Counseling Strategies for Individuals with Addictions

1. Philip G. Monroe, PsyD Biblical Seminary Counseling Strategies for Individuals with Addictions

2. Philip G. Monroe, PsyD Biblical Seminary pmonroe@biblical.edu Counseling Strategies for Individuals with Addictions

3. www.biblical.edu • Degrees: • MA in Counseling • MDiv (2) • Urban MDiv • DMin • Certificates: • Biblical Counseling • Advanced Professional Counseling • On-line Studies • Coaching/Consultations

4. The Goal • To consider practical methods to help those struggling with addiction grow in insight and find the “way of escape” (1 Cor. 10:13) • To better tailor our methods to the needs and character of those we help

5. What is addiction? • Addiction is a body, spirit, and will problem • Sin is both chosen and irresistible • We are made to desire God and creation. But since sin enters the world, • We long for things that are out of reach • These unfulfilled longings are painful • We often turn good desires into demands • We desire too little rather than too much • We often want behavior management rather than transformation

6. The Descent of Desire Foolishness Friendship Sin Infatuation Bondage Betrayal Tragedy Worship Adapted from Addictions: A banquet in the grave (E. Welch)

7. Recovery of Godly Desire Delight in the fear of the Lord Doing violence against addictions: A response to God’s grace Engage the battle at the level of imagination Speak honestly, uncover subtle lies Surround yourselves with wise counselors Remember God’s commitment to you Engage in the battle against distorted affections Adapted from Addictions: A banquet in the grave (E. Welch)

8. Or another way to look at it… • The pathways to bondage • (and breaking free)

9. Self-deception is the root of all other sins. It is THE gateway sin. It is the lies we tell ourselves that make other sins palatable. If we were to see ourselves as we really are, we could not “ingest” nor accept things that are evil. These things often come in the form of “needs” or “normal” desires, reactions, etc. False Worship: Done daily, hourly, by the second in the most subtle ways. You can find it in the “innocent” second look, the momentary daydream, the place you go in your mind when you have nowhere you have to be. Any one of these may not be false worship, but a quick review of common patterns will probably identify your tempting “must haves” of life. Habits Habits are not merely acts of the will that can be turned off or on. They begin to take on a life of their own at the cellular, neuronal, environmental, etc. level. Your body may crave food, drugs, pornography, etc. Even after years of saying no, you may still struggle with them. BONDAGE! Self-Deception False Worship We live in a fallen world with fallen communities and fallen bodies. We are deceived and deceiving. In the midst of trouble, we reveal what is in our hearts by our response to that trouble.

10. Habits BONDAGE! Self-Deception False Worship

11. Habits BONDAGE Self-Deception False Worship Breaking Self-Deception • Fight for truth! (Self-deception is the gateway sin) • Challenge! Having thoughts of self other than we want to have • Identity as lost sheep • Recognition of vulnerability to “finding” ourselves

12. Habits BONDAGE Self-Deception False Worship Proper Worship • Practicing proper meditations • Meditating on 1 thing • Looking beyond self to God/other • Example: What do you think about when you wake up in the night?

13. Habits BONDAGE Self-Deception False Worship Habit Change • Protecting good habits; building new • Doing violence to bad habits • Using all the means of grace/mercy (spiritual, biological, communal, economical, etc.)

14. Thesis • Knowing the end point on a map is important but we should not neglect the starting point for the person in front of us nor the process of getting to that end point, or… • Sometimes biblical counselors know the problem and the solution but have spent less time focusing on good interpersonal processes needed to walk with the other.

15. Two Techniques • Insight: The Cycle of Addiction • Process: Readiness for Change Assessment

16. 1. The Cycle of Addiction • Most individuals have a common, vicious cycle of abstinence to addiction • Most individuals do not adequately see the subtle details of their cycle • Learning the cycle of addiction may help the person be more alert to temptations, vulnerabilities, lies, as well as the “ways of escape” available • You are helping them wake up from a coma!

