Introduction
The present report presents a description of three individual counseling sessions. The client is Sam, who is 37 years old, single, with no children, unemployed, and homeless. Sam has been homeless for several months due to his loss of employment last year. Sam’s major health problem (and the reason for job-related issues) is his addiction to cocaine. The client stated that his addiction had started with the abuse of prescribed opioids in his mid-20s. The man is taking part in a program for addicts and has finished detoxication recently. He is receiving pharmacological treatment, but the client is also willing to have a counselor’s support. He has a history of addiction treatment but relapsed twice, so although he is determined to be drug free, he still expresses doubts and concerns regarding treatment outcomes. Sam stresses that his “overwhelming homelessness” makes his cravings for cocaine “stronger each day,” so he is afraid of “another relapse that can become the last one” (Sam, personal communication, June 4, 2020). During the first session, short- and long-term treatment goals were discussed and established.
Short- and Long-Term Treatment Goals
The short-term goals were formulated in the following way:
- Identify triggers of cravings;
- Describe things, ideas, concepts, events making the client feel happy and satisfied;
- Develop a plan for a lifestyle change;
- Create a plan for resisting Sam’s cravings.
The following long-term goals were also established:
- Set a drug-free lifestyle;
- Create the pattern of potential relapse and a plan to prevent it;
- Land a good job;
- Reestablish the relationship with a relative living in the suburbs.
Theoretical Framework
The theoretical framework that guided the work during the counseling process was social cognitive theory (SCT). This theory has been found effective in explaining and addressing risk behaviors, including addiction (Eslami et al., 2018). According to SCT, social support, motivation, self-efficacy, and outcome expectations predict individuals’ behavior. Self-efficacy is specifically relevant in treating addiction, and it can be referred to as “the confidence to resist substance use across different high-risk situations” (Eslami et al., 2018, p. 1). As for outcome expectations, this aspect is associated with a person’s belief that a specific behavioral pattern leads to particular results. Perceived social support is an important predictor of effective abstinence. Therefore, the involvement of close ones is often an integral element of treatment. At that, motivation remains the central factor affecting the outcomes of treatment, so it is critical to ensure the client’s high motivation during counseling.
Specific Techniques
Cognitive Behavior Therapy
Various techniques can be utilized to assist people with addiction, and cognitive behavior therapy (CBT) is seen as one of the most efficient methods (Decker et al., 2016). Two major components of such treatment are the client’s cognitive and behavioral changes. During the first session, Sam told his story and was encouraged to identify the goals to be attained. As mentioned above, he found homelessness and addiction to be the primary challenges he could hardly “fix without professional assistance” (Sam, personal communication, June 4, 2020). He seemed highly motivated, which was an important premise for the positive outcomes of the treatment. The client also tried to examine the nature of his cravings and associated triggers. Clearly, the thoughts of his social status made Sam willing to “be high all the time” although he understood that “that was a road to nowhere” (Sam, personal communication, June 4, 2020). The client’s understanding of the negative influence of certain behaviors is critical for the healing process.
Addressing Long-Term Goals
In order to identify the potential source of social support, Sam was asked to draw a genogram. It turned out that Sam had very loose ties with his foster family and the relatives who lived in another state. The only person who could help and actually expressed his readiness to assist was Sam’s cousin, who used to have a similar problem. Sam’s homework was to contact this person and discuss possible interaction. The problem related to this task consisted in rather complex relationships with that person. Sam had a serious fight with his cousin years ago and was reluctant to contact him due to some biases. It has been acknowledged that homework and the client’s consistency are strong predictors of positive outcomes of the treatment (Decker et al., 2016). Sam reported that first it was “hard to keep the conversation going,” but Pete, Sam’s cousin, offered help at the end (Sam, personal communication, June 11, 2020). Sam was doubtful as to accepting this offer since he was afraid to “let everyone down again” (Sam, personal communication, June 11, 2020). The client understood that this was an appropriate option, and specific communication patterns were discussed.
Role-play is a common technique used in psychotherapy that can help in reaching diverse goals and shape clients’ behavior (Sperber & Lowenkamp, 2017). This method was also effective in Sam’s case as the client developed some communication skills and became more confident. During the second session, Sam was more motivated to try role-playing again. Sam was also unsure whether he could and should accept the invitation. On the one hand, he had food and shelter provided in diverse centers for the homeless, so he did not have to change his lifestyle so dramatically. On the other hand, such a generous offer could become the first step in attaining the goals related to employment. Mennemeyer et al. (2017) claim that contingency management strategies have proved to be effective as the majority of patients remain abstinent for longer periods. Pete’s assistance became a form of voluntary contingency management strategy for Sam, who agreed to live with his cousin in another town. Sam was to help Pete with his farm, which was critical for addressing employment and housing issues for a certain period of time.
