Sometimes an effective intervention is developed from nothing more than reviewing an old technique and its components. I cannot remember the first time I was told to “list the pros and cons” when facing a decision. Treatment professionals, mutual support people (i.e. 12 Step sponsors), parents, spouses and just about anyone who has ever been given the advice themselves has passed this pearl on to ­others.

What is overlooked with this sage bit of wisdom is a natural predisposition against making changes. I have found this to be especially prevalent when working with individuals afflicted with addictions. Fears of failure, fears of success, lack of self confidence and a negative self image are just a few of the reasons given for the inertia. Usually, a long list of reasons for making a change cannot overcome these internal roadblocks. Often, even when I reach an agreement with the client that the change is necessary, and that the proposed solution to the problem is sound, I find in the follow-up sessions that inertia has taken over and that no action has been taken.

Generally, clients offer very little in the way of plausible reasons for not taking action. They readily acknowledge that the change is needed, that the course is a reasonable one, and that their situation would be improved by making the change. Conversely, they were able to articulate well the negative consequences of not making the change. What was not being adequately explored was either the payoff for not making the changes or the perceived negative outcomes from making the changes. When this became evident, I ex­plored ways to incorporate these two elements into the decision making process.

The result is what I call the Four Quadrant Problem Solving Aid, or the Four Quadrant Decision Making Aid. Either moniker describes the process. I have revised the old method of drawing a line down the middle of the paper to separate the pros and cons by having the client draw an additional line. The aforementioned vertical line is supplemented with a horizontal line to divide the paper into quadrants.
In the upper left quadrant I instruct the client to list all of the anticipated positive outcomes for taking the proposed action on the issue being considered. The upper right quadrant is for the anticipated negative outcomes taking the action. The lower left quadrant is for the anticipated positive outcomes for NOT taking the proposed action on the issue being considered. Finally, the lower right quadrant is for the anticipated negative consequences for NOT taking the action. I usually will work through one or more of these with the client.
Actively addressing considerations for not taking the proposed action accomplishes two important factors. First, it acknowledges that they exist. As simple as this sounds, we often miss the mark by calling this inertia denial, defensiveness or resistance; and ignore its significance in the transition from decision to action. Second, by identifying a client’s reluctance to take action, it is easier to identify, address valid concerns and separate them from frivolous excuses.

Four Quadrant case study
An example of the technique in action, along with the results, may help to illustrate the application of this intervention. I had a client whose daughter was in residential substance abuse/behavior modification treatment. The daughter’s primary counselor wanted to start joint counseling sessions. My client was struggling with this decision as her daughter’s perceived behavior was continuing to be manipulative and deceitful, and she felt that her daughter’s manipulation was being effective and that the treatment staff believed her. Past visits had left her feeling that the staff was working against her and “siding” with the daughter. After brainstorming the four quadrants, there were two quadrants that held a clear majority of the items. One was the anticipated negative results of taking the action. The other was the anticipated positive results for not taking the action. Further processing of the entire list shifted some of the items to create an even further imbalance. When she was able to see the results in front of her, she decided not engage in joint counseling. The decision and reasoning behind it were respected by her daughter’s counselor, who made no attempt to pressure my client to change her mind. Later, the same client reported to me that she had utilized the Four Quadrant technique in her decision-making process when offered a promotion and major change of job responsibilities at her place of employment.
For this client, the considerations for not taking the action were at least as important as the considerations for taking the action. By acknowledging and processing the considerations for not taking the action, she was able to make an informed decision which she was able to translate into action; which in this case was to decline to make the change. As a result of her previous utilization of the technique, she decided to replicate the technique for assistance in her decision-making concerning her employment. She decided to take the action and accept the promotion/job change. In both of these situations, understanding the reasoning behind why she was taking, or declining to take the action, was instrumental in translating the decision into action.

This speaks to another consideration. Many of our clients have difficulties with self-confidence, and often will not take action due to not believing they are capable of taking action they know is ultimately in their best interest to take. Having their fears on paper assists them in overcoming them. One client was struggling with relationship issues. The relationship had started while both were in active addiction and now that she and her partner were in early recovery she was filled with self doubt about her feelings and his. She was given the assignment of completing the technique. During the next session, she processed how she was able to see that most of her fears were groundless. She was then able to make a renewed commitment to the ­relationship.

Now, let’s put the technique into practical application. You are my client and I am going to assist in deciding if the technique will benefit your practice or not. First we construct and label the quadrants. When completed it looks like this:
 • Anticipated positive outcomes utilizing this technique with my clients
• Anticipated negative outcomes utilizing this technique with my clients
• Anticipated positive outcomes from not utilizing this technique with my client
• Anticipated negative outcomes from not utilizing this technique with my client

Next, brainstorming outcomes and placing them in the appropriate quadrant is assigned as homework. Finally, we process the completed quadrant chart. Since I am not available to help with the processing, you will have to determine for yourself if this technique is worth trying with your clients. I have found that it has beneficial for my clients, I hope you will also.

Robert Proehl, CADC provides substance abuse and anger management counseling to clients at Gateway to Prevention and Recovery in Shawnee, Oklahoma. He has worked in the field of substance abuse counseling for over 12 years and is currently enrolled in a Master’s program in counseling. He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Comments

Add New Search RSS

Write comment
Name:
Email:	do not notifynotify
Title:

Powered by !JoomlaComment 3.26

3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."