Exiting treatment: mapping achievable goals
A collaborative, mapping-based intervention for helping clients identify goals for leaving
treatment.
Authors: E. Day and D. Best, University of Birmingham; N. G. Bartholomew, D. F.
Dansereau, and D. D. Simpson, Texas Institute of Behavioural Research at TCU.
March 2008
Treatment effectiveness initiatives
The National Treatment Agency’s treatment effectiveness strategy (NTA, 2005) was
launched in June 2005. It incorporates mechanisms and initiatives to improve the
effectiveness of drug treatment, in line with the Government’s National Drug Strategy
objectives. The strategy identifies treatment engagement and delivery as areas where
the quality of interventions could be improved. Effective Care Planning is proposed as
one mechanism by which treatment quality can be both improved and measured.
This project is a collaboration between the NTA, Texas Institute of Behavioral Research
(IBR at Texas Christian University) and The University of Birmingham. It proposes a
method of Care Planning that builds on an evidence-based model of service
improvement adapted for use in England. The model is summarised in Simpson (2004)
and the IBR publication Research Roundup (Fall-Winter 2004/05) Volume 14 (see
www.ibr.tcu.edu).
A wide variety of node-link mapping materials are available as Adobe PDF® files for
free, easy downloads at www.ibr.tcu.edu
This manual is an adaptation of material first produced by TCU Institute of Behavioral Research
(www.ibr.tcu.edu), together with new material developed at the University of Birmingham. TCU has granted
the University of Birmingham permission to adapt their material for the purpose of producing and
publishing this manual.
Copyright © The University of Birmingham 2008
All rights reserved. Except as otherwise permitted under the Copyright Designs and Patents Act 1988, no
part of the work may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the
University of Birmingham. Enquiries concerning reproduction outside these terms should be sent to The
University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Birmingham B15 2QZ
2
Introduction: Mapping, collaboration, and long-term goals ................................................ 4
Background and rationale for using node-link mapping for engaging clients in
setting goals in preparation for leaving treatment
Session 1: Getting started: first maps.................................................................................... 9
Using maps to explore client’s history and current concerns as a foundation for
setting goals
Session 2: Strategies for staying drug-free ......................................................................... 17
Using maps to engage the client in developing a relapse prevention plan
Session 3: Recruiting a supportive network ........................................................................ 25
Using maps to help the client chart evaluate and harness their available social
support
Further Sessions: Additional maps to support goal-setting ............................................... 32
Further maps to assist the client in goal setting and monitoring of progress
Appendix: Research evidence for node-link mapping......................................................... 40
And other useful reading materials
© Copyright 2008 The University of Birmingham, UK. All rights reserved.
Acknowledgements:
Specific sections of this manual contain materials initially prepared in part by local therapists, and their work
is gratefully acknowledged. These include Professor Alex Copello, Adam Huxley, Jim Lucas, and Anna Regan
3
Introduction
Mapping, collaboration, and long-term goals
This section introduces the basics of node-link mapping and the use of structured maps
for planning for exiting drug treatment. This approach highlights the importance of
developing the keyworker-client relationship through collaboration. A thoughtful plan
for exiting treatment with realistic and measurable goals helps focus the working
relationship on a more positive future. This chapter is designed as a primer for treatment
staff on simple, yet effective strategies to strengthen motivation and engagement in
planning for exiting treatment.
Node-link mapping
Node-link mapping was first studied as a handy tool for helping students take better
notes during lengthy college lectures. In these studies, some students were taught to
take notes by placing key ideas in boxes called ‘nodes’ that were connected to other
nodes with lines (‘links’) representing different types of relationships. The final product
often resembled a map or flow chart of the lecture. Other students took notes as they
would usually take them. The results showed that students who used this ‘node-link
mapping’ system did better on tests and felt more confident about understanding the
lecture than did students who took traditional notes (see figure 1). There seems to be
something about visually displaying information that helps us better understand things
and recall key ideas (hopefully when we need them).
Types of maps
Node-link maps are tools that can visually portray ideas, feelings, facts, and experiences.
There are three broad categories of these maps:
•
Free or process maps
•
Information maps
•
Guide maps
Although this manual uses the category of maps called ‘guide maps’, it is helpful for the
potential user of mapping approaches to have a broad overview of all the ways mapping
can be used successfully.
Free or process maps: using an erasable board, flip chart, or paper and pencil, client(s)
and keyworker can work together to create a map of the problem or issue under
discussion. The keyworker should take the lead in briefly explaining mapping to the
client(s) and providing a starting point for creating the map. However, when at all
possible, both keyworker and client should have pencils or pens available to facilitate the
joint creation of a map. Figure 1 shows an example of a free map or process map
created during a group session on ‘relapse’. In this case, the counsellor created the map
on an eraser board with group members’ input and led a process discussion on the
issues raised:
4
Free mapping
Things Learned from
Relapse
P
P
P
“ Finally accepted
that I need help ”
I can regain control
Realizing it
“ sneaks ” up
Ex
P
Hit rock
bottom
I
Desire to
quit for
good
P
It had been
6 month since
I used
Denial
L
Legend
P = Part
L = Leads To
EX = Example
Over
Confidence
Figure 1: An example of free mapping
Information maps: information maps have been used in a variety of settings to help
communicate basic information in a readily understandable way. Information maps are
usually prepared ahead of time to serve as handouts or presentation slides. These maps
organize facts in a specific content area and present them in an easy-to-remember
format. Early mapping studies with clients attending psychoeducational groups on HIVrisk reduction found that information maps were useful in helping clients learn and
retain information about HIV transmission and high-risk practices (see figure 2).
H
I
R
V
R
R
ImmunoDeficiency
Human
C
Virus
C
People Only
Can not be
spread by animals,
plants, or insects
C
Smallest living
microbe (germ)
Survives by invading
cells and destroying
them
A major problem
with the Immune
System that fights
disease
HIV is a human virus that invades and destroys the cells of the immune
system.
A
I
R
D
R
Acquired
C
Can be acquired.
In other words,
it can be spread
S
R
Immune
Deficiency
C
Refers to the
immune system.
White blood cells
that fight disease
R
C
Not working.
Deficient.
Unable to fight
germs
Syndrome
C
A group of illnesses
or symptoms related
to a specific cause
(HIV)
AIDS is the late stage of HIV infection, resulting in illnesses and cancers the body can no
longer fight off.
Figure 2: An example of an Information map
5
Guide maps: the mapping exercises contained in this manual use guide maps. Guide
maps are pre-structured templates with a ‘fill-in-the-space’ format that help guide the
counsellor-client interaction during a session, while also allowing ample freedom for
self-expression. As part of an individual counselling session, these maps provide a
structure for thinking about and talking about goals, personal resources, and specific
steps and tasks for arriving at goals. In group work, guide maps can be used as
homework or as individual worksheets that are then processed and discussed within the
larger group. These mapping activities can provide some assurance that each group
member has had a chance to visit a particular issue personally. Similarly, guide maps can
be used to focus and keep a discussion on track. An example is given in figure 3.
