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Substance Abuse: Growing Beyond 12 Step Program Dependency
10 CEUs Substance Abuse: Growing Beyond 12 Step Program Dependency

Section 4
Resistance Self-Efficacy

CEU Question 4 | CEU Test | Table of Contents | Addictions CEU Courses
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed the internal struggle addicts face as well as the photo technique and the drawn exercise to assist their rational adult voice and feeling child voice to compromise.

On this track we will be discussing overcoming resistance, as well as the Finding the Trouble Spot technique.

As you know from the last track, addicts struggling with internal conflict are often having difficulty coming to terms with their two inner voices, the child voice of their feelings and the adult voice of their logic. To come to a compromise, the adult logical voice needs to be willing to acknowledge the child feeling voice.

I’ve noticed addicts, as you probably have, resist the acknowledgement of their feelings. As you are well aware, resistance often comes when people with addictive personalities attempt to change their behavior. They feel embarrassed, ashamed, unworthy, and fearful regarding acknowledging their feelings. Resistance is built into their subconscious and dependent thought.

Samantha, age 38, was an intelligent, educated, and attractive businesswoman. Once Samantha started to acknowledge her feelings, by stating "I guess that when I have thought about stopping  drinking I feel scared."  I encouraged her to have a dialogue with her feelings. It seemed to work with her to call her feelings her child voice.

Samantha said, "I know when I’m doing something self-destructive, like when I drink and pass out in front of the TV most nights, but I just can’t seem to make myself do what’s right." I suggested to Samantha that she have a conversation with her feeling voice – talk to herself. At first, she resisted, saying, "I couldn’t do that – that’s crazy." However, the following is the dialogue Samantha developed between her rational, logical side and her feeling side.  As you hear the dialogue evaluate if you are currently treating an addicted client that might benefit from the encouragement of a similar dialogue.

Acknowledging the Feeling Voice

-- Logical Samantha stated: Why won’t you do what’s good for you? Why do you drink every night and let yourself pass out on the couch?

-- Feeling Samantha: Why shouldn’t I? It’s more fun than working or doing things that are good for me.

-- Logical Samantha: Wow! I didn’t know you were so angry at me about wanting to have a healthier life. I’m only wanting you to do what’s good for you. I know you can enjoy drinking, but sometimes it’s too much.

-- The Feeling side of Samantha stated: Well, my best friend at work, Karen, drinks and still seems happy. I don’t see why I can’t.

-- Logical Samantha stated: There are other ways you can enjoy yourself. You could go for a walk, for example, or spend time with friends. You don’t have to drink every night. Do you think we could do that?

After thirty minutes of dialogue, Feeling Samantha replied: Yeah, that doesn’t sound too bad. Maybe I could try just one evening of drinking less. I think.

-- Logical Samantha: Gee, that not only sounds like it might work, but like it might be more fun than drinking, passing out in front of the TV every night and waking up with that god-awful headache.

-- Feeling Samantha: Okay, let’s do it, but let’s make it more about fun than about not drinking. I care about feeling good, and if I can feel good without drinking.... That would be great.

Can you see one of your current clients involved in a similar dialogue?  Let’s look at what happened.

In this dialogue, Logical Samantha acknowledged the wants and needs of Feeling Samantha. With your client would it work better for you to use the words logical and feeling, or adult and inner child? Through this acknowledgement, Samantha’s logical side came to a compromise with her feeling side. Her logical side wanted to change her behavior to stop drinking, but the feeling side wanted to enjoy itself and saw drinking as the only option. In the session, her two voices negotiated a compromise that pleased both: not cutting out drinking entirely, was a good first step.

5-Step "Finding the Trouble Spot" Exercise

If you have a client like Samantha, of course, he or she may resist the idea of having a conversation with him or herself. However, one technique I find helpful to overcome this resistance I call "Finding the Trouble Spot." Here’s how the five steps in the "Finding the Trouble Spot" exercise work: Before Samantha had this dialogue with herself, I requested she practice this exercise.

Step #1 - First, I ask Samantha to get comfortable. I allowed her to spend a few minutes focusing on her body. I then ask her to find the place in her body where tension seemed to be most strongly concentrated when she felt the compulsion to drink. For Samantha, it was in her chest. Once she found it, I told her to put awareness on her chest.
Step #2 - Secondly, I had her use imagery to visualize soothing, relaxing warmth surrounding her to ease that discomfort. I then requested her to place her hand over that spot, in her chest.
Step #3 - Third, once Samantha had her hand placed, I told her to simply ask what her body wanted to tell her.
Step #4 - The fourth step is listening. Holding her attention to that spot, she listened to her subconscious. I told Samantha to pay attention to any and all images, ideas, physical sensations, or thoughts that surfaced into her awareness. I find this process usually takes about 10 minutes.
Step #5 - Fifth, I told Samantha to begin a dialogue. I suggested she could offer ideas regarding the concerns raised by her feeling child’s voice, and ask questions. I then suggested Samantha repeat this exercise.

Through the course of several sessions, the more she made contact with her Trouble Spot and listened and created a dialogue with her child voice, the easier Samantha was able to access her inner child feeling voice.

Samantha's Dialogue with her Trouble Spot
Samantha: Why are you so heavy?
Trouble Spot: I’m worried that you will lose your job from drinking so much.
Samantha: Why do you worry about it so much?
Trouble Spot: Because I know that if you lose your job, we won’t have money to buy food and I’m scared of what would happen then.
Samantha: If I decide not to have a drink tonight, will you go away?
Trouble Spot: Yes, if I don’t have to worry so much I’ll be happier.

This exercise helped Samantha learn from her subconscious instead of simply suppressing those feelings that originated there. Can you see how this might help a client with addictive behavior? How might it benefit your Samantha?

On this track we have discussed overcoming resistance, as well as the Finding the Trouble Spot technique.

On the next track, we will discuss the fear of self-awareness and five common myths that addicts believe about expressing feelings.

Peer-Reviewed Journal Article References:
Crano, W. D., Siegel, J. T., Alvaro, E. M., & Patel, N. M. (2007). Overcoming adolescents' resistance to anti-inhalant appeals. Psychology of Addictive Behaviors, 21(4), 516–524.

Donaldson, S. I., Graham, J. W., Piccinin, A. M., & Hansen, W. B. (1995). Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology, 14(4), 291–300. 

Sayette, M. A., Norcross, J. C., & Dimoff, J. D. (2018). Addiction training and multiple treatments for all clinical psychologists: Reply to Freimuth (2018). American Psychologist, 73(5), 695–696.

Schulte, E. M., Sonneville, K. R., & Gearhardt, A. N. (2019). Subjective experiences of highly processed food consumption in individuals with food addiction. Psychology of Addictive Behaviors, 33(2), 144–153.

Shih, R. A., Miles, J. N. V., Tucker, J. S., Zhou, A. J., & D'Amico, E. J. (2012). Racial/ethnic differences in the influence of cultural values, alcohol resistance self-efficacy, and alcohol expectancies on risk for alcohol initiation. Psychology of Addictive Behaviors, 26(3), 460–470.

Stolzenburg, S., Tessmer, C., Corrigan, P. W., Böttge, M., Freitag, S., Schäfer, I., Freyberger, H. J., & Schomerus, G. (2018). Childhood trauma and self-stigma of alcohol dependence: Applying the progressive model of self-stigma. Stigma and Health, 3(4), 417–423. 

Online Continuing Education QUESTION 4
When do clients with addictive personalities encounter resistance? To select and enter your answer go to CEU Test.

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