Trauma Informed Practice

Trauma-Informed Practice in Addiction Treatment
Xueqi Gao
Suffolk University

Trauma-Informed Practice in Addiction Treatment
Currently I am working with clients with substance use disorders at an all men residential treatment program. I had developed my theoretical orientation from Albert Ellis’s Rational Emotive Behavior Therapy (REBT), Aaron Beck’s Cognitive Behavior Therapy (CBT), and Carl Roger’s Client-Centered Therapy (CCT). Combining examining faulty thinking, distinguishing thoughts, emotions, and behaviors, and practicing distress management skills, I have seen significant progress clients have made in recovery. The Rogerian idea of providing a warm and safe environment for client to express feelings and thoughts
leads me to use motivational interview substantially during therapy sessions as well. Trauma-informed approach adds new elements into the therapy, such as establishing safety and allowing clients to be vague; it also enhances some of the interventions that are already used during sessions, such as practicing coping skills, managing negative emotions, following clients’ pace and providing support and empathy, as well as connecting with others. The goals and techniques of CBT I usually use are based on Ellis and Beck’s theory.
The ABC model Ellis presented clearly expressed the ideal of how feeling, thinking and behavior “are never pure, but accompany and holistically influence and integrate with each other” (Ellis, 2001, p. 19). He argued that it’s the beliefs (B) of adversity or adverse situation (A) that caused disturbance behavioral consequences (C), rather than that those situations create problems. Beck had a very similar idea to that of Ellis: situation does not directly decide how people feel; rather, the perception mediates between the situation and the feelings or how people respond (Beck, 1995). He claimed that forming core beliefs and intermediate beliefs (i.e. rules, attitudes) from early developmental stages is a learning process for individuals, and these beliefs later influence automatic thoughts when facing an event. The cognitive behavior approach teaches the client to discriminate faulty thinking from rational thinking, to challenge and test out validity of beliefs, and to replace dysfunctional thinking with healthier alternatives that lead to less disturbing emotions or destructive behaviors. It also stressed counseling techniques and teaching clients skills to achieve these goals. I sometimes call on clients to hold on to a statement or a belief for a moment and ask of that belief is actually 100% true, and client usually could see the irrational beliefs. Many clients believe that if they
relapsed, then they have lost everything; I often ask clients what some gains are from being clean for a while or what some skills they have learned before relapse. When I facilitate groups, I hand out self-help forms and belief worksheet to clients to identify and write down ABCs, IBs, beliefs and evidence, as well as how to dispute, new beliefs, and new consequences (i.e. healthy negative emotions and constructive behaviors). Then I help client to examine advantages and disadvantages of beliefs and to see the negative side of holding on to incorrect assumptions. For example, when we talk about anger, I ask client to shout out an incident that they feel angry about, such as someone cut others off when driving; I point out the thoughts (i.e. no one can cut me off, whoever cut me off deserve bad consequences, etc.) that come between events (getting cut off when driving) and emotions/consequence behaviors (i.e. feeling angry, aggressive intentions and behaviors); then I pose the question of how we could change the thoughts and ultimately lead to emotions or behaviors that are not destructive.
Rogers stated that: “The client is the only one who has the potentiality of knowing fully the dynamics of his perceptions and his behavior” (Rogers, 1951, p.
221). When such an environment for individuals to become aware is limited, one develops regressive emotions or disruptive behaviors. Rogers emphasized that changes only occur under certain environmental and therapeutic conditions. After many research, he concluded, that therapists who are genuine and who provide clients unconditional acceptance, caring, and accurate empathic understanding have more successful therapy than other therapists. Roger (1959) considered that achieving congruence between ideal self and actual self is one of the most important counseling goals and that incongruence causes internal confusion, makes people vulnerable to psychological problems, and raises anxiety, maladjustment, and distortion of awareness. Therapists should provide the environment for clients with complete freedom to explore every portion of the mind and freedom from threats. As the individual gradually explore experience and became more realistic in one’s perception, one can become more accepting of oneself “as is” (Rogers,
1951).
Ellis (2001) encouraged to dispute and debate with clients’ thoughts and beliefs. However, I believe that such approach might be perceived by clients as too confrontational and possibly leads clients to act or think defensively; I often pose open-ended questions that allows clients to examin and relect on themr own. Both CBT and CT had stressed the importance of therapeutic alliance and counselors’ attributes, such as empathy, care, and genuineness. The clients ultimately do the work of exploring thoughts and emotions, recognizing irrational belief as well as making changes in behaviors. These could not possibly happen without a safe, non-judgmental environment and a positive therapeutic relationship (Josefowitz & Myran, 2005). Motivational interview combines client-centered framework with CBT, aiming to reduce clients’ resistance and increase readiness to behavior changes (Washton & Zweben, 2006). Clients are encouraged to think through their ambivalence about behavior change and the counselors take the role of facilitator in exploring options to handle dilemma. I found techniques such as roll with resistance, avoid arguments, and avoid coercive or pressuring tactics effective; clients see counselor as allies and supporters, rather than critics or oppositions, and are more willing to open up to behavior change options compared to when using an confrontational approach. Client gaining a sense of control in making choices after evaluating their motivation and exploring their resources, which leads to more successive recovery.