show by our encouragement that we are interested, that the speaker is not boring us, and that we are
putting their needs first. Just being listened to can encourage people to communicate what is on their
minds and can sometimes help them to sort out problems for themselves. It also builds friendships.
For clients who need to establish new relationships, point out that good listening is one of the most
effective conversational skills, and it helps to build friendly relationships quickly.
Next, as appropriate, have the client be the listener, using the same rules. Choose an appropriate topic
about which you can talk for a few minutes while the client listens. If a significant other has accompanied the
client, have the SSO be the speaker and the client the listener. Then debrief first by asking what it was like to
be the listener - what your client was experiencing. (For example, many people say that they thought of all the
things they would have said ordinarily.) Be sure to comment positively on what the client did well to
communicate listening and understanding. If there is something specific that the client could do to be a still
better listener, comment on it, but be sure to begin and end with positive reinforcement. If an SSO is present,
you could reverse roles and have the client be the speaker and the SSO the listener.
5.2b2. Avoiding Roadblocks
A next step is to explain that there are many things that people do, often with the best of intentions,
that are not really listening. Most of these have to do with putting in the listener’s own “stuff” - advice,
opinions, suggestions, and so forth. This is okay to do sometimes, but it really isn’t good listening because it
tends to put up a roadblock (Gordon, 1970). Instead of going along naturally, the speaker now has to deal with
your stuff - and basically go around it to get back on the same track (detour). Most often the conversation
winds up going off in a whole different direction, and never gets back to the original road.
A good conversation, of course, involves you talking about yourself as well as listening - some give
and take. What we are focusing on here, though, is good listening, which is harder for most people than
talking about themselves. Here are the main kinds of roadblocks that stop people from talking to you about
Giving advice, making suggestions, or telling the person what to do
Agreeing or disagreeing with what the person says
Criticizing, blaming, or shaming
Interpreting, analyzing, or being logical
Reassuring or sympathizing
Ignoring, withdrawing, or humoring
Again, it’s okay to do these things at times. Asking questions, for example, gives you information that is of
interest to you. But in good listening, you let the other person talk. In that way, good listening is a sacrifice.
You give up your own “stuff” for a while and give your whole attention to listening. It is a real gift.
5.2b3. Guessing About Meaning
If staying quiet isn’t enough, and many of the things that people say aren’t really listening, then what
can you say to be a good listener? That is the third piece of this module.
Go back to the “How Communication Happens” diagram and point out that when communication is
going well, the lower right box (what the listener thinks the person means) closely matches the lower left box
(what the speaker really means). Most people react to their interpretation as if it were what the speaker really
meant. Good listening involved checking out whether what’s in your lower right box (what you think it
means) is what the person really means (lower left box).
One way to do this is just to ask if what you think the person meant is what they really meant. This
works, but it does tend to get in the way of a smooth conversation. Nevertheless, it’s worth demonstrating.
Again, it may be useful for you to be the listener first while the client is the speaker, then reverse roles. Here
are the roles:
Speaker: Finish this sentence: One thing that I like about myself is that I _______________.
Listener: Ask a series of questions about what the speaker might mean. Always use the form:
“Do you mean that you ________________?”
Rule: The speaker may answer only “Yes” or “No” and say nothing more.
The exercise makes it obvious that one is “guessing” what a speaker means, and often is not right in the guess.
It also becomes clear that a speaker often means more than one thing - there are levels of meaning.
In debriefing when the client has been the listener (question asker), find out what the client was feeling
and experiencing in that role. Besides the insights above, there is often a feeling of frustration that “I wanted
to hear more than Yes or No.” Similarly, the speaker almost always in this exercises feels the frustration that
“I wanted to say more than Yes or No.” It illustrates that good listening naturally keeps a conversation going,
making the speaker eager to say more and the listener eager to hear more.
If the client brought an SSO to the session, have the client practice this with the SSO rather than with
you as a speaker. Their roles may then be reversed for a third round of practice. It can be good practice for
both people who are not the speaker to generate “Do you mean” questions.
5.2b4. Understanding Statements
Asking questions is not the best way to listen. The last step for present purposes is to teach your client
how to form understanding statements. The point is simply to say, as a statement, what you believe the other
person means. It’s a short step from the “Do you mean...” exercise. All one has to do, really, is drop off the
words, “Do you mean that” and inflect the sentence down (for a statement) rather than up (for a question) at
Speaker: I feel really low on energy this week.
Question: Do you mean that you’re feeling pretty tired?
Understanding statement: You’re feeling pretty tired.
Speaker: I don’t like the way you handled that.
Question: Are you saying that how I handled it didn’t seem fair to you?
Understanding statement: How I handled it didn’t seem fair to you.
It is worth discussing how the speaker might feel and respond to each of these. In general, questions pull
subtly for more defensiveness, argument, and negative response. A simple statement just tends to keep the
conversation going, and it doesn’t really matter if the guess was right or wrong. Either way the person tells
you more about what he or she meant.
To consolidate this next step, have the client practice making understanding statements. As before,
you can go first to show how it’s done, then reverse roles with the client. Here are the roles:
Speaker: Complete this sentence: One thing about myself that I would like to change is
that I _____________________.
Listener: Make an understanding statement (not a question).
