Session 9 Protocol: Elective Skill Topic 2

The counselor welcomes the client and provides an overview of the session. In this session, the counselor helps the client recognize and handle seemingly irrelevant decisions.

Provide Information on the Effects of Seemingly Irrelevant Decisions

The counselor helps the client understand that apparently irrelevant decisions can have major repercussions (see Marlatt and Gordon 1985):

Counselor (C): Many ordinary choices seem to have nothing to do with using. Although they may not involve choosing directly whether to use, they move you closer to making that choice. Through a series of minor decisions, you come to a point where using becomes likely. These seemingly unimportant decisions that put you on a path to resuming marijuana use are called seemingly irrelevant decisions. [Refers to form 9C.]

The counselor tells a story about relapsing (adapted from Carroll 1998):

C: George was driving home from work and decided to take the scenic route. He realized he had forgotten to call his wife to say he’d be late. While looking for a pay phone, he remembered that his old smoking buddy Ric lived nearby, so he decided to stop at Ric’s to use the phone. It was a Friday evening, which he remembered was party night for Ric.

George noticed several cars parked at Ric’s house. He paused a moment to deliberate, deciding that he needed to call his wife and told himself that he would go in for a minute to use the phone. Ric answered the door clearly stoned and invited him to reconnect with old friends. George entered the smoke-filled house and recognized friends from his using days who passed him a blunt. Debating only a second, George took it and began to smoke. That was the first of many he had that night. Because George’s marijuana use was linked with these friends, his choosing Ric’s house to make his call led to his getting high that night.

You can see that George made several decisions that led up to his final decision to smoke. At each point, George could have made a different decision that would have kept him from a dangerous situation. Did he have to call his wife? Did he have no alternative but Ric’s house? Could he have said no to his friends? Each decision brought George closer to danger. Ultimately, George’s decision to have that blunt led to his relapse to marijuana use.

Help the Client Anticipate Thoughts of Himself or Herself as a Victim

The counselor helps the client anticipate future thoughts:

C: People often think of themselves as victims (“Things happened, I ended up in a risky situation, and I got high; I couldn’t help it”). They don’t recognize that their little decisions gradually bring them to their predicament. After the fact, it’s easy to see how you set yourself up for relapse, but it’s harder to see what can happen when you’re making the decision. So many choices don’t seem to involve using at the time. Each choice may take you a little bit closer to making a big choice. When marijuana isn’t on your mind, it’s hard to connect using to a minor decision that seems removed from using.