by John W. Herdman, Ph.D.

John W. Herdman, Ph D.

When it comes to using cognitive-behavioral skills and techniques in counseling, one mistake common to many entry-level counselors, and some seasoned ones as well, is that he or she jumps right into challenging the client’s “stinkin’ thinkin’”. A client may say he knows he knows the judge won’t let him see his kids. The counselor says “That’s just negative forecasting, Joe.” The client has no understanding of what forecasting means. Another client says, “I should not have been drinking and driving”. The counselor admonishes her by saying “Lindsey. Don’t ‘should’ on yourself”. These counselor responses, and many more, come from well-intentioned beginning professionals who do not understand the need to lay a foundation of cognitive-behavioral understanding with the client before therapeutic change can begin.

During my professional career I have held deeply to the belief that all people have the capacity within themselves for positive change. I have been doing workshops for the past 20 plus years for counselors, teaching them skills so that they can help clients make changes in their lives. During these years I have developed and adapted ideas and examples to make the learning process more successful. I’ve developed various handouts for my counselors to use with clients and I use them with my own private practice and clinic clients. When I ask myself “what’s in this job for me?” my reward comes back to the positive feelings I bring to myself as I see clients change and regain the life they would like to be living.

I believe that clients change when they can see “What’s in it for me?” Therefore, with each client, I take the first couple of sessions to lay a foundation for change. Once a client has this foundation, the client will begin to learn new skills that build on that foundation. The client can then more readily accept feedback from the counselor and know where the counselor is coming from.

These skills then progress to that all important process of learning theory that one learns by practicing. The client does not control time, but the client does control what he or she does with that time, controlling exactly how often and how much practice is done. In order to stay clean and sober or to stop engaging in self-defeating and irrational behavior the client must change the thinking and the beliefs that lead to the behavior. It sounds easy. It is not. However, by helping the client gain an understanding of cognitive-behavioral skills it increases the probability of positive change.

Laying the Foundation

There are only three things that you control in this life. Can you name them?

The client controls his or her own thoughts, feelings and behaviors. The client does not control anyone else’s thoughts feelings or behaviors. It’s that simple. Believe it.

Tell the client that he or she grew up hearing from a number of people that “You are responsible for your behavior.” Generally that is accepted. One tends to understand that there are consequences to behavior even when one doesn’t like it. Sometimes the client may try to blame someone or something outside of him or herself for the actions. “The devil made me do it.” Ultimately, for the client to begin the process of rational change, the client will need to understand and then accept that he or she is responsible for one’s behavior and no one or nothing outside of him or herself is responsible for what one does.

Clients generally do not grow up hearing “You are responsible for your feelings.” Instead, one hears from many people from a very early age that “You make me mad;” “It makes me anxious;” “The weather makes me depressed;” and, “He/She/It makes me happy.” This is simply not so. People and things do not upset a person or make one mad; it is one’s own thinking about it that makes one upset or mad.

Adult Learners – Active Learners

Alcohol and drug counselors rarely have the coursework in advanced psychology or in adult learning theory. Foundation skills for the client to learn are designed around the principles of adult learning and around the structure of the adult learning cycle. Two points to be made include:

Prefer self-direction when involved in learning and development

Can also be motivated to learn by appealing to personal growth and gain, i.e., WIIFM (What’s in it for me?)

The Four Basic Emotions

Help the client remember that there are four basic emotions – Anger, Anxiety, Depression, and, Contentment. All other emotions fall under the “umbrella” of those four.

Emotional Intelligence (EI)

Having a low emotional intelligence shows itself with uncontrollable emotional outbursts and such things as low frustration tolerance and other irrational behavior. Few low EI people are successful. If emotions are not managed well, one is likely doomed to defeat in efforts at change. The better one knows oneself, the more likely one is to manage one’s emotions. The concept of emotional intelligence is of rather recent origin. It has only been since the mid 1990s that Dr. Goleman popularized the concept. He identifies five abilities that compose the levels of emotional intelligence as follows:

1. Knowing our emotions
2. Managing our emotions
3. Recognizing the emotions in others
4. Managing relationships with others
5. Motivating ourselves to achieve our goals

During the course of counseling there will be many opportunites to remind the client about these levels and using motivational techniques, help the client toward level 5 – achieving goals. Along the way one manages one’s emotions and relationships with others.

Your Left Hemisphere and Right Hemisphere

Neuropsychology is rarely taught to alcohol and drug counselors. Although neuroanatomy is not rocket science, providing the client a simplistic review and reinforcement of things one may know already helps one understand how the brain is associated with thinking, feeling and behavior.

The brain has a left and right hemisphere. The left hemisphere is dominant for most people, and is the site for language development. After one develops language at about 18 months, one sees the world through “the world of words.”

The right hemisphere is known as “the world of non-words.” This is where we store our beliefs and habits and our automatic behaviors like brushing teeth, riding a bicycle, even typing or playing a musical instrument. It is our “auto-pilot.” The right hemisphere allows us to feel and behave automatically without thinking, i.e., without engaging in “the world of words.”

Sigmund Freud was a famous psychoanalyst. Although many of his theories have been disputed or refined, I have found his concepts of conscious and unconscious very interesting. If you are conscious then you are aware and can verbalize. You use language to think and talk. If you are unconscious of something you are unaware and not able to think or talk about what is going on. Just because something is in your unconscious does not mean it isn’t there. It just means that you are not aware of it. Psychoanalysis is an effort to identify the unconscious and bring it into your consciousness. Likewise, cognitive-behavioral therapy attempts to identify beliefs that are stored in the right hemisphere and bring them into awareness so that one can talk about them using the left hemisphere. Then change can happen.

In conclusion, I believe that laying a foundation of skills before implementing cognitive- behavioral therapy leads to success for the client in changing maladaptive behaviors in many aspects of the client’s life. As a counselor, you can learn these foundation skills and then implement best practices of cognitive-behavior therapy.