The most important lesson when working with complex dual disorders clients is to keep things simple. The rule: The more complicated the patient, the simpler and more basic the change plan.
We in the counseling field have a tendency to respond to complexity with more complexity. Of course, that often just further complicates things.
Any program of change is effective only to the extent that the patient is able to successfully implement it. To help with motivation, we take pains to make certain that he or she understands the ‘because’ behind the various elements of recovery. As in ‘I need to go to this meeting because…” or “I have to remember to take this medication because…” It’s important for the patient to have ready answers to such questions — without them, it’s difficult to motivate oneself over time.
And of course, we have to assist the patient in identifying the resources— internal and external– to stick with it in adversity. That’s often a challenge with debilitated clients. Not an insurmountable one, however.
We refer to ‘tasks’ to complete rather than goals or objectives to achieve, because a task is inherently based in action. You succeed through the doing, not the achieving. That’s important to folks who face significant barriers. For them, progress is the measuring stick. You want your patient to know the joy of a structured, purposeful life.
In task-oriented approaches, the emphasis is on what the patient is doing, not the therapist. That’s a partial safeguard against fostering unhealthy dependency. We don’t want to be like Whoopi Goldberg’s old welfare caseworker story, who gushed to Whoopi that she “always knew you’d get on your feet someday.” Whoopi was thinking: “I’d have got up sooner if you’d taken your foot off my neck.”
We’ve come to believe that all successful life changes are made a day at a time (or in some cases, less.) Start by encouraging your patient to accomplish one thing above all others, for that day. That’s to make sure it doesn’t get lost among the inevitable distractions.
You can download a brief workbook here. It was developed based on some of our work, for use at a program with emotionally ill patients in a short-term residential setting.
