Counseling Strategies Action & Maintenance By: Linda L. Barclay PH.D. LPCC/S LICDC CHD 635 Chemical Dependency "Recovery from addictions requires lifestyle changes" "Recovery from addictions requires developing and working with relapse prevention or maintenance plans."

1. L I N D A L . B A R C L A Y P H . D . L P C C / S L I C D C
W A L S H U N I V E R S I T Y
C H D 6 3 5
C H E M I C A L D E P E N D E N C Y
COUNSELING STRATEGIES:
ACTION & MAINTENANCE

2. Changing and Maintaining Behavior Changes
 Recovery from addictions requires lifestyle changes:
 Development of new coping skills – cognitive, emotional, behavioral and
interpersonal skills to deal with problems
 Replacement of addictive behaviors with different pleasurable
experiences and social rewards
 Self-care and sense of purpose, meaning and spirituality in life
 Recovery from addictions requires developing and working
with relapse prevention or maintenance plans

3. Cognitive-Behavioral Therapy (CBT)
 Short-term approach; focuses on immediate problems;
flexible, individualized approach
 Uses concepts from cognitive and behavioral theories of
human behavior
 Central concepts: attributional styles; cognitive appraisals;
self-efficacy expectancies; substance-related expectancies;
“high risk” situations; coping skills and behaviors;
assessment of client’s cognitive functioning and coping
behaviors

4. CBT: Attributional Styles
 Influence client’s perception of problems and recovery
 Dimensions:
 Internal / External
 Global / Specific
 Stable / Unstable
 Examples:
 I got drunk because I am weak
 I got drunk because I was surrounded by people at the party who were
encouraging me drink
 My failure to quit drinking shows that I am a weak person who can never
succeed at anything
 Last night I didn’t use good coping skills and so I got drunk; if I work at
it, I could catch myself next time and use better coping skills to avoid
drinking

5. CBT: Cognitive Appraisal
 A client’s assessment of what are stressful situations and
his ability to cope with the demands of this situation
 client’s perception of situation regarding level of stress, personal
challenge or threat involved
 client’s evaluation of his ability to meet the challenges specific to the
situation – influenced by his coping skills
 If client believes he has the cognitive, emotional and
behavioral coping skills to meet the challenge of the
situation, he will feel less threatened, less stressful and
more able to succeed

6. CBT: Expectancies - Self
 Self-efficacy: belief can successfully use coping skills
 Determined by repertoire of coping skills and
appraisal of relative effectiveness of own coping
skills in relation to specific situation
 Lack of necessary coping skills low self-efficacy
beliefs negative, distorted thoughts about self
and situation reduced motivation to even try to
cope may feel depressed and perceive himself as
hopeless drinks or uses drugs

7. CBT: Expectancies – substance-related effects
 Beliefs about anticipated effects of alcohol or drug on his
feelings or behaviors – idea that certain effects result from
alcohol or drug use
 Positive effects – relaxation, euphoria, social or sexual
facilitation, tension reduction, escape from problems
 Negative effects – physical impairment, anxiety,
depression, paranoia, condemnation from family, getting
into fights, guilt, sense of personal failure

8. CBT: High-Risk Situations
 Situational contexts ( people, places, feelings, activities) can
serve as cues that elicit strong craving or desire to use
 Interpersonal (interactions with others – negative or
positive)
 Intrapersonal (feelings, beliefs, perceptions, physiological
conditions – either negative or positive)
 High-risk situations must be understood in individual
terms

9. CBT: Coping Behaviors
 What a client does to stay sober or clean; what he does to
handle risks to drink or use irresponsibly
If client lacks skills to cope with their interpersonal, social, emotional
and personal problems, then these problems are likely to be
viewed as threatening and unsolvable
Client drinks or uses to deal (or avoid) these problems and the feelings
caused by the problems
 Two behavioral coping approaches:
Avoid situations previously associated with drinking or using drugs
Seek social support when confronted with temptation to drink or use
 Two cognitive coping approaches:
Anticipating the negative consequences of drinking or using
Thinking about the benefits that come from being sober and clean

10. CBT: Assess Cognitive Functioning and Coping Skills
 Must gather specific information about client’s high-risk
situations – those where he drinks / uses and those where
he survived the relapse crisis
 Include both intrapersonal and interpersonal triggers to use
 Must assess consequences of drinking and using episodes
 Must assess expectancies – self-efficacy beliefs, and drug-
expectancies
 Must assess client’s cognitive appraisal and attributional
style
 Must assess repertoire of coping skills – both deficits and
strengths

11. Assess Cognitive Functioning
A + B C
antecedents beliefs consequences
(activating (appraisals,
situations, life expectancies,
events) attributions)
D E
disputing belief new effect

12. Substance-using Beliefs-1
Core Beliefs Emotions Addictive Beliefs
“I am trapped/ Sad or angry “Drugs offer escape”
alone”
“I am undesirable” “Drugs make me more
sociable”
Addictive Behavior
Go to a crack house

13. Substance-using beliefs-2
Activating Situation Anticipatory Beliefs Craving
Drug-seeking Permissive Beliefs
Plan of Action
Example:
Social Situation “I will feel better if… Craving
Call friend “It’s OK now”
with stash