Mapping Guide 1: Exploring Self (Map 1)
(1):
Chris: A fictional case study
Strengths
Health
I’m pretty good
Looking; tall;
mostly healthy
Social Relationships
I have a couple of
friends and I get
along pretty
well with my
daughter.
Emotions/Temperament
I really want to
change my life! I
do know what i’st
like to be happy.
Problem Solving
When I’m clear
headed I make
pretty good decisions.
I can also talk well.
Beliefs and Values
What are your
strengths?
I try hard to do the
“right thing.
”I
love my daughter.
Job/Career?
I have computer skills
I have had three jobs
in the last 12 years
I take work seriously
How can you use your strengths to improve your life?
nd a
Once I get control of my drug habit, maybe I can use my skills
looks to go into computer sales.
How useful was this map and discussion?
Not useful1---2---3---4---5---6---7---8---9---10 Very useful
Comments:
Figure 3: An example of a guide map
Mapping as a keyworking or counselling tool
Mapping has evolved as a counselling tool over the course of more than 15 years of
application and research. A key element – that mapping appears to help foster
understanding and support better recall – is potentially beneficial to the keyworking
relationship.
Mapping serves two major functions in the keyworking process. First, it provides a
communication tool for clarifying information and sharing meaning between keyworker
and client. It can be used effectively with whatever therapeutic orientation or style a
keyworker or counsellor follows. Second, regular use of mapping-based strategies helps
with the continuity of care. Mapping worksheets or notes can be placed in the client’s
file, so that discussions of Care Planning or treatment issues (around goals, for example)
can be picked up where they were left off at the end of the previous session. Clients
may also be offered copies of maps they have worked on in session to help with focus
and task completion between visits.
Using mapping as a tool assists the keyworker in structuring sessions to better address
6
key issues that are important to the client. Of course, from the client’s perspective, it is
the conversation itself that is most important. However, mapping can help make
treatment conversations more memorable, help clients focus, and give clients
confidence in their ability to think through problems and develop solutions.
Another benefit of creating maps with clients is having those maps available for
supervision meetings. When mapping is part of the keyworking or counselling process
with clients, this material can be discussed jointly in supervision. Maps placed in the
client’s file document and efficiently outline the work being done in session. This
provides a foundation and focus for supervisors to offer specific feedback and guidance.
Using this manual
This manual uses a series of guide maps to facilitate a motivational style of working with
a client. The manual is presented in three parts, with two broad overall strategies.
•
To build motivation to change
•
To convert this enhanced motivation into a plan of action.
This may be mapped onto the cycle of change. The three parts may be delivered in three
consecutive 50-60 minute counselling sessions. However, it is important to recognise
that clients move at different speeds towards change, and the process may need to be
speeded up or slowed down. A key skill is attending to ‘resistance’ to change (see Miller
& Rollnick). The skilled therapist is good at judging when to move from building
motivation to strengthening commitment to change, all the time watching out for signs
of uncertainty and ambivalence.
Preparation stage
Familiarise yourself with mapping and with the guide maps used in each session. A
completed, case study example of each map is included for reference in appendix 3.
Practice using these guide maps ahead of time. This can be done by completing some of
them for yourself, or by inviting a colleague to role play with you.
Make copies of all the maps, organized by session. One easy way to do this is to make a
folder for each session to store copies of that session’s guide maps. Some clients may
want more than one worksheet, so be prepared with extras.
With a client new to treatment, spend some time reviewing the initial assessment
documentation completed by the client. Allow enough time to complete an Assessment
Feedback Map (page 20) based on the information.
Working with clients
When first introducing the client to using guide maps, provide a brief explanation of
how the maps are used. For example, “maps are tools to help us structure our
discussions and better focus on the things that are important to you” or “mapping is a
way of looking at things that you may want to work on as a part of treatment”. You
may want to further add: “Some people have found these maps to be helpful for
‘seeing’ things more clearly and remembering important ideas”.
Assure the client that maps don’t have to be filled up with words. Concise summaries,
shorthand, abbreviations, single words, and even pictures can be used to represent the
7
ideas the client wants to focus on. Some areas of a map may contain more
words/information than others; some boxes may be left blank.
Sit in such a way that you can work on a map as a collaborative project with the client.
This might mean sitting around a table or inviting the client to move to the corner of the
desk so that both counsellor and client have a clear view of the worksheet. Offer clients
a variety of pencils or markers with which to work.
Frequently validate and affirm clients’ responses during mapping sessions. There are no
‘right’ or ‘wrong’ responses for completing a map. In the spirit of collaboration,
counsellors’ responses should most frequently reflect interest and curiosity about the
clients’ perspectives.
8
Session 1
Getting started: first maps
This section sets the collaborative tone for subsequent sessions and introduces the client
to working with guide maps. The keyworker takes the lead in introducing the guide
map template. This begins with a review of the client’s life before they entered
treatment, followed by a summary of the gains they have made since starting. The
session then invites the client to consider what they hope to change in the future, and
how this will improve their life. It ends by asking the client to summarise the strengths
that they possess that will help them reach their goals when they leave treatment.
Notes for session 1: a set of guide notes is included for each map. Blank copies of each
map for you to copy and use with clients follow the guide notes. Read over the sample
case study maps to get a feel for completing the maps with clients.
The maps
There are three maps that provide the focus for your first session with the client, and a
fourth map for client homework:
•
Map 1: a roadmap for perspective on the client’s history (‘History’)
•
Map 2: a map summarizing progress made in treatment (‘Progress Report’)
•
Map 3: a map for discussing the client’s long-term goals (‘Things I Would Like to
Change’)
•
Map 4: a ‘homework’ map for identifying strengths/resources (‘Strengths’)
Introduce the client to the idea of working on the map worksheets together in the spirit
of collaboration and better understanding. Most people preparing to leave treatment
hope that their lives will be better in the future. The series of maps presented here help
to consolidate progress made and prepare the client for the challenges ahead.
Mapping helps you capture ideas without a lot of words, and are useful to maintain
focus and concentration. Listen carefully to what the clients says, then add that
information as a concise summary. For example: “I was having a hard time back then – I
lost my job, then my house” might be summarised on a map as lost job, then house.
Map 1: ‘History’
1. Use some of the following ideas to introduce the first map to the client:
I’d like to start by talking about you. I want to review the progress you’ve made
since you’ve been in treatment, covering both the good and the bad things. If it’s
okay with you, I’d like to use this road-looking map to take notes as we talk.
I want you to tell me about things that happened before starting treatment that
you think I should know about in order to help you as much as I can while we
work together on your plans for leaving treatment. To get us started, I’ll record
some of the things you tell me, but I want you looking over my shoulder to make
sure I get it right.
9
Whatever the timeframe you think makes most sense, we’ll start there. Then we
will go along the road (so to speak), and you can tell me about events that were
important. We’ll insert notes about those. Take a minute to think.
2. Work collaboratively with the client to build this map. Engage the client with
invitations to join in the construction. For example:
So your divorce was about a year before you lost your mother? or If you started
using about two years after you started working on the building site, we would
add that about her. Is that right?
3. Naturally, you will probe and ask follow-up questions as the client discusses his/her
recent past. Some of these might be worth capturing, based on the emphasis the client
places on it.
