so I might as well give up,” you'll experience a different emotion than if your interpretation is “At least the prospective employer saw something in me that made him seriously consider me. If I keep trying, I'll land a good job.”

The “D-E-P” (Dispute, Exchange, Practice) offers the opportunity to dispute the thought that's causing a problem. The above example might involve considering that your resume was good enough to result in an interview, and that the interview was good enough to merit a background check. After disputing, clients are taught to exchange the unhelpful interpretation for a more helpful one, such as “I came really close this time. If I fine-tune my approach I'll have an even better chance next time.” Clients are then asked to practice the more helpful thought (applying it in all future similar situations) until it replaces the unhelpful one.

Wide applicability

It is easy to see how the strategy outlined above, helpful in overcoming an obstacle to employment, could also be helpful in overcoming other obstacles. This is just one example of the many tools developed by many schools of therapy to address the decision-making process rather than the specifics of the presenting problem.

Some counselors may see their role as teaching clients what to think. A far greater service can be performed in helping clients learn how to think. Then, what they think is up to them.

Reference

1. O'Keefe E, Berger D. Self-Management for College Students: The ABC Approach. Hyde Park N.Y.:Partridge Hill Publishers; 1999.