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Prejudice and addiction in treatment settings: How can clinicians face personal bias?

Strategies for Counselors: How to Identify and Address Personal Biases Regarding Addiction

We know that unconscious biases and prejudices affect all relationships, whether the relationship is a passing conversation at the super market or a counseling session with a client.

In this article, I focus on a counselor’s possible biases and prejudices regarding addiction. These biases and prejudices can be unconscious and unintended but they still impact the counseling session. Then, I suggest four ways to identify and decrease such biases and prejudices. Specifically, the four ways are:

1. Self-analysis
2. Knowledge of myths and misinformation regarding addiction
3. NLP Assumptions
4. NLP Strategies

Finally, we invite your questions or comments about bias and prejudice at the end.

What can influence counseling for addiction?

Many factors influence a counseling session. For instance, although not necessarily the traditional way of thinking, I believe a counseling session is influenced by three factors:

a) the provider’s theoretical orientation, experience, and current condition
b) the client’s presenting problem, current condition, and beliefs, and
c) the counseling environment

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Each factor contributes to the outcome of a session. To place this theory into a context, think about the following scenarios:

  • The NLP trained counselor believes there is a positive intent to a client’s addiction. At the moment, the counselor’s migraine headache has lasted for three days, so her concentration is less sharp than usual.
  • The client has an appointment with the counselor to discuss his growing internet addiction. Unfortunately, he had a fight with his partner earlier in the day which is still on his mind and is causing him to be less engaged in the conversation.
  • The counseling room is comfortable but the walls are thin. The client knows people in the waiting room can and do listen to what is being said. So, he is concerned about expressing his feelings.

Each factor plays a role in the session and must be considered rather than focusing solely on the client’s presenting problem. So, how can we start to tackle any unconscious or hidden bias and help clients get to the root of a problem involving substance use?

Let’s begin by reviewing a set of self-analysis questions.

1. Self-Analysis Questions: Understanding your own beliefs
A counselor’s beliefs impact his or her assessment and treatment approach. The counselor who adheres to the medical model will focus on a problem within a client needing to be assessed, treated, and cured. The counselor with a more holistic view will examine the role that factors such as perception and the environment play in the problem. Questions to ponder regarding beliefs about addiction include the following:

  • Is harm-reduction a credible option?
  • Is Alcoholics Anonymous (A.A.) the only effective approach?
  • Is addiction a disease or a strongly held habit?
  • What role does pharmacology play?
  • Should a treatment plan be individualized?
  • Will a three-month in patient treatment program “cure” the addiction?
  • Do different addictions call for different treatment plans?
  • What definition of addiction makes the most sense?
  • Do life experiences play a role?
  • Are gambling and pornography considered process addictions?
  • Is it possible for counselors to keep their values out of a session?
  • When is it appropriate to disclose personal values to a client?

A counselor’s responses to those questions set the foundation for his or her approach with a client.

2. Addressing Myths and Misinformation about addiction

A second area to consider is the prevailing myths and misinformation regarding addictions which are often accepted as true. I listed five myths and five rebuttals below; however there are numerous others.

…………………..MYTH 1: There is an addiction gene – No single gene, or set of genes, determine whether or not a person becomes an addict. Current research shows roughly 50% of addiction tendencies are attributable to genes.

…………………..MYTH 2: Marijuana is a “’gateway drug” – The addiction rate for marijuana is lower than that of alcohol. There is little scientific evidence to show marijuana acts as a trigger for harder drugs.

…………………..MYTH 3: Addiction is for life – According to the National Institute on Alcoholism and Alcohol Abuse, 75% of alcoholics recover without treatment. It is also known that vets, addicted to drugs or alcohol during deployment, stop using once they returned home.

………………….MYTH 4: Drugs “fry” your brain – While drug abuse can be bad for the brain, to say it generally causes permanent and severe brain damage is an oversimplification. Permanent or severe brain damage depends on a variety of factors.

…………………MYTH 5: You have to hit “rock bottom” – There is little evidence that the level of consequences a person accumulates before seeking help is related to his or her chances of succeeding in recovery. It’s better to get help early than to hold out for the perfect desperate moment. (Taken from http://www.cnn.com/2012/09/13/health/jaffe-addiction-myths/index.html).

I originally believed in those myths but have since changed my position. My new thinking allows me to work with clients differently.

3. NLP Assumptions can change the way you view addiction
As a review, Neurolinguistic Programming examines the fundamental dynamics between the thinking processes (neuro) and the words we use (linguistic) as well as how their interaction affects behavior (programming).

NLP targets how people

  • communicate externally and internally
  • process, store, and recall information
  • alter their communication to achieve the results and goals they want

Practitioners believe human beings have an extraordinary capacity for flexibility and there is nothing that happens mentally or spiritually they cannot learn to handle. So, the focus is on how a person formulates thoughts and beliefs – those which maintain the use and those which help affect and maintain change. As you can see, the focus of counseling is different than when using the traditional approach.

Addiction counselors trained in NLP are well-versed on the topic of change. The following assumptions are the foundation for work with a client.