4. When the client says that the map is finished, conclude the map by summarizing
what the client has brought forward. For example:
Your map gives me a good idea about how things were for you before you
started here. Later on, we’ll talk some more about how this roadmap might be
helpful for you when you leave.
5. Transition to the next map:
I have another map I’d like to show you. I filled this one in based on some of the
questionnaires and evaluations you have completed over the last few months.
Map 2: ‘Progress Report’
1. After transitioning from talking about the client’s past before starting treatment,
engage the client in a discussion of the progress made during treatment, and possible
challenges for the future. This information can be summarised on the Progress Report
map.
2. One idea for beginning the discussion is to ask the client about what he/she has
found to be the most useful personal outcomes from participation in treatment:
For yourself personally, what has been the most helpful result of participating in
treatment while you have been here?
How do you see your participation in treatment as making a difference in the
future?
In what ways have you changed for the better since you have been here?
When you get out, what will your ____ (partner, spouse, mother, children) notice
that is different about you as a result of taking part in treatment? (Ask question
referencing a significant other who is most relevant to client)
Prompt client with “what else” or “how else” to help fully explore client’s experience of
treatment.
3. Introduce the Progress Report map and review each of the nodes with the client.
4. Use open-ended questions to encourage the client to reflect on each of the issues
addressed in the nodes. Focus discussion on how these issues relate to possible needs,
problems, challenges after the client returns home.
10
5. Transition to the next map:
Based on the things we’ve been talking about, let’s complete another map that
can help identify some possible goals for the future.
Map 3: ‘Things I Would Like to Change’
1. Transition into the next map by turning the client’s attention toward his/her possible
expectations about the future. Use Map 1.3 (Things I Would Like to Change) to discuss
changes that the client would still like to make in their life. The tone of the map might
reflect the general idea of ‘what needs to change in order for you achieve your
preferred future?’
2. Invite the client to consider how he/she might like his/her life to be different or better
as a result of completing treatment.
What are some things that you might want to work on when you leave here, over
and above the obvious issues of drug/alcohol use? Which issues do you think will
make the most difference in your life, either now or in the future?
How would you describe the problem or difficulty you would like to change?
3. After the client describes and discusses each change that might be helpful, ask the
client to give some details about how accomplishing that change would make things
better:
4. Work collaboratively with the client to complete the map, filling in the nodes with the
client’s words and checking frequently with the client to make sure you are noting
things the way he/she prefers.
5. End the discussion with a summary of the key issues and concerns raised by the client
and ideas about how changes will make things better. Transition to homework map:
The next map is one for you to complete on your own between now and our next
meeting together.
Map 4: ‘Strengths Maps’ (homework)
Invite the client to continue thinking about issues that should be addressed before they
leave treatment. In particular, the homework map asks the client to think about
personal strengths and resources that are available to help with the work ahead. Give
the client a copy of the Strengths map (Map 4), briefly review it, and assign it as
‘homework’:
I’m impressed with the careful thought you have given to these issues you would
like to tackle in the future.
Between now and our next appointment, I’d like for you to think about yourself
and consider the personal strengths and resources you bring to solving these
problems. This map has several boxes or ‘nodes’ where you can jot down your
thoughts about your strengths.
Push down the tendency to be self-critical. Think about and jot down at least one
strength you know you have for each of the boxes. Pay attention to yourself and
add strengths to your map as you observe them in yourself during the coming
week. Think about how you have changes since you first came to treatment.
11
Bring this map with you for our next session so you can tell me about those things
about you that will help you make the changes you want to make.
Ending the session
Thank the client for participating and for giving the activities some thought. Briefly ask
the client to rate the usefulness of the maps worked on in the session on a scale of 1 to
10. For example:
I’m interested in how useful you found these maps that we worked on today.
Overall, if 1 equals ‘not useful’ and 10 equals ‘very useful’, how would you rate
the maps and our discussions?
If the client’s overall rating is lower, ask: I wonder how we can make these maps more
helpful for you. Think about it and let me know at our next session.
12
Maps for Session 1
Map 1 .1
Hist or y Map
THEN
NOW
(Use back if needed)
Client Name:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Keyworker:
Date: /
13
/
Client Name:
Education/work
Keyworker:
Date: /
Map 1.2
Progress
Report
/
Crime
Amount and
frequency of
substance misuse
Progress in
treatment
Physical &
psychological health
Social support,
family & friends
Housing and basic
needs
Major strengths
Possible challenges
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
14
Map 1.3 Things I would like to change
Describe what you want to
change
How would life be different if
it happened
Client Name:
(Use back if needed)
Keyworker:
How useful was this map and discussion?
Not Useful 1–2–3–4–5 –6–7–8–9 –10 Very Useful
Comments:
Date: /
15
/
Client Name:
Map 1.4
Strengths
Health and physical
Keyworker:
Date: /
/
Problem solving/
coping
Social relationships
Emotions/
temperament
What are your
strengths?
Values and beliefs
Work or skills
Client Name:
Keyworker:
How useful was this map and discussion?
Not Useful 1– 2–3–4 –5–6–7–8–9 –10 Very Useful
Comments:
Date: /
16
/
Session 2
Strategies for staying drug free
This section will help the client consider how they will maintain the gains they have
made in treatment once they leave. One important goal is likely to be remaining drugfree. This session presents a series of maps to help the client to develop a Relapse
Prevention plan that can help them achieve this.
Notes for session 2: a set of guide notes is included for each map. Blank copies of each
map for you to copy and use with clients follow the guide notes. Read over the sample
case study maps to get a feel for completing the maps with clients.
The maps
Following a review of the homework set at the end of the previous session, there are
three maps that provide the focus for this session:
•
Homework map: identifying strengths and resources (‘Strengths’)
•
Map 1: a map to help the client establish their own individual risk factors for
lapse or relapse (‘Reviewing High-Risk Situations’)
•
Map 2: a map to help the client deal with cravings for drugs (‘How Can I Deal
with my Cravings’)
•
Map 3: a map to help summarise and record a ‘Relapse Prevention’ plan.
17
Homework review: ‘Strengths’
1. Allow time at the beginning of session for discussion about the self-study map on
strengths and resources. For each of the life areas identified in the nodes, use some of
the following process questions to engage the client in conversation.
How did you go about identifying your strengths in this area?
What kinds of good qualities have people told you have when it comes to ______
(e.g., your temperament, your work, your values, etc)?
How do you think you gained this strength?
What things are you aware of that you do to work on this strength?
What would someone who is really close to you (parent, spouse, etc) say is your
biggest strength or personal resource?
If client reports not having had the time to complete the map, etc., simply use a blank
copy of the map to help the client catch up by identifying his/her personal strengths in
each of the areas.
2. Summarise the discussion by asking the client to focus how his/her personal
strengths will help with the changes the client wishes to make in the future:
In our last meeting, you discussed several things you want to see changes in for
the future, when you are finished here and back home.
How will your strengths help you with the changes you want to make?
Which of your personal strengths will serve you the most?
How do you intend to keep working on this strength?
What do you need to remember to keep doing?
3. Transition to the relapse prevention maps:
The maps we will work on today are for looking at strategies for staying drug free
when you leave treatment. Try to keep your knowledge about your personal
resources in mind as you think about how you will go about making things better
for yourself in the future.
