Let's just talk here at the beginning about doing things differently. How about this -- are you right-handed?
Gina: No, I'm left-handed, why?
Therapist: What if I asked you to start brushing your teeth with your right hand. Tonight, after your dinner, use your right hand.
Gina: Okay but that will seem weird and I might not be very good.
Therapist: Once you do it for a while, how would that seem to you? For example, your next appointment is in a week, that will give you 7 days to practice. How would that work for you?
Gina: I believe it would begin to seem fairly routine if I did it long enough.
Therapist: And seeing how this change could be possible could lead to other changes in your life. Are you ready here today to open the door to changes?
Gina: And what is your part in this? How do you work with me, a heavy drinker who admits to her problem but can't give up my drinks?
Therapist: Remember Gina, there are two experts in this room. I am trained and I have expertise in terms of helping people with their problems. And you are an expert on your life and you have expertise on exactly why you drink too much and why you came to me for help in cutting back. Right?
Gina: Right.
Therapist: Think of us in this room as collaborators on an important project. I'm an architect and I want to build a beautiful house by a river, but I don't know anything about geology and I don't know how to properly site buildings. You are the surveyor, and you can help make the house safe from floods and from poor soil by helping us situate that house in exactly the right place.
Improvement in Skills and Coping Strategies
Clearly in the interview with Gina one could detect that she was depressed, as the session wore on she rationalized away her suspension and admitted she felt "hopeless" and "helpless" and that a good stiff drink took all her worries away. Meanwhile, Albert Roberts explains that a person like Gina is in fact feeling helpless and hopeless because of "…cognitive distortions or misperceptions. These distortions provide an inaccurate basis for beliefs and accompanying behaviors… [and] distortions highlighting negative self-worth, inadequacy, and doom provide powerful fodder for depression, inactivity, learned helplessness, and disempowerment" (Roberts, 1995, 202).
Professor of Counseling Richard James warns that there is no "panaceas or quick fixes"...
"Many problems of clients in severe crisis stem from the fact that the clients sought quick fixes in the first place," James writes (James, 2008, 4). The quick fix that James mentions is a "pill" but in Gina's case the quick fix was the bottle. Hence, the crisis for Gina has deepened. But the fact that she has a self-awareness of her flaws and her problem opens the door for some self-reflection.
Conclusion
A competent, creative therapist should be able to bring Gina to a point where she understands that doing things differently can work for her. There is no point in lecturing Gina about her drinking problem. And the 12-step program offered by Alcoholics Anonymous is an option that is out there as well. The approach to an individual like Gina is to empathize -- showing true empathic understanding, not sympathy -- and become a very skilled listener. If she sense that instead of listening to her the therapist is thinking about the next thing he will say, this therapy will not work. But sincerity, professionalism, and research into her deeper issues (by making her the surveyor and keeping the collaboration on equal footing) can help her make the changes she needs to make to get her job back and continue the productive aspects of her life.
Bibliography
Beckham, Nancy. 2001. Natural Therapies for Menopause. McGraw-Hill Professional: New York.
Bracewell Catherine, Gray Rosaire, Rai, Gurcharan S. Essential Facts in Geriatric Medicine. Milton Keynes: MK7.
James, Richard K. 2008. Crisis Intervention Strategies. Cengage Learning: Independence, KY.
Roberts, Albert R. 1995. Crisis Intervention and Time-Limited Cognitive Treatment. SAGE: Irvine, CA.
Rygh, Jayne L., and Sanderson, William C. 2004. Treating Generalized Anxiety Disorder: Evidence-Based Strategies, Tools, and Techniques. New York: Guilford Press.
Stotland, Nada L. 2005. 'The Contexts of Midlife in Women,' in Menopause: A Mental Health Practitioner's Guide. Arlington, VA: American Psychiatric Publication.
Mansell, Warren, Stott, Richard, Salkovskis, Paul, and Lavender, Anna. 2010. Oxford Guide to Metaphors in CBT: Building Cognitive Bridges. Oxford University Press: New York.
Vaillant, George E. 1995. The Natural History of Alcoholism Revisited. Harvard University Press: Cambridge, MA.
