Sunday July 23rd 2017

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8 Ways Addiction Counselors can Build Trust with Clients

The importance of building trust

As you may have found, when trust and rapport are not established, a client tends to be more guarded and resistant to the counseling process. So, rather than give advice or try to change a client, I believe a counselor’s role is to observe, provide feedback, and give information. As a Neurolinguistic Programming (NLP) clinician, I also believe:

1. Clients ultimately make the decision to change – or not.
2. When a client resists counseling, rapport has most likely not been built or has been lost.
3. Clients with addiction issues may be more resistant and less trusting than other clients.
4. It is important to understand the client’s experience – perceptions, support systems, and triggers rather than thinking the counselor must be an ex-addict to effectively counsel a person. The client’s story will be very different than the counselor’s and should be the focus.

Based on these suppositions, I offer several strategies for building rapport with a client experiencing addiction issues and apply those strategies in a hypothetical case.

1. Building Rapport

The foundation of counseling and the first step in building trust begins with a client-centered approach including: (1) genuineness, (2) unconditional positive regard, and (3) empathy. This means being truthful and honest, accepting the client but not the behavior, and having empathy for the client’s situation.

A “feeling of sympathy emerges from the recognition that another person is suffering, in contrast to empathy, in which the other person’s pain or suffering is felt. A person expresses sympathy, but shares empathy.” – Diffen.com

I continue building trust with the client using several basic NLP strategies. For people who have read previous articles, you will recognize the strategies. However, I am providing an additional context for their use. To gain trust, a counselor can:

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1. Build rapport with the client.
2. Conduct a thorough assessment to clearly understanding all aspects of the problem.

According to NLP tenets, the basis for rapport is “when people are like each other they like each other.” Strategies for building rapport with a client include: observing eye accessing clues and predicate phrases, as well as matching and mirroring the client’s behavior.

2. Eye Accessing Cues and Predicate Phrases

Accessing cues typically refers to eye movements and indicate the sensory representational system a person uses to acquire information. So, we are talking about how the human mind processes and stores information. The primary representational systems are visual, auditory, and kinesthetic. If a client’s primary representational system is visual, a phrase by the counselor such as “I see what you mean” tends to make the client feel heard. Similarly, if a client’s primary representational system is auditory, a counselor making the statement “I hear what you say” tends to make the client feel understood. Voice tone, breathing patterns, and posture also provide cues.

Visual, auditory, kinesthetic, and auditory words are known as predicate phrases. These phrases offer hints to a person’s preferred representational system. A comment such as “I pictured something different” provides information. When eye accessing and verbal cues are observed and duplicated, a subconscious message is conveyed that we (the client and the counselor) are similar. In addition to replicating a person’s primary representational system, there are other ways to build rapport.

3. Matching and Mirroring

Matching and mirroring are also effective tools in building rapport. Matching is doing exactly what another person does; mirroring is doing the same thing as the other person in reverse. Five ways to match or mirror are as follows:

1. Physical actions – If the client crosses his or her legs, then, the counselor should have legs crossed.
2. Speaking tone, volume, and tempo – If the client speaks softly and quickly; then, the counselor should speak softly and quickly.
3. Breathing – Matching the client’s breathing allows the counselor to create an internal experience of what the client is feeling.
4. Chunk size – If the client discusses specific details or is vague, do the same.
5. Common experience – a shared interest tends to create a feeling of closeness.
4. Assessment Strategies

I use the assessment process to build rapport. My goal is to gain a clear understanding of the client’s perception of the problem at the deepest level by conducting the outcome specifications and logical levels exercises. In addition, I explore the positive intent of the behavior and ask Meta Model questions.

5. Outcome Specification

The process of clarifying goals is referred to as an Outcome Specification in NLP. Knowing exactly what the client wants to achieve helps the counselor identify a purpose-driven course of action. The exercise includes the following nine questions:

1. What do you want?
2. How will you know when you have reached the goal?
3. Where will the goal be relevant and/or irrelevant?
4. What stops you from pursuing the goal wholeheartedly?
5. What personal resources could you use to achieve this goal?
6. What additional resources will you need to achieve the goal?
7. How might the pursuit of the goal affect important people in your life? Is there any risk associated with achieving this goal?
8. What daily actions can you take to achieve your goal? What is the first step?
9. Given everything you have considered to this point, is achieving the goal worth it?

6. Logical Levels

The Logical Levels exercise is a valuable NLP tool for organizing a person’s thinking because it helps the counselor understand what makes the client “tick.” The counselor uses the process to identify difficulties and to help the client understand in a clear and structured manner where he or she is stuck. The highest level is identity and the lowest level is environment; each level builds on the previous levels. NLP table

7. Positive Intention

A common NLP belief is that every behavior has a positive intention. Truly understanding and applying this principle can bring about a powerful change in a client’s thinking. For example, the positive intent behind aggressiveness may be protection or the positive intent behind fear may be safety.

