The Relationship theory state in all relationships we are either in recovery or relapse, Assuming we all interact with different elements present in our environment the intensity (energy) of different relationships grows stronger or weaker as life happens; For example, our first relationship being the bond between mother and child. Survival depends on less more intense relationships, as an infant then for a toddler, or teenager. Another way to say this would be the amount time involved in a mother-child exchange has a major significance to one’s existence. Relationships result in tension (friction) causing a discomfort (stress) Recovery from tension relieves the symptoms of friction. Relapse is a conscious or unconscious reversion back to an unhealthy relationship. RT assumes we all have a tendency to be drawn to particular relationships with a propensity toward stressful and unhealthy ones, relapse inevitably will follow. Becoming aware of such relationships enables us to choose alternative methods of behavior reducing relationship intensity. An example would be an alcoholic working at a bar, or a sex offender living close to their substance (relationship) of choice. Relapse prevention is an ongoing process of recovery.
Being aware of our relationships, knowing which one are stressful, alternative actions can be tried. Knowing how and when relapse happened, the results for the next encounter with a given relationship can be changed to have a different outcome. Being able to recognize which relationships may cause us harm and understanding how our behaviors and attitudes contribute toward involvement in harmful relationships, we are able to better assess the potential harm a particular relationship is currently having on ourselves and others.Developing an awareness and ability to recognize which relationships are harmful can be a motivational influence in developing different thought patterns, and behaviors to reduce stress and relapse. Becoming aware of such relationships avails opportunities to choose alternative methods of behaving which reduce relationship intensity even further. What is important in Relationship Theory is self-motivated internally induced willingness to explore better relationships. Using Motivational Interviewing and Brief Interviewing Relationship Theory can be used with individuals, groups and families.
Brief Interventions for substance abuse empower individuals to take small steps to behavioral change. A substance abuse problem may not always be the presented problem. Recognizing changing behavior takes action on an individual basis is a vital part of treatment outcome. Motivational interviewing techniques are designed to help clients recognize their ability to manage parts of life by changing behaviors. As with BI Motivational Interviewing sees “moving toward any decision” is worth consideration, and can contribute to motivation in the future. Harm reduction also considers small change as good change. When coupled within the Relationship theory paradigm abuse and dependence become associations producing a relationship that produces less stress (recovery) or one of disease (relapse). No judgment is placed on either state of mind. Being aware of our relationships, knowing which one are stressful, alternative actions can be tried. Knowing how and when relapse happened, the results for the next encounter with a given relationship can be changed to have an alternative outcome. Motivation comes from within, as realizations that as thoughts change so can behaviors. MI, BI, and HR all recognize the importance of self-empowerment. The Relationship Theory Give us a simple chart to place relationships in and to measure their effectiveness.
Brief Interventions fill part of a “hole” between prevention efforts and more serious treatment (TIP 34, samhsa, p XV). It can also reduce the amount the cost of emergency room visits in the future. By catering to the presented problem of each individual BI can effect changes in client’s behavior. The ultimate goal is to reduce the harm when there is continued use of drugs changing behavior, If not addressed the result could be harmful. A more comprehensive goal would include a specific goal for each client, established by mutually agreed on use pattern (TIP 34). BI takes small steps to confirm clients overall belief in self, and willingness to take actions to make a change.
The acronym FRAMES give a road map when done with a pension can produce expected results. Goals achieved. Using basic listening skills efficiently enables the counselor to engage clients using Feedback, empowering Responsibility, give suggestions based on best practice principles, explore (Menu) options of possible behavior changes, showing Empathy, and promoting Self-efficacy (TIP 34 2008, Osborn, 2008). BI “should be targeted specifically to those who are relatively low on the readiness-to-change continuum (Osborn, 2008, p. 155).”The best way to look at BI is as a short term, Informative treatment with flexible goals, allowing individuals to decide on control or abstinence. BI is a detailed, attentive process relying on assessment, engagement, and prompt application of change strategies (TIP 34).
The HR model seeks to reduce harm caused by substance abuse. For example an individual presenting the problem of having multiple driving under the influence charges may see the problem as being in the wrong place at the right time. They just seem to be caught more than others. They may feel their drinking is not a big problem, but the problem is they get caught driving while over the legal limit. They may feel since they have been drinking for some time they can handle their intoxication better than they know. So what is the presenting problem? Is it drinking or is it driving under the influence? What choice does this individual have that will reduce the potential of being caught once again with another DUI? Two options are obvious. One is to stop drinking another is to stop driving while intoxicated. The natural choice would be to stop driving under the influence. Discussions based on Harm reduction would concentrate on ways to drink and not drive such as having a designated driver, drinking at home, or reduce the amount drunk or abstain from alcohol consumption when driving is anticipated. Harm reduction focuses on changing behavior seen as potentially harmful to oneself and others. Driving under the influence has a great potential to harm others as well as one self. Reducing the potential to harm others demonstrates an individual’s ability to willingly accept responsibility for their actions.
Other forms of HR are needle exchanges for IV users, reducing the harm of using dirty needles may cause to the user. Methadone programs are used as a drug replacement to reduce the urges to get high. Pharmacological interventions have been used to facilitate detoxification. Counseling as a form of education can be beneficial in helping individuals recognize potential harm substance abuse may be causing in their lives. Once change is considered than options can be explored. Methods used in harm reduction counseling encompass Brief Interventions such as empowering clients to embrace self-worth, Motivational Interviewing by encouraging setting goals that strengthen self-efficacy, and exploration into better life skills.
“Change is the central feature of any therapeutic interaction (Aasheim & Wallace, 2008, p. 131).” Like BI MI is a relationship-centered client-centered system of change. By understanding where each client is on a scale of motivation to change methods can vary. The goal is to guide an individual in a course of discovery, where hesitation towards change is diffused. The stage of change one is in could be pre-contemplation, contemplation, preparation, action, maintenance and relapse. The four key attitudes embraced in MI are expressing empathy, developing discrepancy, rolling with resistance and support self-efficacy (Aasheim & Wallace, 2008).
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