Although substance-abusing patients typically present with a host of problems, including chaotic lifestyles and skills deficits, it is important for therapists to assess their patients' areas of strength and competence. By doing so, therapists show that they have respect for their patients' individual talents and assets. Further, they can appeal to areas in which the patients feel a sense of pride, thereby eliciting greater cooperation in other therapy tasks.
For example:
Walter (all names have been changed) was a patient who was very mistrustful
of authority figures, and his collaboration in the process of therapy
at the start of treatment was tenuous at best. Although he seemed to
be quite hostile and resistant, he did prove himself to be rather intelligent
(in spite of his limited education). When
Walter would engage in high-risk behaviors (e.g., drive while intoxicated),
the therapist would appeal to the patient's intelligence to get him
to reconsider this maladaptive behavior.
The therapist would say:
"Walt, you and I have discussed how you have survived to this point, mainly due to your smarts. You seem to be someone who thinks fast under pressure. That's why I'm so perplexed that you would risk your safety and freedom by driving drunk. It just doesn't seem to fit. What's your opinion about all of this? I'm interested to hear your views."
Aside from noting the patients' intelligence, therapists can encourage patients to collaborate in the work of therapy by focusing on other attributes such as their survival skills, the love of their friends and family, their spirituality, their integrity, their potential abilities to be positive role models for others, their advanced vocational skills (when sober), and other legitimate personal attributes.