17. The Cycle of Addiction Abstinence “Never again” Penance Trigger(s) Tempting Thoughts Guilt Defeated Interpretations SUDS Indulge “I can handle it” Adapted from Patrick Carnes

18. Breaking the Cycle of Addiction Abstinence “Never again” Penance Trigger(s) Tempting Thoughts Guilt Defeated Interpretations SUDS Indulge “I can handle it”

19. Recovery of Godly Desire Delight in the fear of the Lord Doing violence against addictions: A response to God’s grace Engage the battle at the level of imagination Speak honestly, uncover subtle lies Surround yourselves with wise counselors Remember God’s commitment to you Engage in the battle against distorted affections Adapted from Addictions: A banquet in the grave (E. Welch)

20. Where does this fit in the process?w • Address impact of shame • Practice hope and worship in brokenness and despair • Explore roots, shoots, fruits of addiction (cycle) • Denial, self-deception, impulsivity, complacency? • Self-talk? • Validate desires and seek to deal with them in godly manner • Offer accountability and practical ideas • Point out victory!

21. 2. Stages of Change • Not every addicted person wants change • Some want change but are afraid • All of us are fickle in that we want change sometimes and refuse it other times • There is a common pattern of change motivation • J. Prochaska: http://en.wikipedia.org/wiki/Transtheoretical_Model • A wise counselor continually assesses the person’s openness to change and tailors their counsel to that place: We meet people where they are at—not where we wish they were!

22. Stages of Change • Precontemplation • (Not Ready) Not Thinking • Contemplation • (Ambivalence/Unsure)  Thinking • Determination • (Ready) Planning • Action • (Trying) Change • Maintenance/Relapse/Recycling • (Holding)  

23. Precontemplation What You’re Dealing With • Reluctance • Rebellion • Resignation • Rationalization Goal: Move them to thinking

24. Precontemplation The Approach • Sensitive feedback: primary emotion • Provide choices • Instill hope/explore the barriers • empathy and reflection • Raise doubt • Avoid ALL arguments/don’t label

25. Contemplation What You’re Dealing With • Ambivalence not commitment • Will it really be better? • Can things really be different? • What’s the cost to change?

26. Contemplation The Approach • Information, incentives • Emphasize the positives • Give reasons for change • Stay 0pen, listen, affirm • Risk/rewards

27. Determination What You’re Dealing With • Preparation • Acting on some strength and some truth • “I’ll do it on Monday”

28. Determination The Approach • Strategize the best way for them to make changes • Enthusiasm does not make up for ineptness • Remove barriers and support success, focus on details

29. Action What You’re Dealing With • Doing something public • Making changes • 3 – 6 months typically • Observable actions

30. Action The Approach • Help take steps, support success • Don’t get in the way • Empathy, empathy, empathy • Talk details • Reflect: “What’s it been like…”

31. Maintenance/Relapse/Recycling What You’re Dealing With • The unexpected costs • Lapses • Relapses

32. Maintenance/Relapse/Recycling The Approach • Expect some lapses, be realistic • Help them recycle • Help with strategies to prevent relapse

33. Stages of Change: Homework? • Precontemplation • None or observational only • Contemplation • Pros/Cons, Costs/Benefits, light reading, “one little change” • Determination • Cheerleading work, building supports, journaling for details • Action • Keeping track of successes/concerns, increased biblical study • Maintenance/Relapse/Recycling • Things to help them grow in wisdom for the long haul

34. Don’t forget the basics • Joining (Attending/Listening) • Perceiving/Assessing (Listening) • Responding and Empathy (Listening) • Probing (Listening) • Summarizing and Focusing (Listening) • Challenging (Listening) • Goal Setting (Listening) • Action (Listening)

35. Remember to… • Set the stage for work together • Validation, exploration, trust, safety • Balance teaching, exploration, and honest responses • Uncover denial/deception and recognition of divided loyalties (in love) • Offer accountability • Focus on commitment strategies

36. Finally… • Don’t forget that God is doing a work in you while you work with another • Your frustration should tell you something… • What am I learning about my own denial, complacency, etc? • What do I do with life in a broken world?

37. www.wisecounsel.wordpress.com