14. Substance-using Beliefs-3
Activating Beliefs Automatic Craving/urges
Stimulus activated Thoughts
Internal Cues
External Cues
Feeling sad “If I take a fix “What the hell” Craving
I will feel better”
Continued Focus on strategies Facilitating
Use / relapse (action) Beliefs
(permission)
Purchase / use Look around for “ I can do it this
drugs money time without any
harm”

15. CBT: Interventions
 Work with the client to help him monitor cycle of
antecedents, beliefs and consequences in drug use
 Work with the client to develop relapse preventions
plans (action and maintenance) plans based on
information obtained
 Teach new coping skills – both cognitive and specific
behavioral skills
 Help the client practice skills in counseling – either
in individual or group counseling
 Work with client to modify plans if he slips –
incorporate new skills as needed

16. Counseling Strategies: Specific Tools
 Counseling interventions are tools that help the client take
charge of their behavior and make changes (action and
maintenance).
 Initially the client learns how to use these tools in session,
but the goal is for the client to use the tools outside the
session.
 This process is called SKILL GENERALIZATION.

17. Counseling Strategies: Specific Tools
 Self monitoring
 Help the client identify how behaviors, thoughts, and
emotions link together or interact with the client’s
pattern of drug use.
 Help the client learn to monitor her behavior, including
what she does, when, and why she may do it, what she
thinks, how she feels, and eventually how she can
respond differently.
 Help the client identify how one behavior links to
emotional responses and vice versa.

18. Counseling Strategies: Specific Tools
 Cognitive Modification Strategies
 Address client beliefs that contribute to drug use behavior
 Investigate the client’s “cognitive expectancies” (beliefs) and teach
them to challenge those beliefs and promote active cognitive
evaluation about the natural consequences of drug use behavior
before actually engaging in it.
 Teach clients to alter distorted perceptions and thoughts through use
of thought stopping and urge surfing.

19. Counseling Strategies: Specific Tools
 Expectancy Challenges
 The clients’ expectancies about drug use could present a
road block to behavior change. It is crucial to teach clients
how to challenge these expectancies.
 Present information to your clients that may contradict or
refute the existing beliefs about effects of drug use.
 Be careful not to lecture or preach, and try not to put the
client on the defensive when presenting the information.
 Example:

20. Counseling Strategies: Specific Tools
 “Hypothesis testing”: In this method, the client learns how to
view his or her beliefs as a hypothesis that needs to be
examined rather than an unquestionable fact.
 Example:
 A similar strategy called “data collection” teaches the client to
gather evidence to support and refute his or her beliefs about
drug use.
 Example:

21. Counseling Strategies: Specific Tools
 Examining consequences
 Help clients identify how certain beliefs or behaviors have lead to
drug use.
 Explore how clients’ behavior might be different, if they believed
differently about the situation. This can empower clients to consider
that they may be able to change their behavior, if they change their
thinking.
 Have clients walk through natural consequences of their behavior.
This helps the client to stop automatic, and unexamined behavior.
Have clients walk down (imagine) the full length of the behavior
chain, in order to see a likely risk outcome to what initially seemed
like an innocent act.
 Example:

22. Counseling Strategies: Specific Tools
 A similar technique is called “playing the tape to the end”. This
technique is used during active craving.
 The client is taught to use this technique while they are
experiencing craving. In this technique, client will imagine
what will happen if they act on the craving and urges. They will
walk themselves through change of events that will follow, and
the negative consequences/pain they will have to face, if they
listen to current using tape.

23. Counseling Strategies: Specific Tools
 Thought stopping
 Many times these clients are faced with ruminating/obsessive
thoughts. They may describe that their mind wanders, spins,
or races out of control with negative thoughts related to
personal short comings, regrets, of the past, put downs or
doubts, or using thoughts. This technique will help the client to
stop these sabotaging thoughts.
 1- Saying “STOP” out loud.
 2- Imagine the word “S-T-O-P” in their mind.
 3- Imagine a stop sign or stop light that will break the cycle of
negative thought.
 4 - Use physical stimulus – “rubber band”

24. Counseling Strategies: Specific Tools
 Skill Development: Problem solving and
planning
 Help clients define problems, learn brain storming, and
select the most appropriate solution.
 Help clients learn to think a head by setting goals, and
mapping strategies to reach the goals. Outline the logical
sequences of events which need to happen in order for
them to reach their desired goals.

25. Counseling Strategies: Specific Tools
 Coping Skills training
 Skills training begins with assessing the current level of
client skills to determine whether he or she has the skills
necessary to successfully cope with a particular situation
or successfully complete a task without drug use.
 The client may have failed in certain situations to avoid
drug use or may have avoided using coping skills
 The counselor will help the client to explore and develop
new coping mechanisms for situations where they have
failed to cope without drugs.

26. Counseling Strategies: Specific Tools
 Examples of coping skills training:
Relapse management skills (thoughts, cravings, refusals)
Anger management skills
Stress management skills
Relationship skills (communication, intimacy, social
support)
Other essential life skills (vocational, financial, planning for
emergencies, coping with persistent problems, etc.)
 Homework Assignments can help clients to generalize skills
learned in session to situations outside counseling.