Map 1: ‘Exploring High-Risk Situations’
1. The purpose of this map is to help the client think in detail about the last time they
used. The more specific they can be the better, because the greater chance that they
will identify internal and external triggers to drug use. For example:
Where – specify in as much detail as possible, including other people present
How/why – elicit the client’s own understanding of why they used. If they are
unsure or say something vague like boredom, explore further if possible
When – in addition to the day, encourage the client to identify the time of day
and what was happening immediately before and after the use.
This map will form the basis of some of the later work on identifying triggers to drug
18
use, so it is worth spending time and effort getting as clear a picture as possible of the
context in which the client typically uses. There will be lots of information here but the
client may not be immediately able to identify ‘why’ they used but a skilled keyworker
will be able to help the client to better understand their drug use.
Help the client to explore their drug use by asking open questions. For example:
Why do you think you used?
What is it about having a row with your partner that makes you want to use?
If the client cannot easily answer these questions, they may feel frustrated or annoyed,
but you can prevent this by explaining why it is important to ask. You might say
We all do things automatically without really knowing why, but with a bit of
careful thought we can often work out a reason. It is only by exploring and
learning about ourselves that we can change our behaviour.
However, if the client is still struggling or becomes frustrated, do not feel under pressure
to continue. You can return to it in later sessions.
2. Help the client to identify external factors or triggers. These include people, places
and objects. Once a client has identified these triggers they can then begin to put into
place some strategies to deal with them. For example:
People – specific people can trigger drug use e.g. dealers, other users, friends,
family members that evoke certain feelings in us.
Places – specific places can trigger drug use. These might include places where the
client has used before and places where others are likely to use.
Objects – specific objects can trigger drug use. For a heroin user, this might be
foil. For an IV user this might needles/syringes/citric/spoons etc. For a crack user, it
might be a pipe/can/plastic bottle.
3. Help the client to identify internal factors or triggers, including thoughts, feelings,
images and physical sensations. Once a client has identified these triggers they can then
begin to put into place some strategies to deal with them. For example:
Thoughts – the most powerful thoughts are typically those clients have about
themselves, other people or the world: e.g. everybody hates me, I’m useless
Feelings – these can be any strong emotion. Those feelings that most often trigger
substance misuse are anger, anxiety, low mood and shame.
Images – some people are more likely to work in visual images than words. One
picture can convey a lot of information. Examples may include flashbacks of
traumatic incidents.
Physical sensations – strong feelings are often accompanied by changes within the
body that can be very unpleasant.
Any of the above can occur in isolation, or one may trigger a chain of events. Anger and
anxiety have the same physical sensations as they are both driven by adrenalin
(increased heart rate, sweating, butterflies in the tummy, restlessness). Sometimes
clients confuse these two feelings, so it is worth spending time so the client is clear.
19
4. Once the client has identified their external and internal triggers, they can begin to
think about how they can solve some of these problems. This will strengthen the client’s
belief in their ability to adapt and focus on problem-solving, and will be ultimately
summarised on Map 2.3 (Relapse Prevention plan)
In some cases, it can be more productive to avoid specific external triggers. If we decide
to keep our distance from people, remove ourselves from situations and throw away any
objects that are likely to lead to drug use, we are more likely to reduce or stop. Later on,
when we have built up our confidence, we can learn to be more assertive in previously
risky situations. Similarly, we can learn to say no to our friends and family who continue
to use, because they are not ready to give up.
With internal triggers, the aim is firstly to help the client to acknowledge that the feeling
is difficult and to realise that they cope with it by using drugs. The second step is to help
the client identify alternative coping strategies. Often, being able to name a feeling and
acknowledge its pain is sufficient to give an individual a sense of control.
It is important to find solutions that are going to work for the client. Suggestions and
ideas can help, but it is more beneficial if clients come up with the solutions themselves.
Useful hints for tackling these problems include:
The client is likely to feel vulnerable in these sessions and so a good therapeutic
rapport is essential. One of the most important things the therapist can do is
validate the client’s feeling and acknowledge the emotional distress it is causing.
Don’t feel under pressure to say very much. Compassionate and active listening
may be enough.
If possible, help the client to make a link between a particular feeling and their
substance misuse, i.e. the client has not yet found a way to cope with the feeling.
Map 2: ‘Dealing with Cravings’
1. The purpose of this map is to help the client develop some ways of managing
cravings, or urges to respond to internal or external triggers. This can be approached
from a number of different angles including positive self-talk, distraction and relaxation.
2. Positive Self-Talk can be used to dispel some myths about cravings e.g. ‘they will not
go away’, ‘I will be overwhelmed’, ‘I am never going to be able to stop’. Positive
statements that focus on more accurate information can be useful things to tell yourself.
3. Distraction is designed to help a client focus on doing something else, which will then
give rise to other thoughts and feelings. By doing so, the cravings will temporarily
subside and become more manageable. Distraction is a tool that can be effectively used
early on. It is also an approach that most clients will have had at least some experience
in using in the past.
Clients may use substances as a way of distracting (avoiding) difficult feelings and
cravings are an example of a difficult feeling. It is therefore useful to help the client
identify more productive ways of distracting themselves. It may be useful to consider the
pros and cons of a particular distraction technique.
Distraction should not be relied on as the only way of dealing with cravings or any other
problems. It will only work in the short term and is likely to reinforce beliefs that the
20
only way of dealing with cravings is to distract from them.
4. Relaxation focuses on ways of allowing the client to control their feelings of anxiety,
in particular the features relating to the heart i.e. doing less and slowing down the heart
rate. Although stress levels are reduced through exercise on a regular basis, vigorous
exercise is not a form of relaxation.
For clients who use crack cocaine or other stimulants, relaxation can become particularly
important. Using exercise as a way of dealing with a craving to use crack cocaine can
cause further problems in that the increase in heart rate and adrenalin from exercise can
make the craving more challenging to manage. Relaxation techniques should ultimately
aim to suppress adrenalin/noradrenalin.
Remember that it is important to find solutions that are going to work for the client.
Suggestions and ideas can help, but it is more beneficial if clients come up with the
solutions themselves.
Map 3: ‘Relapse Prevention’
The purpose of this map is to help the client put together the things learnt from the
previous two maps in order to create a simple plan that will help them avoid relapse to
regular drug use in the future. Lapses (or brief, self-limiting periods of drug use) are
common and represent an opportunity to try and understand why a client might find
themselves in high risk situations and help them to anticipate such settings. What’s
more, identifying external or internal triggers to drug use may allow the client to
develop adaptive strategies (a relapse drill) to help them deal more effectively with them
if they happen again.
Start by summarising the important internal and external factors or triggers that have
been known to precede drug use in this client. Use map 2.1 to help this process.
Next, summarise the discussion from map 1 about ways of coping with internal and
external triggers.
Summarise the key features of cravings experienced by the client, and possible ways of
coping with these.
Finally, discuss possible strategies to adopt if a lapse does occur in the future. The node
entitled ‘What to do if I lapse’ should contain specific information where possible,
including names of people that might be able to help, what specifically they could do,
and how to contact them in an ‘emergency’. These issues will be revisited in session 3.
