WORKING WITHIN COGNITIVE PROGRAMS

Carl Reddick ©

7/12/02

Why is Cognitive Programming different?

Social Service agencies have, historically, been known as ‘helping agencies’. In that particular incarnation they have presented themselves as places where persons could apply to have their problems resolved. Now, at the turn of the century, we are finally realizing that most social problems are horribly intertwined. Problems that affect the education of a school child reach far beyond the number of teachers in the classroom. Problems with substance abuse will often have generational antecedents. Lack of employment and job readiness may have their origins in drug and alcohol usage. Lack of social learning skills may be more closely tied to pro-criminal thinking patterns than lack of opportunity in the local community.

Cognitive programming, also known as cognitive restructuring or challenging belief patterns, does not focus on the behavior. It focuses on the thoughts driving the behavior. These thoughts are often perceptions of the self. Questioning a person’s behavior will inevitably lead directly to resistance and denial. Questioning what it is that the other thinks about themselves, and their possibilities for change, leads in a different direction altogether.

For example, a therapist may focus on the medical aspects of addiction; a benefits counselor may focus on client eligibility, and a teacher on the subject matter to be taught. All these are important, but none will lead a resistive drug addict to get clean and sober, none will lead a poor person to apply themselves to the accumulation of wealth, and none will encourage a resistive and disruptive student to learn.

Those agencies interested in cognitive programming soon discover that their basic function had previously been to apply direct first aid to a specific client deficit. Here’s your check...here’s your group session...here’s your F. But the issue driving the behavior has been left to the nebulous ‘them’ that deal with mental issues. “I don’t know why he does it and I don’t care” is not an untypical response from social service agencies. Well, in this age of diminishing resources and higher public expectations, the bar has been raised for the public service provider.

Consider this...’what are the causes of crime’? I mean the real causes. Take a moment and reflect on what your neighbors discuss when they speak of this issue. Poverty? Poor family relationships? Lack of education? Drug usage? Now ask yourself, “Which of these causes is addressed by the criminal justice system”? What do the judges, the district attorney, the police department, the probation, and the prison systems do that addresses these causes?

Now apply this question to your own agency. What do you do day in and day out, and how much of an effect is that having on the root causes of the problem that drove the client to your agency?

This is how cognitive programming is different. Cognitive programming, or more correctly cognitive/ behavioral programming, helps the client to understand what she thinks about herself and how that type of thinking exacerbates the problem in the first place. When that issue is addressed we can begin to expect change. That change can lead to a resolution of the underlying issue and the removal of the client from your service roster.

I. Cognitive Restructuring

Cognitive restructuring is the first step in cognitive programming. It is just one piece of the cognitive/behavioral spectrum. It is often called the ‘motivational piece’. If your agency is in direct service delivery (welfare, employment, housing, probation, counseling etc.) You may have noticed directives to do more with less. That is: ‘job readiness’ for welfare departments, or ‘drug programming’ for housing departments, or ‘parenting skills and contracts’ for local schools. The list is expanding daily and agencies often feel overwhelmed at where to even begin offering a subject matter they are not familiar with to a population that is hostile to the entire concept. Welcome to cognitive restructuring.

Levels of Receptivity: Usually persons seeking help from public service agencies have some fairly low levels of being receptive to new ideas about their current situation. So the restructuring process usually begins with the question “why change?” Working within cognitive programming requires an exceptional level of listening skills. So listen very very carefully to the client’s answer to the question ‘why change? Write it down. Consider it. Mull it over and treat the answer with respect. Therein lies the key to all the rest of the work ahead.

Reception levels will vary. Those who are ready for change will be very verbal at this stage. Those not ready to change will become withdrawn. The goal of cognitive restructuring is not to change everyone...it simply aims to provide a tool to persons that are dissatisfied with their current situation. A tool that challenges an individual’s belief about who they are and what they are capable of. A tool that answers the very valid question “What’s in it for me?”

Other solutions: Now we are ready to work with the question ‘why change?’ What would a changed world look like to the client? Where would they be working...how did they get that job...what does their family look like...what is their stress level? Is this something they truly want? The answers to these questions will usually be affirmative. And just as quickly, denial and self-doubt will set in.

Effective Programming: Andrews and Gendreau (1994) are very specific in ‘what works’ as far as programming is concerned.

Effective Programs are:

Multifaceted and address the complexity of the client’s lives.

Teach clients to change/manage antisocial thinking.

Increase self-control and problem solving skills.

Addresses lying, stealing, and aggression.

Teaches pro-social skills.

Enables participants to recognize risky situations.

Teaches how to formulate concrete well-rehearsed plans.

Ineffective programs are:

Programs that only use pieces of researched programs.

Psychodynamic therapies with non-directive counseling.

Participant directed group sessions.

Programs that target services that are not predictive of change (poverty/race /history)

Thinking Patterns: Cognitive restructuring providers become extremely adept at recognizing the vocalization of thinking patterns. The patterns that restructuring first attempts to deal with are the justifications of behavior that brought the person to your agency in the first place. These are predictable. The first and easiest one to deal with is the belief that ‘I am a victim’. Another pattern is the beliefs that ‘society’ is something separate from this particular person. The overarching pattern is the attempt to justify behavior.

