Therapist Unlimited Blog

A Brief Review of Effective Behavioral Therapy and a Synopsis of the
‘I-SOAR’ program as developed by Wellspring Behavioral Health

Seth W. Wallace, Ph.D., M.S., LPC
Clinical Director of Wellspring Behavioral Health
39 Mill Street Berlin, CT 06037
Phone: 860-829-8963

What is Behavioral Therapy?

Behavioral treatment for addiction should not be conceptualized as a punishment or an activity that must be endured. It should be conceptualized as an opportunity to learn more about the process of addiction. It is a manner through which many people have discovered positive and productive coping skills that have enabled practical and emotional success. Behavioral therapy conducted on an individual basis for those struggling with painful emotional concerns is a dynamic process that comprises fluid ‘in the moment’ responsiveness and a thoughtful, jointly determined course of action between a client and therapist. During that process the feelings clients and counselors may experience for both life and each other may ebb and flow. But as surely as fresh tides roll in and cleanse Sunday afternoon beaches strewn with human debris, determined clients and counselors can work together to create waves of new perspectives capable of cleansing minds littered with even the most negative and unproductive thinking.

In addition to 1:1 counseling, effective treatment for addiction is frequently conducted in groups. In group settings a safe environment of a) understanding peers, and b) dynamic and process oriented ‘here and now’ interventions are mixed with a measured balance of thoughtful and methodical planning and deliberation. Clients are encouraged to set personal agendas but many request help accessing and expressing their feelings and beliefs. Sometimes this results in practical and specific questions regarding addiction, relationships and so on. At other times the group is asked to respond with their own reactions to remarks made by other group members. In this way, the group is taught how to help one another by engaging in meaningful discussion. The art of assertive (neither too aggressive nor too passive) interaction is modeled and taught; especially at crucial moments when other members are asked to ‘hear’ and internalize often provocative information. The longer a group can stay together and get to know one another, the more honest, accurate and effective their confrontations and remarks become. Therefore, in sum, the groups are both didactic and process oriented.

Why do People Become Addicted

Most people become addicted to drugs or alcohol because of a genetic propensity (sometimes called a stress/diathesis model) and a concurrent emotional developmental delay often caused by neglect, abuse, and/or some other form of trauma when young. This developmental delay usually results in impulsivity, a difficultly adequately regulating emotions, a history of troublesome interpersonal relationships, employment difficulties, and often, antisocial thoughts and behavior. Other clients succumb to addiction as a result of extended experimentation and a concurrent availability of the substance.

Effective Use of Multiple Counseling Techniques

Counselors at Wellspring Behavioral Health (WBH) implement a variety of effective counseling techniques. Client need determines what particular therapeutic counseling style is engaged at any given point during the treatment process. Our effective strategies stem from numerous methods of well researched models of thought. For example, I often conceptualize clients using a psychodynamic oriented Object Relational (OR) approach because this is an appropriate model to implement with clients wishing to explore the genesis of their feeling states and the manner in which early relationships may affect their adult interactions and behavior. However, I often alter my initial conceptualization and turn to other techniques when necessary. Cognitive-Behavioral Therapy (CBT) is another very useful approach that requires clients to analyze the rationality vs. irrationality of their initial thoughts and feelings in an attempt to assess how realistic their thinking really is. In still other instances Family Systems approaches are engaged; especially when helping families discuss and delineate common family dynamics that may include alliances, triangulation, enmeshment and detachment. Spiritual conceptualizations and interventions can also be invaluable for those with amenable value systems. Many clients who are early in recovery gravitate toward Christian/Spiritual Counseling because of its clearly outlined and easy to understand processes. Other theories such as Social Learning Theory, Behaviorism, and Existential therapeutic models of treatment are engaged when necessary and appropriate. However, in many cases, we engage several of these theories simultaneously. This eclectic therapeutic style is appealing to most clients because they are greeted and worked with in a style (or styles) they are comfortable with. This is a central appeal to WBH.

In short, all of these therapeutic methods can be salient and effective in producing behavioral change when used in conjunction with good timing and appropriate individual or group session facilitation. In the early stages of the process it is critical to infuse clients with a sense of pride in their recovery efforts while concurrently framing guilt as an often unproductive and dangerous mindset. It often helps to illustrate the difference between responsibility and accountability during this process.