Ending the session
Thank the client for participating and giving the activities some thought. Briefly ask the
client to rate the usefulness of the maps used in the session on a scale of 1 to 10:
I’m interested in how useful you found the maps we worked on today. Overall, if
1 equals ‘not useful’ and 10 equals ‘very useful’, how would you rate them and
our discussions?
If the client’s overall rating is lower, ask:
I wonder how we can make these maps more helpful for you. Think about it and
let me know at our next session.
21
22
How useful was this map and discussion?
Not useful…1-2-3-4-5-6-7-8-9-10…Very useful
Comments:
How long did you use for?
How much did you use
What did you use?
EXPLORIN G YOUR
S UBS TAN CE US E
Map 2.1
‘INTERNAL’ factors
Client Name:
What were you feeling emotionally?
What were you feeling physically?
Keyworker:
What were you thinking about before you use?
When did you use?
Where were you?
Who was with you?
‘EXTERNAL’ factors
Date: /
/
Maps
23
How useful was this map and discussion?
Not useful…1-2-3-4-5-6-7-8-9-10…Very useful
Comments:
Things I can tell myself
Map 2.2
Client Name:
Ways of distracting myself
Date: /
Ways of relaxing myself
Keyworker:
How can I deal with my cravings?
/
24
How useful was this map and discussion?
Not useful…1-2-3-4-5-6-7-8-9-10…Very useful
Comments:
Client Name:
LAPS E
How do they feel?
Date: /
/
How can I avoid these?
What do I do if I lapse?
Keyworker:
EXTERN AL
CRAVINGS
IN TERN AL
Map 2.3
How can I cope with cravings?
How can I avoid these?
Session 3
Recruiting a supportive network
This section builds on the work done in developing a Relapse Prevention plan in the
previous session, and helps the client to review their social network in order to optimize
their chances of achieving their long-term goals in regards to drug use.
Notes for session 3: a set of guide notes is included for each map. Blank copies of each
map for you to copy and use with clients follow the guide notes. Read over the sample
case study maps to get a feel for completing the maps with clients.
The maps
In addition to reviewing the homework map, there are seven new maps for working
with clients in subsequent sessions. These maps are designed to help keep sessions
focused on goals, plans, and tasks related to reentry needs.
•
Map 1: a map for exploring the client’s social network (‘Social Network’)
•
Map 2: a map for working out which members of the social network provide
which particular type of support (‘Peer Inventory’)
•
Map 3: a map to help the client use their social network to help them achieve
their goals (‘Social Network Support Plan’).
25
Map 1: ‘Social Network’
1. Research has shown that people that are successful at abstaining from drug use over
a long period of time manage to enlist the help of one or more people. The keyworker
can have a useful role in helping the client to explore their social environment and
organize the resources available to them to maximize their chances of achieving their
goals. This session uses a two-stage approach, firstly to explore the client’s network of
friends, family, work colleagues, and other acquaintances to work out what sort of
support might be available, and secondly to start to organize this support into a longterm plan.
Introduce the idea:
We know from experience that people who are successful in stopping or cutting
down serious drug use and moving on with their lives are the people who manage
to enlist the help of others around them. Similar to the adage that ‘a problem
shared is a problem halved’, we know that help from other people can be crucial
in life.
Today I want us to spend some time looking at your ‘social network’ in some
detail. By this I mean all the people that you have contact with (or could have
contact with) on a regular basis. This might be family, friends, work colleagues, or
acquaintances. Let’s see how we get on at filling out this map.
2. Start by putting the client’s name in the box in the middle, and invite them to suggest
others to go in the ovals around it. Make reflective statements, or ask open-ended
questions, to clarify and amplify the information given about each person and add this
to the map in summary form.
You live with your dad?
What does your mum think of your drug use?
How often do you see your brother? What sort of things do you like doing
together?
What do you like about spending time with John?
3. If the client struggles to suggest names to add to the map, work systematically
through the past week asking where they went and who they saw on each day.
Alternatively start with family, then work through friends, acquaintances, etc. Don’t
forget people who the client was friendly with prior to starting drug use – it may be
possible that you can help the client to get back in touch with them.
The aim of the exercise is to build up a network of supportive (or potentially supportive)
people. It is likely that people who currently use drugs are not going to be the best
supporters of the client’s goal of abstinence, and careful thought needs to go into
whether to include them on the map. On the one hand you don’t want to dismiss
people who the client is close to, but on the other hand it is useful to have a discussion
about the pros and cons of this person’s support. Where possible it is useful to either
not include active users on the map, or else indicate on there that they are using in
some way.
26
Map 2: ‘Peer Inventory’
1. Having spent some time exploring the client’s social network, it is useful to discuss
the concept of different types of support – emotional, practical, spiritual etc. Different
problems that the client may face will require different sorts of support.
Now that we have thought about all the people in your life that might be able to help
you, I want us to spend some time working out what sort of help might be useful, and
which of your network members might be able to provide it. We know that the
emphasis in society at the moment is on people being independent and self-sufficient.,
but also that research has shown that the level of social support that someone receives
makes a big difference to their ability to cope.
Imagine that you had one of two problems: you are upset by the death of an elderly
family member, or your car has broken down. Would you go to the same person for
help with both of these problems? Possibly, but when you think about it you will
probably conclude that different people are good at different things e.g. help with
solving problems, moral support, being a good listener, helping with tasks or sharing
the load, providing information & resources, emergency help
2. Show the client the Peer Inventory map. Ask them to help you complete it, focusing
on some of the names identified on the Social Network map. For each name mentioned,
discuss the potential types of support that the person might be able to offer
3. It may also be useful to have a discussion about the different factors that make a
relationship supportive, and in particular giving feedback & active listening. Likewise it is
important to mention that supportive relationships are a two-way street – in order to
receive support you need to offer your support to others
Map 3: ‘Social Network Support’
1. A final stage in this process is to help the client match up particular problems to
potential supportive individuals in their network. The Social Network Support Plan map
can be helpful in doing this.
2. Start by helping the client list the current problems that they have. These might have
come from a current care plan, or else have been highlighted in the earlier sessions from
this manual e.g. aspects of a Relapse Prevention plan.
3. Encourage the client to use the Social Network map to fill out the middle section of
the Social Network Support Plan map, giving careful consideration to who might help
achieve each task.
4. Use the Peer Inventory map to help fill out the right hand section of the Network
Support Plan map, discussing how exactly each person might help the client to achieve
their goals.
5. When the client is happy that the map is complete, review the results with them to
ensure that nothing has been missed out, and give them a copy to take away.
Ending the session
Thank the client for participating and for giving the activities some thought. Briefly ask
the client to rate the usefulness of the maps worked on in the session on a scale of 1 to
10. For example:
27
I’m interested in how useful you found these maps that we worked on today.
Overall, if 1 equals ‘not useful’ and 10 equals ‘very useful’, how would you rate
the maps and our discussions?
If the client’s overall rating is lower, ask:
I wonder how we can make these maps more helpful for you. Think about it and
let me know at our next session.
28
How useful was this map and discussion?