Please make a special note that cognitive programming stays as far away from the ‘behavior’ as possible. Cognitive programming focuses exclusively on the thoughts, perceptions, and beliefs of the client.

Listen for the pattern:

‘Everyone knows...’

‘I can’t...’

‘If they would only...’

‘It’s only a matter of time until...’

‘It got (stolen, killed, burned)...’

‘I wouldn’t have done it if he hadn’t of...’

‘You know what happens when I...’

‘No matter what happens I always...’

‘They always...’

‘I can’t stand it anymore’

Challenging thinking patterns: Motivation is a strange process. You will actually see a different type of person when the ‘light goes on’. Many of our clients have extremely limited interpersonal skills. This is what you are working with. So when a client withdraws or becomes hostile the cognitive worker needs to seize that energy and teach a lesson. Interpersonal skills and a type of language would usually be the first goal of the service provider. Cognitive skills that challenge the person’s belief system help them to navigate in this new world where their self-image is crumbling around them. Remember you are dealing with thinking patterns that, for the most part, have been reinforced since birth.

The ‘language’ asks what the specific complaint is. For example:

“Why are you here?”

“I’m addicted to drugs so I can’t change”

“Why do you use drugs?

“To hide the pain”

“The pain of what, specifically?”

“Everything “

“What, specifically”

“I’ll never get a job”

“You’d like a good job.”

“Yeah”

“Does using drugs get you closer to a good job...or farther away?”

The spark you see in the resistive client eyes needs to be fanned into a tiny flame. You see, you are not working with the behaviors (drug usage, unemployment); you are working with the beliefs (drugs hide pain, I’ll never get a job).

You have now entered the client’s world. This is your honest attempt to see the problem and the world as the client sees it. Look at their well-worn paths. Look at the barriers, as the client sees them. Walk around in their mind. Get comfortable there because this is the entire system you are attempting to help her change. So you need to have a good understanding of this world. This is a world of their own creation. But it is only the portion they willing to reveal. Often this world masks a different, far scarier, world where drugs are only a symptom. To show you the whole world would be shameful to the client. So we deal with only that which is revealed. Remember our job, at this point, is motivation, not therapy.

Defending the world: The client will now begin using the skills she has spent her whole life perfecting in order to defend her world. Events will be remembered to prove that behaviors she exhibits make sense and are necessary to her very survival. This will occur even if these behaviors are the cause of the misery that drove her to your agency in the first place.

But we will focus only on their beliefs. In cognitive programming we understand that the world will not conform to anyone’s belief about the way it ‘ought’ to be.

When clients realize that their behaviors are driven by their beliefs they will look for scapegoats to blame for their behavior. This is a fascinating and very predictable stage. Everyone from his or her parent to ‘society’ will be mentioned. They will judge their behavior in relationship to other’s behavior.

But we will focus only on their beliefs. In cognitive programming we understand a discussion of behavior relative to the rest of the world will soon fizzle out when we ask the question, ‘and what did all that get you?’

When the clients realize that this is a response frequently heard by the cognitive change provider, they will then challenge the provider’s world. Be very careful here. You are guiding, not imposing your beliefs on their world. Your beliefs will most likely not work in their world. This is especially true in the areas of domestic violence. This is where the client begins to realize that most, if not all, of their beliefs (their world) are not true. And if it’s not true, it must be a lie.

But we will focus only on their beliefs. In cognitive programming we understand the fear caused when belief systems are challenged. We understand the disorientation caused when clients realize they have confused their actual person with their current personality.

The Traps: As the cognitive process progresses some clients will begin to look to the provider as the holder of the ‘golden truth’’. They will deduce that the provider has certain knowledge that can be imparted to the client to ‘fix’ them. Beware this trap. Cognitive providers do not give advice. They resist the urge to mount the soapbox. They keep focused on the client’s vision of himself. They quickly turn all discussion of the provider back to the task at hand.

It is unethical to set up a scenario where the client is led into viewing the world as the provider views it. That is not cognitive programming. That is brainwashing.

As a group, the clients will be very busy validating each other’s lives. This is a self-defense technique on their part. It takes a strong provider to keep the conversations and discussions on a track set by the program, not the participants. Free flowing discussions will inevitably focus on validation of behavior that brought the group together in the first place. Cognitive programming is very different from the dynamics of a therapeutic community. The questions ‘what happened last week’ or ‘does anyone want to share’ are inappropriate at this stage. We are presenting information and questioning beliefs at this stage.

Facilitating Change: The cognitive change provider should now have an accurate picture of what the client wants. Avoid discussing what the client doesn’t want.

The provider must also have a good idea of the client’s belief system. (“ I’ll never get a good job”)

The provider must articulate the ‘logic’ behind the belief system. (“You use drugs to hide the pain of never being able to get a good job”).

The provider then asks what job prospects would look like if the client stopped using drugs. (“Would stopping drugs make your job possibilities better or worse?)

