The Space Between Stimulus and Response

Reflections on addictions counseling and creating change

“One cannot brave the vigors of loneliness and desperation of such inward journeys without a companion.” – Rollo May

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I am perhaps more comfortable with cognitive-behavioral therapies because these were emphasized in my graduate program. However, I do strongly agree that our responses to our circumstances can create more suffering than our circumstances themselves. There is a parallel concept (Buddhist in origin) in meditation and mindfulness work— the two arrows of suffering. When misfortune happens, two arrows fly. The first arrow is our actual pain over the circumstances that are unavoidable, but the second arrow is self-inflicted emotional pain, resistance and judgment.

I also find that the A-B-C model of CBT is very accessible, and it can help clients to identify their role in a bad situation, and it can help clients understand why they respond in intense and sometimes problematic ways. Identifying our thoughts is also the foundation of implementing positive self-talk for coping. I also appreciate that CBT emphasizes positive behavioral change as an effective means of changing outlook or perspective, as it can be very difficult to change thinking styles. “Train the body and the mind will follow.”

I also try to draw from existential therapy, which I find very thought provoking. The four existential givens (death, freedom, isolation, and meaninglessness) are rarely addressed in conventional therapies, though they may be at the very foundation of a client’s concerns. I think it can be important to be with clients wherever they are– even if it is a dark place. I see value in the core principle of this therapy, to assist clients in finding meaning in their lives, though we as people are finite, though we can only actualize ourselves within certain limits. In suffering and struggle, one has the opportunity to find meaning and self-definition in how she carries herself. I also see how many disorders can be conceptualized as an unwillingness to acknowledge our responsibility for being-in-the-world. An addiction in which one is obsessed with a set of behaviors or a chemical effectively serves to distance one from the circumstances of her environment, and also prevents her from acting in it.

I believe, as humans, we are always striving to achieve meaning in our lives. Nietzsche has proposed a will to power, but I think power is only one way we strive to imbue our lives with meaning or definition. Seligman has proposed that there are three approaches to happiness: the pleasant or pleasurable life, the good life, and the meaningful life. He emphasizes the latter concept, and particularly that the most fulfilling experiences will be those we have earned though action. We want to have earned our happiness. Pleasurable experiences alone (e.g., a delicious meal at a restaurant) can only provide so many fulfillments, as they do not aid us in our strivings for self- definition. I try to help clients generate more meaning in their lives and to help them to get back into the world by moving from being reactive to active. Often this includes an uncovering of personal responsibility and values, and helping clients to act in accordance with those values. Valuing makes certain behaviors possible, even if they make us anxious.

I am lucky in that I tend not to be too judgmental. Compassion is possible because I believe that all behaviors stem from needs and patterns of reinforcement. I do not feel pressure to make others believe what I believe, and I can be comfortable “agreeing to disagree.” Even if I have a strong belief, I can understand that clients must reflect on their own experiences for answers.

I hope that I am hopeful. In working with clients, I am less idealistic than when I started. However, I genuinely believe that all of my clients have unrealized potential for living better. I can see strengths in even my resistant clients, and I try to appreciate how maladaptive behaviors once served them. With respect to substance abuse, I also believe that relapse or a step in the wrong direction does not have to be a great setback; it can be an opportunity for learning and self-understanding. Erring does not take away all that has been learned in recovery or therapy. I try to encourage clients by recognizing small achievements on their way to larger goals, and I try to encourage recovery as a journey rather than a destination. As Dr. McWay said in his lecture this week, reflect on how difficult change can be, even for you as a high-functioning person…


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