Not useful…1-2-3-4-5-6-7-8-9-10…Very useful
Comments:
Client’s Name:
M y S ocial N etwork
Maps
29
Peer Inventory
Peer Inventory
People who are
important to
me:
What makes this
person important
to me?
How will this person
be supportive of me ?
Client Name:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Keyworker:
Date: /
30
/
31
Client Signature:
Date: __/__/__
Keyworker Signature:
What could they do?
Keyworker Name:
Who might be able to
help me?
Client Name:
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
(Use back if needed)
The problems I have
Social Network
Support Plan
Further sessions
Additional maps to support goal-setting
A key task of preparing the client for life beyond treatment is to equip them with the
skills to set their own goals and solve their own problems. These additional maps help
the client to think about their goals for the future, set and monitor their own targets,
and make decisions for themselves.
The maps
This section has four maps for working with clients in subsequent sessions. These maps
are designed to help keep sessions focused on goals, plans, and tasks related to leaving
formal treatment.
•
Map 1: a map for exploring a picture of the future (‘The Future That I Want For
Myself’)
•
Map 2: a map for setting goals (‘Goal Getter’)
•
Map 3: a map to help make decisions (‘Decision’)
•
Map 4: a map for exploring set-backs (‘Running Into a Brick Wall’)
32
Map 1: ‘Future’
1. Suggest using map 4.1 (‘The future that I want for myself’) to help the client renew
motivation and commitment to change by discussing his/her vision of a preferred future.
As you work on the things you want to accomplish in order to have a successful
reentry, it’s helpful to step back and look at the big picture.
2. Complete the map with the client. Listen reflectively as the client works through the
nodes of the map and builds a picture of how he/she would like to have things be in the
future.
3. Once the map has been completed, ask further open-ended questions to help the
client create a more detailed picture of the desired future:
Your picture of what you want for your family in the future includes _______ and
______. What would your wife (husband, partner) add to this picture of family
life? What would your children add?
What is different about what you hope for in terms of friends and how things
have been with friends in the past?
How did you develop your preferences for a living situation? What else would you
want to have different or better in the future?
You’ve noted that you have plans for work and your career. What are some of the
key strengths that you bring to your work?
I like what you said about _________________ being a common thread amongst
the things you want for your future. How did you come to realize these things
shared this common thread?
4. Summarize the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
Map 2: ‘Goal Getter’
This map is used in the formal Care Planning intervention, and is useful to help the client
set him or herself more useful goals. Setting goals that are overly ambitious or poorly
described can lead to failure and demoralization. It is useful to break down individual
goals into smaller steps that are ‘SMART’:
Specific: make the step as specific as possible and express it in positive terms.
Do you want to stop using cannabis or cut down your use? How much money do
you want to save each week?
Measurable: you will need a way to evaluate progress and work out if the client is
achieving each step towards their goal.
How ill you know if you have cut down your use? Will you measure this is money?
Number of days used? Number of times used? How will you know when you are
feeling less depressed?
Achievable: is the step achievable? Does the client have the resources necessary to
achieve each step? Can any obstacles be identified and removed before starting?
33
Realistic: setting unrealistic steps or goals is counterproductive, as it is likely to end in
failure. If a client fails to achieve a step, this leads to demoralization, and potentially to a
drop in motivation. Therefore make all the steps set in the early stage of the Care
Planning process overly simple, to ensure that the client has every chance of succeeding.
Then praise them extensively for achieving the step/goal.
Time-limited: all steps must have a review date attached to them. At first, this should
be as close as possible to the date that the goal was set on, allowing quick feedback
and progress.
1. Invite the client to continue working on setting goals to be achieved even when they
leave treatment. Give the client a copy of the Goal Getter map (p47), and explain how
to use it:
One of your aims for the future is to get a better job with more pay. Can you
think of any way of doing this?
Engage the client in completing the map. Lead the discussion so that it follows the
map’s template. Start by breaking down the goal into a number of smaller steps,
following the principles described above. Encourage some thought and discussion about
identifying a more concrete goal and several steps that might be involved in the goal.
You’ve said that changing your relationship with your wife is one thing that seems
important for you to address. Part of this is working out how to walk away or
handle disagreements differently. How might you go about learning that? What’s
one thing you could do to work on this?
Once the steps to achieve a certain goal are established, enquire about possible
problems that the client might encounter. At this point it is common to realize that the
steps set to achieve the goal are still too large and difficult to achieve, and they may
need further revision.
Add information about the client’s strengths and social supports that might help them
achieve their goal.
At the end of the session discuss with the client how they could use the Goal Getter
map to help them manage life in the future.
Map 3: ‘Problem Solving’
1. Introduce the map to help make difficult decisions and solve problems (map 4.3).
Introduce it by saying:
Everyone is faced with a difficult situation from time to time. If you don’t have a
way of dealing with it, the problem may soon get out of hand. Ultimately this may
threaten your plans or upset your goals. This map may help you make a difficult
decision that you are faced with.
2. Complete the decision map with the client. Listen reflectively as the client works
through the nodes of the map and discusses the pros and cons of each choice in the
decisional balance.
3. Once the map has been completed and discussed, ask further open-ended questions
to help the client think about thoughts and feelings about the decision:
34
What got you to thinking that you needed to make a firm decision about
______________?
There are three boxes for possible choices and consequences. If you had to add
one more box to each list, what would you put in those boxes?
Who else will be (was) affected by your set back? What advice might they give
you (did they give you) about what happened?
What else have you considered might be positive about ______________ (one of
the choices)? And what else might be negative about that choice?
What will tell you or give you confidence that the choice you picked is the best
one for right now?
How will you evaluate it?
4. Summarise the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
Map 4: ‘Brick Wall’
1. Suggest the Running into a Brick Wall map based on client’s report of having a setback or other experience that did not turn out as desired, either recently or in the past.
So testing yourself by going to the bar with friends didn’t work out so well. In this
map, it’s shown as sort of running into a brick wall.
2. Complete the Brick Wall map with the client. Listen reflectively as the client works
through the nodes of the map and discusses how the set back happened and what was
learned.
3. Once the map has been completed and discussed, ask processing questions to help
the client further consider different aspects of the set back:
At the time you ______________, did you wonder if you might be heading for a
brick wall? What did you tell yourself?
What other thoughts or action did you have leading up to _____________.
Who else will be (was) affected by your set back? What advice might they give
you (did they give you) about what happened?
How did you figure out what to do to keep things from being worse?
You noted that what happened made you wiser by ________________. How will
you use this new wisdom in the future?
4. Summarise the discussion. Transition to one of the subsequent maps or assign it as
homework, based on what the client identifies as the next useful area of exploration.
35
How useful was this map
and discussion?
1-2-3-4-5-6-7-8-9-10l
Comments:
Family
Drugs & Alcohol
Friends
What do these things have in common?
Leisure
Work
36
Date:
/
Keyworker:
/
Client Name:
Map 4.1 The future that I want for myself
Maps
37
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
Keyworker:
MY GOAL
Specific Actions
Client:
Possible Problems
Helpful people
& useful thoughts
Map 4.2 Goal Getter
__/__/__
Solutions
Strengths you
have or need
When
Date:
Map 4 .3
Decision
Client Name:
YOU HAVE A DECISION TO MAKE ABOUT...