If the client answers that the job prospects would be better if the stopped using drugs then the provider should ask them why they use drugs.

And so it goes. Most clients will then switch to the real (different) reason they use drugs. Repeat the above process. This is called the Socratic dialogue. When the client reaches the end of logic, they will say they use drugs because that’s ‘who they are’. Remind them that originally they told us that usage was to hide ‘the pain’. At this point you can broach the subject of drug usage as possibly the most destructive element of their current personality. At no time, and under no circumstances do we attack the person? We continue to concentrate on their beliefs only. And we simply inquire about their statements. Therapy is for the therapists, moralizing is for the preachers; solutions are for those smarter than we are. We are just inquiring about beliefs. And if the client should have an insight into their current situation we can make the appropriate referral to the appropriate specialist.

One of the goals of cognitive restructuring is to produce more motivated clients all along the system. More motivated to cooperate, to improve themselves, and to solve their problems, with our assistance, by themselves. Only by taking personal responsibility for their belief systems can they have any hope of changing the behavior that brought them to our agency in the first place.

II. Cognitive Skills Training

The second step, and this is often a separate program altogether, is to teach new skills to the participants. Once the client looks at ‘the problem’ from a different angle (a different cognition) they find themselves in an uncomfortable place with few relevant skills. If a person has responded to stress and anger with violence, they are probably in need of negotiation skills, anger management and so forth. These are the skills we, as providers, take for granted. Please resist the urge to assume these skills and solutions are already part of your client population’s repertoire.

Teaching Steps: Cognitive skills training help clients consider alternative ways of responding to interpersonal situations. This includes taking thoughtful rather than impulsive action. A good example is the ‘skill steps’ in making a complaint (Goldstein and Glick 1987)

1) Decide what the complaint is

2) Decide whom to make the complaint to

3) Tell the person your complaint

4) Tell the person what you would like done about the problem

5) Ask the person how she feels about what you’ve said

Providers that already own these skills may see the above steps as so obvious they don’t even need to be taught. Believe me, these skills are new work for persons used to attempting to get their own way through violence.

What used to be presented rehabilitation is now being referred to a habilitation. In other words, some of the skills necessary to fulfill the expectations your agency has of this clientele were never instilled in the first place. Job seeking skills, parenting skills, sobriety skills, financial and legal skills are simply absent. Worse yet, the client’s attempts to ‘deal’ with the addiction or the children or many other issues exacerbate the problem. Even worse, these ‘attempts’ (as destructive as they are) are validated by the client’s peer group. So deconstruction of the skill into ‘steps’ cannot be overlooked. And every exhibit of resistance to the validity of the ‘step’ being taught should bring up the cognitive restructuring pieces mentioned above.

‘You can’t raise babies like that’

‘Like what, specifically?’

‘Like that’

‘Like what specifically?’

‘You know, you gotta spank them’

‘You spank your children’

‘Yeah, or else they won’t do what you say’

‘Why were you sent to this class?’

‘They said I hit my kids’

‘You hit your kids’

‘I spanked my kids’

‘Why’

‘They wouldn’t do what I said’

‘And what did that get you?’

‘It got me here...to this stupid class’

‘That must be disturbing and confusing to you’

At this point in the conversation the provider can introduce new concepts in dealing with a crying child. New steps to consider.

Role Model: At all times the provider must employ the ‘language’ and speak in a way the client can emulate.

Role Play: People learn at different speeds and therefore role-playing and the subsequent analysis is a necessary part of cognitive skills training. Some programs employ personal journals often called ‘thinking reports’. Some rely on videotaping. All cognitive skills programs have constant and constructive feedback.

Homework: In addition to role-playing, homework reinforces the skills being presented. Remember, these skills are an ability to listen, express a complaint, avoid a fight, respond with respect, and negotiate a solution. Every assignment must reinforce the link between thinking and behavior.

II Summary There is a classic pattern of thinking employed by the resistive client (Van Dieten 1994).

A feeling that the current situation is unjust for reasons beyond the client’s control

Extreme resentment at the injustice of the situation

Anger or Victim’s stance (Samenow 1995)

Threatened sense of self

The incident itself (beat the child, don’t show up for the job interview)

Vindication - I’m OK

Cognitive programs, as contrasted with Freudian, medical, or educational models require certain components. In applying the components addressed above remember these things once you’ve encountered the ‘problem’ as presented by the client:

1) Completely understand the problem from their point of view

2) Write their ‘solution’ to the problem down and ask them if you have worded it correctly.

3) Ask why they believe that particular solution would solve that particular problem.

4) Ask them what goal they are trying to achieve applying that particular solution to that particular problem.

5) Inquire how long they have been applying that particular solution to that particular problem.

6) Ask them what usually happens to the problem when they apply that particular solution.

7) Raise the possibility of the existence of a different solution.

8) Teach them pro-social skills as alternative solutions to these problems.

This is difficult work and demands a strong commitment from both the provider and the provider’s administration. A solid understanding of these basics will be necessary prior to launching any program purporting to be cognitive or cognitive-based.