  1. Communication is more than what you are saying.
  2. No one is wrong or broken. People work perfectly to accomplish what they are currently accomplishing.
  3. People already have all the resources they need.
  4. Behind every behavior is a positive intention.
  5. Every behavior is useful in some context.
  6. The meaning of a communication is the response you get.
  7. If you aren’t getting the response you want, try something different.
  8. There is no such thing as failure. There is only feedback.
  9. Having choice is better than having no choice at all.
  10. In any system, the element with the most flexibility exerts the most influence.
  11. The map is not the territory.
  12. If someone can do something, anyone can learn it.
  13. You cannot fail to communicate.

What a difference it makes when an Addictions Counselor adheres to those assumptions, rather than assuming the client had a life-long disease and is always recovering.

4. Using NLP Strategies to identify your own prejudice
Certain NLP Strategies can help identify prejudices and biases. The four strategies I discuss are: Perceptual Positions, Mind Cleanse, Meta Model questions, and Presuppositions.

……..4.1. Perceptual Positions
One strategy to consider is the Perceptual Positions that surround an issue between two people. The first position represents an individual’s point of view, the second position represents the other person’s point of view, and the third position views both positions from a distance. Each position has individual goals, opinions, and beliefs.
………4.2. Mind Cleanse
For centuries, pictorial methods for recording knowledge and modeling systems have been used for learning, brainstorming, memory, visual thinking, and problem solving. I envision a counselor using a pictorial method, like the Mind Cleanse, to identify negative thinking and to replace the negative thinking with positive thinking.
………4.3. Meta Model Questions
Meta Model questions help identify and transform problematic vagueness in a person’s thinking.

Presuppositions

Presuppositions refer to information assumed to be true for a statement or question to make sense.

Hypothetical Case Presentation of a Counselor Identifying Her Biases

Sarah is a newly licensed substance abuse counselor with NLP training. In an effort to do her best with clients; she decides to explore her biases and prejudices. She bases her thinking on the NLP assumptions, knows the myths and misinformation regarding addiction, and decides to work through the four strategies previously mentioned.

Sarah found the Perceptual Positions exercise easy to complete. She talked to several “recovering” addicts and was able to understand their drug use in relationship to her love for all things sugar. From a more neutral, third person position, she was also able to see both points of view, hers as a counselor and those of the addicted person.
To begin the Mind Cleanse, Sarah wrote the word “Addicts” on a blank piece of paper and recorded the following thoughts:

  • Addicts are hard to treat.
  • An addict will resist my approach.
  • An addict can’t be cured.
    He or she will frustrate me.
  • I won’t be able to help a person addicted to meth.
  • Clients with addictions can fool me.
  • I won’t be able to tell if a client is lying to me.
  • A person should be able to control himself.

After Sarah completed the list, she focused on her breathing and allowed her mind to settle.

The final step in the process was for Sarah to write the word “Addicts” on a second sheet of paper and record her thoughts. Surprisingly, her thoughts were quite different. They included:

  • I am a confident person.
  • I was effective with my clients during the internship. Several of them told me how much I helped them.
  • I need to have a more open mind.
  • My supervisor at the agency promised to mentor me.
  • I earned straight A’s in my courses.
  • I have been told I am a good listener.
  • Overcoming addiction is a process and everyone goes through the process differently.

The new list lessened her doubts and concerns in regard to counseling clients.

Meta Model Questions –

In looking at the nine Meta model “distinctions,” Sarah found she used four distinctions:

  1. Modal operators of judgment and necessity: how a person should or must be.
  2. Mind-reading: she knows what a client is thinking.
  3. Generalizations: if one addict is manipulative, all addicts will be manipulative.
  4. Cause and effect: because a client’s mother drank, so will the client.

Sarah used the Meta Model questions to challenge her ineffective thoughts. The questions she asked herself were as follows:

……….1. Modal Operators
……………..SARAH – He should be able to control himself.
……………..META QUESTION – According to who? or What would happen if he didn’t control himself?

………..2. Generalizations
………………SARAH – If one addict is manipulative, all addicts are manipulative.
………………META QUESTION: All addicts?

………..3. Cause and Effect
……………….SARAH – Because a client’s mother drank, so will the client.
……………….META QUESTION: How did the client’s mother’s drinking cause him or her to drink?

…………4. Mind Reading
………………..SARAH: I know she is angry with what I said.
………………..META QUESTION: How do you know that? or Are you sure?

Presuppositions

Sarah reviewed the circumstances she assumed to be true when making statements to the client. If her statement to the client was “We will review the homework assignment when you come to the next session,” her presuppositions included:

a. The client would come to the next session.
b. The client heard the homework assignment.
c. The client would do the homework.
d. There would be a next session.

In identifying the presuppositions, Sarah was able to clarify her message to the client and make a statement which implied certain criteria would occur: the client would keep the session, the client understood there was a homework assignment, and the client would do the homework assignment.

These strategies can help you assess and address your own prejudice!

Unidentified biases and prejudices can play a major role in both the counseling session and the counseling relationship. For that reason, I have suggested several strategies which may be useful for counselors to use in recognizing and reducing potential prejudices and biases. Those strategies included: self-analysis, myth examination, knowledge of NLP assumptions, and four additional NLP strategies.

Please leave your questions or comments in the section below. We’ll do our best to respond to you personally and promptly!

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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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