Keyworker:
Date: /
/
Possible Choices
You Can Make
A
C
B
Consequences of
Each Choice
POSITIVE
NEGATIVE
POSITIVE
NEGATIVE
WHICH CHOICE SEEMS THE BEST?
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
38
POSITIVE
NEGATIVE
Client Name:
M ap 4 .4 Running int o a
Br ick wall
Keyworker:
Date: /
/
What was the unsuccessful attempt?
W hat m ade it
unsuccessf ul ?
Your thoughts?
Your actions?
What can you do differently next time?
How useful was this map and discussion?
Not Useful 1–2–3–4–5–6–7–8–9–10 Very Useful
Comments:
39
Describe how this has
happened to you before?
Appendix
The research evidence for node-link mapping
Node-link maps have an empirical base in research dealing with the effects of using two
dimensional visual representations. These graphic representations are frequently found
to be more effective than verbal discourse or written narrative in dealing with complex
problems and issues. Flow charts, organizational charts, Venn diagrams, pictures, and
graphs can increase communication efficiency by making related ideas easier to locate
and recognize, and, as a result, potentially more amenable to inferences and recall
(Greeno, 1980; Larkin & Simon, 1987; Mayer & Gallini, 1990). Spoken language or
written narrative are in physical formats that produce linear ‘strings’ of ideas. Visual
representations, on the other hand, have the capability of simultaneously clustering
interrelated components to show complex multiple relationships such as parallel lines of
thought and feedback loops.
Complexity often makes personal problems both difficult to analyze and solve, and
emotionally daunting. A visual representation such as a node-link map can capture the
most important aspects of a personal issue and make alternatives more obvious for both
the client and the keyworker/therapist. Because this has the potential to make a
problem appear more manageable and a solution more probable, it may diffuse at least
some of the anxiety surrounding the issue, as well as increase motivation to work
toward a solution.
In 1989, maps were first studied as personal management tools for college students in
substance abuse prevention research funded by the National Institute on Drug Abuse
(NIDA) in the USA. Later, maps were also introduced to heroin dependent clients and
their counsellors in three urban Texas methadone clinics as part of the DATAR project
(Drug Abuse Treatment for AIDS Risk Reduction). Positive findings from this research led
to the use of node-link maps in the CETOP project (Cognitive Enhancements for the
Treatment of Probationers). Again, this confirmed node-link maps as useful counselling
tools, this time with a particularly complex client group (probation violators in a criminal
justice system treatment program). Some of the maps in this manual were initially
created by Don Dansereau and colleagues for the DATAR and CETOP projects, and then
modified by counsellors in the studies to suit their clinical needs. Others were created in
drug services in Birmingham and the North-West region of England as part of the BTEI
and ITEP projects.
Research evidence now exists to support the use of node-link mapping in drug
treatment sessions. The following provides a summary of the potential benefits:
Quality of the therapy session
Memory for the session: maps make treatment discussions more memorable (K.
Knight, Boatler,& Simpson 1991, K. Knight, Simpson, & Dansereau 1994)
Focus: maps increase on-task performance in group sessions and are especially helpful
for clients who have problems maintaining attention (Dansereau, Dees, Greener &
Simpson 1995, Dansereau, Joe & Simpson 1993, D. Knight, Dansereau, Joe & Simpson
1994, Joe, Dansereau & Simpson 1994, Czuchry, Dansereau, Dees & Simpson 1995,
Dansereau, Joe & Simpson 1995).
Communication: maps give clients greater confidence in their ability to communicate.
This is especially so where English is not the first language and clients with limited
40
education (Pitre, Dansereau & Joe 1996, Dansereau, Joe & Simpson 1996, Blankenship,
Dees & Dansereau1997, Newbern, Dansereau & Pitre 1999).
Ideas: maps facilitate the production of insights and ideas. They can help to:
•
stimulate greater session depth (Dansereau, Dees, Greener & Simpson 1995,
Newbern, Dansereau & Dees 1997);
•
identify gaps in thinking (Pitre, Dansereau & Simpson 1997);
•
uncover psychological issues (Collier, Czuchry, Dansereau & Pitre 2001, Czuchry
& Dansereau 2003b, Dansereau, Joe & Simpson 1993);
•
provide greater breadth (Dansereau,Joe & Simpson 1993).
Quality of client and therapist relationship
Mapping facilitates the counselor-client therapeutic alliance (Dansereau, Joe & Simpson
1993, Dansereau, Joe & Simpson 1996, Dansereau, Joe, Dees & Simpson 1996,
Simpson, Joe, Rowan-Szal & Greener 1996).
During treatment outcomes (e.g, issue resolution & more effective life
skills)
•
Positive feelings toward self and treatment: maps facilitate self-confidence, selfefficacy & problem solving. They can foster positive feelings about personal progress
in treatment and positive perceptions of treatment process (Dansereau, Joe &
Simpson 1993, Dansereau, Joe & Simpson 1995, Dansereau, Joe, Dees & Simpson
1996, Joe, Dansereau & Simpson 1994, Pitre, Dees, Dansereau & Simpson 1997,
Czuchry, Dansereau, Dees & Simpson 1995, D. Knight, Dansereau, Joe & Simpson
1994, Pitre, Dansereau, Newbern & Simpson 1997, Blankenship, Dees, & Dansereau
1999, Newbern, Dansereau & Pitre 1999)
•
Arrive for sessions drug-free: clients who map miss fewer sessions and have fewer
positive urinalysis tests for opiates or cocaine (Czuchry, Dansereau, Dees &
Simpson1995, Dansereau, Joe, Dees & Simpson 1996, Dansereau, Joe & Simpson
1993, Joe, Dansereau & Simpson 1994, Dansereau, Joe & Simpson 1995, Dees,
Dansereau & Simpson 1997).
After treatment outcomes (e.g. sober/drug-free, no arrests)
•
Clients who have mapped during treatment have fewer positive urinalysis tests for
opiates, less needle use, and less criminal activity (Pitre, Dansereau & Joe 1996, Joe,
Dansereau & Simpson 1997).
Mapping bibliography
Blankenship, J., Dansereau, D. F., & Simpson, D. D. (1999). Cognitive enhancements of
readiness for corrections-based treatment for drug abuse. The Prison Journal, 79(4),
431-445
Collier, C. R., Czuchry, M., Dansereau, D. F., & Pitre, U. (2001). The use of node-link
mapping in the chemical dependency treatment of adolescents. Journal of Drug
Education, 31(3), 305-317
Czuchry, M., & Dansereau, D. F. (1999). Node-link mapping and psychological
problems: perceptions of a residential drug abuse treatment program for probationers.
