We shortchange our clients when we confuse their readiness for discharge with their ability to follow program rules. Training through behavior modification in a treatment setting does not always translate well into the real world. Serious problems with addiction are impossible to solve with single-event interventions-even if the intervention comes in the form of a long-term residential program.
Teaching self-advocacy involves preparing our clients to set their own goals and meet their own needs. It encourages self-efficacy by allowing many opportunities for making choices during treatment. The primary goal is to promote personal growth to the point where our clients no longer need us.
Some clients might interpret this idea as rejection, and might have had real-world experiences of being discharged prematurely from other treatment programs. Many of our clients have given away their power to drugs, lovers, family members and treatment programs, and teaching self-advocacy helps them to get it back. So we need to have a good handle on the pace at which each of our clients can move toward self-advocacy.
Clients at the “pre-contemplation” stage of change are not yet aware of the need for or the benefits of self-advocacy, so don't try to teach it until your client expresses an interest. Just work to raise your client's awareness of what it is. Be sure to compliment clients in pre-contemplation for things they are doing right, and use reframing techniques to normalize behavior that clients might feel disqualifies them from running their own lives.
During the “contemplation” stage, clients are ambivalent about self-advocacy. They are beginning to understand the concept, but aren't quite sure if they'll come out ahead or behind on the deal. Some might be accustomed to others taking care of them. Some might not believe they're able to self-advocate successfully. Listen reflectively and don't fall into the trap of arguing for self-advocacy while your client works to come up with counterpoints for each suggestion.
Alan H. Cohen, author of Why Your Life Sucks (Jodere Group, 2002), offers several insights about power that are relevant to our clients' ambivalence about self-advocacy. Obstacles include:
Believing that destiny, fate, or some other power outside themselves makes their choices irrelevant.
Ignoring their conscience. Many clients report an intuitive, internal warning they disregard to pursue problem behavior.
Letting others make their choices for them. These individuals could be family members, friends, counselors, celebrities, or cults.
Putting others on a pedestal.
At contemplation and beyond
Help your clients at the contemplation stage to sort out the advantages and disadvantages of self-advocacy. Explore fears, concerns and reservations as well as benefits. This will help move your client to the “preparation” stage.
At preparation, clients have made a commitment to take charge of their own lives. You can help them inventory the internal and external resources that will help support this change. Exploring exceptions (discussing times when clients successfully did self-advocate) can help uncover these resources. Helping clients decide on the specific plan and the pace of change makes it more likely they'll succeed with the plan on the “action” stage.
Assertiveness skills are essential to self-advocacy, so these often need to be a focus of treatment. Modeling assertive communication and healthy boundaries constitutes one of the best ways to teach these skills to your clients.
Clients could practice assertiveness through role play in counseling sessions, and agree on a plan to try it out in specific situations outside a session. If the client is not successful at self-advocacy, switch roles so that you play the client, and model a self-advocating approach. The good results that assertiveness yields often encourage clients to continue in a healthy direction.
At the action stage, clients are beginning to advocate successfully for themselves, and are able to evaluate their own progress. Since many clients are still tentative at first, it is important to highlight progress they may have missed. You can help them celebrate milestones and make adjustments that fine-tune the change plan.
After three months of successful self-management, clients enter the “maintenance” stage. We have to walk a fine line between being there when we're needed in order to avoid relapse and undermining self-efficacy by re-assuming too much responsibility ourselves. When clients ask you to do something you think they are capable of doing themselves, ask, “How would you do that?” and “How would you explain to somebody else how to do it?”
Use of groups
Groups serve as excellent vehicles for teaching self-advocacy. Group members often extend the reach of treatment by supporting one another outside the group. Self-advocacy groups often agree on ground rules at the first session. These rules might include empowering each group member to steer unproductive conversations back to self-advocacy, and an agreement that nobody-even the group leader-may offer advice unless requested.