8. Meta Model Questions

“John Grinder and Richard Bandler developed the Meta Model by modeling two very successful therapists, Fritz Perls and Virginia Satir, and Perls and Satir, got extraordinary results from their clients by having them be more specific in what they expressed. By using certain types of questions to gather information and gain understanding of the client’s deep structure. Grinder and Bandler observed that in moving from the deep structure to the surface structure, people unconsciously do the following:

  • Delete – Presenting only some of the information available at the deep structure.
  • Generalize – Making general statements about what is believed, how others are seen, and one’s values. People tend to ignore possible exceptions or special conditions.
  • Distort: – Choosing to over-simplify or fantasize about what is possible or what has happened” (http://www.renewal.ca/nlp24.htm).

So, during the assessment process, I ask specific questions.

Hypothetical Case of Man Addicted to Weed

Demetri is a 27-year-old man who made an appointment with me because his wife threatened to take the children and leave unless he does something about his heavy pot smoking. She was very concerned, because he recently lost his job for being stoned at work and because her father, who was a heavy smoker, died of lung cancer. Demetri admits to daily pot smoking. He says he can’t get through his depressing work and his frustrating life without help. He is very clear that he doesn’t want to be meeting and is keeping the appointment only because of his wife’s threat.

Demetri mentioned that he watched his friends smoke, saw himself relaxed after he smoked, and read about medical marijuana being helpful. His predicate phrases led me to consider that his primary representational system was visual; so, I watched his eye movements to see if they supported my assessment – and they did. His eyes looked up to the left and right, which indicated he was visual, but he also looked down and to his left which indicated he was talking to himself in his own voice. So, I asked questions such as, “Do you see yourself as stopping?” and, “Have you read about any side effects of smoking pot?” (eg. becoming dependent on marijuana)

Demetri slouched in his chair, his voice was soft and he spoke slowly; so, I slouched in my chair, and spoke softly and slowly. We both liked to play golf; so, we talked easily. He reluctantly agreed to discuss the reason for the appointment and to participate in the assessment exercises. I confirmed that rapport was established by sitting up in my chair and leaning forward; which he also did. However, I plan to continually monitor our rapport in case something occurs during a session that might upset it.

Demetri’s Responses to the Outcome Specification Exercise

1. He wants his wife and kids to stay.
2. He will know he’s reached his goal when his wife sleeps in their bed, again.
3. His goal is relevant in his life and for his family.
4. Weed is the only way he can manage his depression and frustration and it is a way for him to ‘hang’ with friends.
5. He stopped smoking cigarettes; so, he can quit smoking pot, but he doesn’t want to quit.
6. Additional resources he would need include having a detox plan, learning new coping mechanisms, and finding effective ways to relax.
7. His wife would be very happy, but his smoking friends would miss him.
8. He could smoke less each day, he could seek help, and he could find other ways to relax. His first step was to keep this appointment.
9. He guesses the goal is worth achieving because he really loves his wife and doesn’t want to lose his family, but he remains reluctant.

In response to the Logical Level questions, Demetri provided the following answers:

Demetri’s Responses to the Logical Levels Exercise – the problem behavior is heavy pot smoking

1. Environment –He smokes in his car before going to work in the morning and before he goes home after work. He doesn’t want his wife or the kids to see him and he doesn’t want any paraphernalia or pot in the house.
2. Behavior – He inhales pot from a bong at least twice daily.
3. Capabilities – His friend supplies him with pot at a cheap price. He never smokes in the house, so his kids don’t know. He can stop if he wants to stop.
4. Beliefs – His beliefs included “I’m not hurting anyone,” “My wife should understand the pressure I am under, but she thinks I’m a loser.” “I never cheat on her and I am a good father.”
5. Identity – I am a loving husband and father who smokes weed to manage life.

One option was to intervene at the Environment Level and to suggest Demetri spend less time with his friends or remove the pot and paraphernalia from his car. Instead, I chose to focus on the Belief Level and his words “I am not hurting anyone,” and by intervening at this Level, the other Levels may change as well.

During the assessment processes, I asked Meta model questions. For example:

  • Demetri said, “My wife should understand the pressure I am under.”
  • I asked, “Have you talked with her about the pressure?”
  • Demetri said, “I’m not hurting anyone.”
  • I asked, “According to who – and the answer cannot be you?”
  • Demetri said, “I can afford the weed.”
  • I asked, “How much money do you think you spend on weed per month?” and “When is the last time you took your wife out on a date?”
  • Demetri said, “She thinks I’m a loser.”
  • I asked, “How do you know that?”

Finally, I asked Demetri about the Positive Intent of the pot smoking. He surprised both of us by saying that it was to get away from his life which “sucked.” This led us to redo the Outcome Specification exercise to focus on the goal of finding joy in life.

Now we had a place to begin.

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About Dr. Janice Walton, PhD

Dr. Walton has a doctorate in Psychology and is a licensed Marriage Family Therapist. After following traditional counseling approaches for years, she became interested in neurolinguistic programming and how those techniques can be used with individuals whose lives are affected by addiction. To this end, she joined the staff of the iNLP Center and has recently developed a course for professionals entitled "NLP for Addictions". All courses offered by the Center can be viewed at: http://inlpcenter.org/; the link to Dr. Walton's website is: http://www.tlcorner.com/.

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