Summary

In short, behavioral counseling for those struggling with painful emotional concerns is a dynamic process comprised of fluid ‘in the moment’ responsiveness combined with a thoughtful, jointly determined course of action/care. During that process the feelings clients and counselors may experience for both life and each other may ebb and flow. But determined clients and counselors can work together to create waves of new thought bursting with fresh perspectives and processes capable of cleansing minds littered with even the most maladaptive and negative of thoughts. If clients and counselors work hard enough, a new path can be created; one leading to a Wellspring of health and peace.

Individualized System of Opiate Addiction Recovery
(I-SOAR)

Wellspring has developed a comprehensive system for opiate addiction recovery we believe is far superior to most models of treatment currently being implemented throughout the country. In addition to standard individual and group counseling that includes psycho-education, substance abuse education and relapse prevention, we have devised a system we believe gives our clients a much better chance at success both during and following direct treatment. As many professionals know, the success rate for remediating chronic substance abuser behavior is abysmally low. With the method of care we now implement however, we believe we can significantly increase success rates (operationally defined as abstinence on a consistent basis for over a year).

The I-SOAR program addresses the needs of addicts in new ways. As noted, we use an Integrationist model of psychotherapy as delineated above. However, counseling is but a small part of our overall treatment protocol. We appeal not merely to the conscious and unconscious mind of the addict but we also attempt to address the often ignored biological and practical needs of addicts. We attempt to help addicts: a) legally and safely satiate their desire for high risk behavior (we encourage the development of hobbies; whether they be stock car racing, ballooning, or parachute diving), b) we implement a significant and long lasting ‘therapist as mentor’ component (to address relational deficits), c) we offer practical guidance in the form of career counseling (covering the gambit from temperament and skill surveys to help preparing for job interviews), d)we encourage and manage exercise regimens (this includes personal training), e) we offer therapeutic recreation (kickball, handball, hiking) and e)we encourage and manage (through consultation) nutritional regimens. In addition, we have also worked in conjunction with hypnotists, trauma specialists, and physicians who prescribe agonist therapy in the form of buprenorphine (Suboxone) to our clients.

We believe our program to be both bold and effective (success rates are above the 80% range based on an extremely low drop out rate, anecdotal reports of continued success after treatment, and randomized drug testing during treatment).

While our success rate has been tremendous to date, we realize the treatment protocol we offer is not without chance or risks. First among these is how to appropriately structure boundaries between the therapist/mentor and client. Certainly when I act as a mentor my boundaries are much more fluid than they might be in a typical counseling situation. However, the very act of getting out of the office and participating in an experiential activity (e.g. gardening, a trip to watch stock car races) is crucial in developing the bonds and trust necessary for the addict to eventually trust me as therapist/mentor. I imagine many therapists may be uncomfortable in this dual role. But from what I can determine thus far, the gains in trust and consequently much more effective therapy are well worth it. Without question the mentor process can be messy and involves both therapist disclosure and therapist humility. But it is in this act of showing a common human bond that therapeutic movement appears to originate. It is important to note, however, that this mentor component must be implemented with same-sex clients and therapists. The opportunities for inappropriate interactions as a result of the bonding process seem to outweigh possible gains. Consequently, while we work with females in traditional group and individuals sessions, we have not yet had the opportunity to offer the complete I-SOAR benefits to a female.
In addition to the boundary issue, much care must be put into forming idiosyncratically appropriate treatment plans for each client.

Finally, the therapist/mentor in this treatment model must have an experienced and broad therapeutic background, a willingness to commit to truly living the life suggested to clients in sessions, and the desire to collaborate and seek often intense and frequent supervision.

Because the I-SOAR component to our program remains relatively young, I welcome any comments from peers; whether they are reactions, suggestions, or constructive criticism.

Seth W. Wallace, Ph.D., M.S., LPC
Clinical Director, Wellspring Behavioral Health
39 Mill Street
Berlin, CT 06037
(P) 860-829-8963
(F) 860-829-8965