41
Journal of Substance Abuse Treatment, 17(4), 321-329
Czuchry, M., & Dansereau, D. F. (2000). Drug abuse treatment in criminal justice
settings: Enhancing community engagement and helpfulness. American Journal of Drug
and Alcohol Abuse, 26(4), 537-552
Czuchry, M. & Dansereau, D.F. (2003). A model of the effects of node-link mapping on
drug abuse counselling. Addictive Behaviors, 28(3), 537-549
Czuchry, M., & Dansereau, D.F. (2003). Cognitive skills training: impact on drug abuse
counselling and readiness for treatment. American Journal of Drug and Alcohol Abuse,
29(1), 1-18
Czuchry, M., & Dansereau, D.F. (2004). The importance of need for cognition and
educational experience in enhanced and standard substance abuse treatment. Journal of
Psychoactive Drugs, 36(2), 243-251
Czuchry, M., Dansereau, D. F., Dees, S. D., Simpson, D. D. (1995). The use of node-link
mapping in drug abuse counselling: The role of attentional factors. Journal of
Psychoactive Drugs, 27(2), 161-166
Dansereau, D. F. (2005). Node-link mapping principles for visualizing knowledge and
information. In S. O. Tergan & T. Keller (Eds.). Knowledge and information visualization:
Searching for synergies. Heidelberg/New York: Springer Lecture Notes in Computer
Science.
Dansereau, D. F., & Dees, S. M. (2002). Mapping training: the transfer of a cognitive
technology for improving counselling. Journal of Substance Abuse Treatment, 22(4),
219-230
Dansereau, D. F., Dees, S. M., Chatham, L. R., Boatler, J. F., & Simpson, D. D. (1993).
Mapping new roads to recovery: cognitive enhancements to counselling. A training
manual from the TCU/DATAR project. Fort Worth, TX: Institute of Behavioral Research,
Texas Christian University
Dansereau, D. F., Dees, S. M., Greener, J. M., & Simpson, D. D. (1995). Node-link
mapping and the evaluation of drug abuse counselling sessions. Psychology of Addictive
Behaviors, 9(3), 195-203
Dansereau, D. F., Dees, S. M., & Simpson, D. D. (1994). Cognitive modularity:
implications for counselling and the representation of personal issues. The Journal of
Counselling Psychology, 41(4), 513-523
Dansereau, D. F., Joe, G. W., Dees, S. M., & Simpson, D. D. (1996). Ethnicity and the
effects of mapping-enhanced drug abuse counselling. Addictive Behaviors, 21(3), 363376
Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1993). Node-link mapping: a visual
representation strategy for enhancing drug abuse counselling. Journal of Counselling
Psychology, 40(4), 385-395
Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1995). Attentional difficulties and the
effectiveness of a visual representation strategy for counselling drug-addicted clients.
International Journal of the Addictions, 30(4), 371-386
Dansereau, D.F., & Simpson, D.D. (2005). Brief Intervention – Mapping the Journey: a
Treatment Guide Book Fort Worth: Texas Christian University, Institute of Behavioral
Research. Online: www.ibr@tcu.edu
Dansereau, D.F., & Simpson, D.D. (2006). Brief Intervention-Mapping Organizational
Change: a Guide Book on Program Needs. Fort Worth: Texas Christian University,
Institute of Behavioral Research. Online: www.ibr.tcu.edu
Dees, S. M., & Dansereau, D. F. (2000). TCU Guide Maps: a Resource for Counselors.
Fort Worth, TX: Institute of Behavioral Research, Texas Christian University
Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1994). A visual representation system
42
for drug abuse counsellors. Journal of Substance Abuse Treatment, 11(6), 517-523
Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping-enhanced drug abuse
counselling: Urinalysis results in the first year of methadone treatment. Journal of
Substance Abuse Treatment, 14(2), 1-10
Joe, G. W., Dansereau, D. F., Pitre, U., & Simpson, D. D. (1997). Effectiveness of nodelink mapping-enhanced counselling for opiate addicts: A 12-month follow-up. Journal of
Nervous and Mental Diseases, 185(5), 306-313
Knight, D. K., Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1994). The role of nodelink mapping in individual and group counselling. The American Journal of Drug and
Alcohol Abuse, 20, 517-527
Knight, K., Simpson, D. D., & Dansereau, D. F. (1994). Knowledge mapping: a
psychoeducational tool in drug abuse relapse prevention training. Journal of Offender
Rehabilitation, 20, 187-205
Newbern, D., Dansereau, D. F., Czuchry, M., & Simpson, D. D. (2005). Node-link
mapping in individual counselling: treatment impact on clients with ADHD-related
behaviors. Journal of Psychoactive Drugs, 37(1), 93-103
Newbern, D., Dansereau, D. F., & Pitre, U. (1999). Positive effects on life skills,
motivation and self-efficacy: Node-link maps in a modified therapeutic community.
American Journal of Drug and Alcohol Abuse, 25, 407-423
Pitre, U., Dansereau, D. F., & Joe, G. W. (1996). Client education levels and the
effectiveness of node-link maps. Journal of Addictive Diseases, 15(3), 27-44
Pitre, U., Dansereau, D. F., Newbern, D. & Simpson, D. D. (1998). Residential drug-abuse
treatment for probationers: use of node-link mapping to enhance participation and
progress. Journal of Substance Abuse Treatment, 15(6), 535-543
Pitre, U., Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping techniques to
improve substance abuse treatment in criminal justice settings. Journal of Drug Issues,
27(2), 435-449
Sia, T. L., Dansereau, D. F., & Dees, S. M. (2001). Mapping your steps: 12-step guide
maps. Fort Worth: Institute of Behavioral Research, Texas Christian University
Simpson, D. D. (2004). A conceptual framework for drug treatment process and
outcomes. Journal of Substance Abuse Treatment, 27, 99-121
Simpson, D. D., & Joe, G. W. (2004). A longitudinal evaluation of treatment
engagement and recovery stages. Journal of Substance Abuse Treatment, 27, 89-97
Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1995). Client engagement
and change during drug abuse treatment. Journal of Substance Abuse, 7(1), 117-134
Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1997). Drug abuse
treatment process components that improve treatment. Journal of Substance Abuse
Treatment, 14(6), 565-572.
Other useful reading materials
Relapse prevention skills
Mary E. Larimer, Ph.D., Rebekka S. Palmer, and G. Alan Marlatt, Relapse Prevention: an
Overview of Marlatt’s Cognitive-Behavioral Mode. Available at
http://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf
Wanigaratne, S., Relapse prevention in practice. The Drug and Alcohol Professional,
2003. 3(3): p.11-18.
Marlatt, G.A. and D.M. Donovan, Relapse Prevention: Maintenance Strategies in the
Treatment of Addictive Behaviors. 2005, New York: Guilford Press.
43
Wanigaratne, S., Wallace, W, Pullin, J., Keaney, F. & Farmer, R. Relapse Prevention for
Addictive Behaviours. 1990, Oxford: Blackwell Science.
Social networks and behaviour, and network therapy
Copello, A., Orford, J., Hodgson R., Tober, G. & Barrett, C. Social behaviour and
network therapy – basic principles and early experiences. Addictive Behaviours, 2002.
27(3): p.345-366.
Copello A, Williamson E, Orford J & Day E.(2006) Implementing and evaluating social
behaviour and network therapy in drug treatment practice in the UK: a feasibility study.
Addictive Behaviors, 31(5) 802-810
Williamson E, Smith M, Orford J, Copello A, Day E (2007). Social behaviour and network
therapy for drug problems: evidence of benefits and challenges. Addictive Disorders and
Their Treatment 6(4):167-179
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