During the second session, Sam was encouraged to develop scenarios of his possible relapse. The client found excessive free time to be hazardous as he could focus on the issues in his life and even suicidal ideation. As an effective strategy to address this threat, Sam was determined to work hard on Pete’s farm and try to develop proper relationships with his cousin. Another relapse possibility stemmed from possible problems that could occur during Sam’s life on Pete’s farm. The client stressed, “my temper is well-known… Pete may kick me out the same day” (Sam, personal communication, June 11, 2020). Therefore, Sam created a number of behavioral patterns he had to adhere to when living in Pete’s house. The client reflected on his previous interactions with Pete that were more often in their adolescence. He determined behaviors that seemed appropriate and the conduct that had to be avoided.
Addressing Short-Term Goals
As mentioned above, Sam established short-term goals during the first session, and he discussed attaining them during the three sessions. The major focus was on Sam’s cravings and ways to respond to them. The client described ideas and events that have led and could result in using substances. It turned out that several people had a negative impact on Sam and could trigger his use of drugs. In order to avoid this kind of threat, Sam was determined to stop interactions with those people. The thoughts regarding Sam’s previous and possible employment appeared to be another potent trigger. Sam loved his job, but a series of dismissals due to substance use made his future employment “absolutely impossible” (Sam, personal communication, June 4, 2020). Sam was encouraged to concentrate on opportunities (ways to gain employment) rather than his previous and potential failures.
When discussing the things that made Sam feel satisfied, it turned out that physical activities, including hard work, often distracted Sam from thinking about drugs. Sam recollected that after detoxication, he “could make some bucks” but used his “hands rather than head” (Sam, personal communication, June 4, 2020). The client referred to that experience as “pleasing and satisfying,” which made it obvious that Pete’s offer was “a chance not to be wasted” (Sam, personal communication, June 4, 2020). Hence, physical activity was one of the methods to respond to cravings in Sam’s plan. Web-based self-help groups and counseling chats have proved to be effective, so this strategy was also on Sam’s plan (Schaub et al., 2019). Seeking help and being distracted by chatting or online conversations seemed an effective strategy for Sam.
During the third session, the client created a plan for behavioral change. The plan included his work on his cousin’s farm. Sam was also determined to “work out every day” (Sam, personal communication, June 18, 2020). He wanted to start a hobby but was still unsure what exactly to choose. Sam was also doubtful about a hobby as he thought he would have no free time on the farm.
Progress and Challenges
The three sessions can be regarded as effective as the progress is apparent. The client who had an opportunity to change his life did not use that opportunity and could have missed the chance this time as well. The client’s communication skills improved considerably, which had a positive effect on his interactions with his cousin. The two men had similar grounds related to their past substance abuse experience, and those common grounds could help Sam in starting a new life. At that, the timespan was limited, so the actual progress cannot be estimated so far.
It is also important to mention some challenges that can undermine the positive changes that have taken place. The current economic situation in the country results in a decrease in financing diverse projects aimed at helping addicted people. The fact that Sam has a cousin ready to help is a valuable chance, but the two man’s relationships can deteriorate, which can lead to negative consequences.
Conclusion
On balance, it is necessary to note that the client benefited from his participation in the three sessions. He improved some skills and developed sound plans that outlined major paths to follow. Sam is determined to change his life and is ready to move to another place that is very different from this city. However, the history of his past relapses and upcoming financial issues can hinder these positive shifts. Therefore, it can be necessary to continue supporting the client with the help of web-based tools. This close support may be needed during the first two months, and a gradual shift to self-care and the utilization of other types of assistance (support groups, for example) will take place. These sessions show the relevance of social bonds, although it is also clear that having relatives ready to be engaged to such an extent is rather rare.
References
Decker, S. E., Kiluk, B. D., Frankforter, T., Babuscio, T., Nich, C., & Carroll, K. M. (2016). Just showing up is not enough: Homework adherence and outcome in cognitive–behavioral therapy for cocaine dependence. Journal of Consulting and Clinical Psychology, 84(10), 907-912. Web.
Eslami, A. A., Norozi, E., Hajihosseini, M., Ramazani, A. A., & Miri, M. R. (2018). Social cognitive theory as a theoretical framework to predict sustained abstinence 6 months after substance use treatment. Journal of Substance Use, 23(3), 300-306. Web.
Mennemeyer S. T., Schumacher J. E., Milby J. B., Wallace D. (2017). Costs and effectiveness of treating homeless persons with cocaine addiction with alternative contingency management strategies. The Journal of Mental Health Policy and Economics, 20(1), 21-36.
Schaub, M. P., Castro, R. P., Wenger, A., Baumgartner, C., Stark, L., Ebert, D. D., Quednow, B. B., & Hauga, S. (2019). Web-based self-help with and without chat counseling to reduce cocaine use in cocaine misusers: Results of a three-arm randomized controlled trial. Internet Interventions, 17, 1-12. Web.
Sperber, K. G., & Lowenkamp, C. T. (2017). Dosage is more than just counting program hours: The importance of role-playing in treatment outcomes. Journal of Offender Rehabilitation, 56(7), 433-451. Web.