All therapeutic intervention, whether that be via therapy or counselling, must follow a six-step ‘blueprint’ in order to provide effective care to the client.
The six stages are:
- Developing trust.
- Exploring problem areas.
- Helping to set goals.
- Empowering into action.
- Helping to maintain change.
- Agreeing when to end.
Step one, developing trust, is critical for every therapist to secure. Due to the vulnerable nature of many people who seek therapy, it is essential that therapists can express empathy, warmth, and approachability, all of which contribute to the perception that the therapist has a genuine desire to help the client navigate through whatever troubles they might be facing.
Upon first meeting a new client, the best way to show a genuine desire to help is to listen to their worries/concerns and try to establish what their trigger point to coming to therapy was. Helping to ease a client’s worries is critical at this stage and can be achieved by reiterating the fact that coming to therapy was the right decision, and that you have the tools to help them navigate through their hardships.
It is also critical in any therapeutic relationship, that the therapist makes it clear that their confidentiality will always be maintained. The best way to make this guarantee is via a ‘charter’- essentially a ‘promise’ that you will always maintain their confidentiality. This should make clients feel more at ease and ready to ‘open up’, allowing them to express their genuine emotional reactions.
The most effective way to develop a trusting relationship between client and therapist is to, first, work on one’s own communication skills. By doing so, a client’s character can be assessed through a process of active listening and observation. When observing a client, things to consider at this stage include tone of voice and body language (e.g., eye contact, fidgeting, facial expressions.)
It is also critical that, as a therapist, you don’t neglect your own body language ‘etiquette.’ You should ensure that you are displaying ‘open’ body language (e.g., nodding to show that you understand, maintaining eye contact, uncrossed arms etc.) This should aid in the development of a rapport between client and therapist, which should in turn lead to the formation of a positive relationship that enables the client to open up and come back for help in the future.
Step two is all about exploration. It is the stage in which the therapist seeks to learn what the client’s problem is, and why their problem persists. This stage is often introduced with CBT (a type of therapy that aims to uncover a client’s thinking patterns.)
Conducting a thorough client assessment in the exploration stage helps clients to learn about themselves to aid them in their long-term recovery. The assessment should comprise of four major parts; current problems with addiction (nature of addiction, is health affected, does the client truly want to change, is there immediate risk), how the problems fit with past experience (where and when did the addiction begin, does the client know why they became addicted, is/has there been addiction in the client’s family environment, has there been a life trauma), relevance of current life circumstances (how does the addiction affect the client’s relationships, health, employment & well-being, does the client currently have any support networks), and future expectations (revealed by motivational interviewing- identifying the client’s intrinsic values and goals to stimulate behaviour change.)
In the exploration stage, an ASI (addiction severity index) should also be used. This is a tool designed to measure the varying levels of addiction from ‘mild’ to ‘definitely needing treatment.’ An ASI most commonly takes the form of an hour-long interview which focuses on seven key areas of the client’s life: medical status, employment, drug use, alcohol use, legal status, family & social status, psychiatric status. Combined with the use of a client assessment, ASI is a highly effective method used to gain perspective of a client’s struggles, both for the client themselves and for the therapist.
Step three involves establishing goals. The best way to set goals is to do so in line with one’s personal values. Despite all human beings having a set of core values (community, creativity, humanity, love, nature, spirituality, meaning of life, value & authenticity), people struggling with addiction often find their values become ‘warped.’ This stage of therapy should therefore focus on helping clients to reassess their core values to enable them to discover what they find most important in their lives. Any values that are not being met can be focused on in the goal setting process, whereby a SMART (specific, measurable, achievable, realistic, and timely) objective is set.
Step four is the act of empowering the client into positive action. In order to encourage feelings of empowerment, a therapist must clarify exactly how the client should act to work towards their goals, as established in the previous step. One example of a way in which this can be done, is by planning alternative exercises that will distract the client from their addiction (e.g., going to the gym tomorrow night instead of the pub.) Having a replacement activity such as this will make the process of ‘letting go’ of the addiction that little bit easier, since there is something else scheduled to take its place. Working with clients in this way enables them to remain in control of their recovery, as they are being encouraged to accept personal responsibility to reshape their future. For clients that need a bit of a ‘push’ to commit to engaging in positive actions, therapists should seek to remind clients of the advantages and disadvantages of remaining in their present states, as well as being encouraged to consider the gains, costs, and effects of their addiction on themselves and their significant others. Contingency plans should also be set in this stage, to instil confidence in clients that they CAN recover, and if they do happen to have a ‘slip up’, its not the end of the world.
Step five centres aroundmaintaining change.It focuses on determining how the client can stay in recovery post therapy, therefore encouraging the formation of a support network external to the therapy room. It also encourages the client to develop new interests, perhaps built on from personal values discovered in step three, and ‘replacement activities’ tried in step four.
The following acts of empowerment should be established in the client’s life to stand them in good stead for long-term success and relapse prevention: generosity, integrity, positivity, sincerity, honesty, communication, acknowledgment of core & personal values, accountability, independence, and self-respect. Through personal development in the ways highlighted above, the client can be encouraged to maintain lasting and healthy change.
Step six, the final stage of the process, refers to the mutual agreement between client and therapist of when their therapy should come to an end. Before it can conclude however, the concept of relapse should be thoroughly explored so that the client knows what to expect. They need to understand that relapse is not about a ‘lack of willpower’ but is due to a complex combination of different factors. It is important to emphasise, however, that with adequate relapse prevention strategies in place, and coping mechanisms in place in the event that a relapse does occur, relapse is by no means ‘the end of the world.’ Recognising that a one off ‘slip-up’ is just that, a one off, reduces the likelihood of ‘all or nothing’ thinking occurring, whereby, for example, a recovering alcoholic who has one drink thinks, ‘that’s it now. All my hard work is undone so I may as well have 10 more drinks.’ Instead, they can rationalise that they have made an unhealthy decision but are still strong and capable of recovery. This positive self-talk should in turn prevent further drinking/engagement in addictive behaviour due to feelings of self-loathing leading to an urge to relieve the negative feelings with said addictive behaviour. Therefore it is critical that before therapy can come to an end, clients know exactly what to do and what not to do should they struggle with a ‘blip’ (note: use of the word ‘blip’, not ‘relapse.’)