Rule: The speaker should then respond with “Yes” or “No” and also say some more about what he or
she means. In response to this, the Listener makes another understanding statement, taking in
the new information.
Note that some speaker statements don’t go anywhere. “One thing about myself I’d like to change is my hair
color.” Or “One thing about myself that I’d like to change is that I smoke.” Even these sometimes lead in
surprising directions, but in general the speaker should offer something that has some feeling, importance, and
ambiguity attached to it.
One thing about myself that I’d like to change is that I’m scatter-brained.
You have a hard time concentrating on one thing at a time.
No, it’s not really that. But I’m losing things all the time, even in my small apartment.
And that doesn’t seem normal to you.
Yeah, well I guess everybody loses things, but I just feel like I can’t keep track of anything - where my
life is going, what day it is, birthdays, anything.
It’s like you’re out of touch with what’s going on around you.
Yes, and even with what’s going on inside me.
And that’s pretty upsetting. You feel a little out of control.
I feel a lot out of control. . . .
If an SSO is present, start with yourself as the speaker and both the client and SSO as listeners. Coach
them along the way in forming understanding statements, with lots of positive reinforcement. Then have one
of them become the speaker, and coach the other on making understanding statements, offering a few yourself
(but be careful not to usurp the listener role).
Don’t try to cover this whole module in one session. Cover an appropriate amount of material, and
then craft a home assignment to allow the client some practice in his or her own social environment. Listening
skills can be tried out with a partner who knows that it’s practice, or with someone else when only the client is
aware of trying to practice new skills. A reflection sheet (Form aa), filled out by the client after one or more
practices, can be a helpful aid for discussion at the next session.
5.2c. Increasing Positive Interactions
There is one more component to address within this module. This pertains particularly to
clients who have a primary relationship, whether or not the SSO is participating in treatment.
Decreasing negative communications and replacing them with more positive patterns of
communication is only one piece of the puzzle. Cognitive-behavioral relationship therapy
typically includes increasing the level of shared positive activities - another way of making deposits in the
relationship piggy bank.
Begin this section by explaining that good relationships are fostered by doing positive things together.
During dating and courtship, most of the time that people spend together is focused on fun and positive
activities: sharing meals, dancing, physical intimacy, etc. Over the course of a relationship this can decay, and
less time is shared in pleasant activities, more in routine or even aversive activities. Sharing positive
experiences strengthens a relationship (including friendships) and deepens positive feelings for each other.
Make sure that this rationale makes sense to the client (and SSO) before proceeding.
The key here is to find fun, pleasant, positive activities that can be shared and that do not involve
drinking (see SARC module 5.8). One avenue, in a relationship with some history, is to ask what attracted the
couple (or friends) to each other in the first place - what things they did together that were fun early on in the
relationship, etc. When both partners are present, keep this discussion free of implicit criticism (“Well, back
then he was fun to be with.”) Use reflective listening to emphasize positive aspects that are offered (a
relationship-building form of self-motivational statements). Brainstorm what things the client and SSO enjoy,
that they could do together as experiences that would be positive for both.
Negotiate specific shared positive activities as assignments between sessions. Be careful not to make
too big a jump at first. If it has been a long time since they shared fun activities, start small and simple. The
goal is just to have a good time together (without drinking). Positive communication practice can be integrated
into these assignments. For example, a “sofa session” can be assigned in which each partner takes turns
talking about his or her day, feelings, hopes, etc. - perhaps 5 minutes each at first - while the other gives full
attention to listening without roadblocks. If both partners are participating in treatment, it is wise to try this in
the office first to make sure that the needed skills are in place or can be coached. As with all assignments, give
priority to asking about and discussing the assignment at the beginning of the next session. Assignments of
having fun can continue while other modules are in progress.
Reference: Form aa
5.3. Coping with Craving and Urges
Craving and urges to drink are most often experienced early in treatment, but may persist for weeks or
even months after a person stops drinking. These experiences may be uncomfortable, but they are very
common and do not mean something is wrong. Expect craving to occur from time to time in your clients, and
be prepared to cope with it.
The words “urge” and “craving” refer to quite a broad range of subjective experiences that include
thoughts (“Wouldn’t it be nice to have a drink now”), positive expectancies (“I’d feel better if I just had a
couple of drinks”), physical sensations (such as tremulousness), emotions (like feeling anxious), and behaviors
(such as pausing as one passes the beer display in a store). The fundamental phenomenon is a subjective
experience of increased risk (probability) of drinking despite at least some desire not to do so. This can be
experienced as an actual or potential loss of control, in the sense that Jellinek (1960) called “inability to
abstain” (to distinguish it from an experienced inability to stop drinking once started).
In this regard, perhaps the most important and central message of this module is that experiences of
urges and craving are predictable and controllable. The following are particularly important messages to give
to a client:
1. Urges to drink are common and normal in the course of recovery. They are not reason for alarm or
a sign of failure. Instead, learn from them.
2. Urges to drink or craving tend to occur in certain predictable situations; they are triggered by things
in the environment. The drinker may not initially be aware of the environmental triggers for these
experiences, but they can be identified. Typically they are sensory experiences - seeing, hearing,
smelling something that has been associated with drinking (or withdrawal).
3. Sometimes the triggering event is internal - such as a thought or physical sensation. Physical
sensations may include tightness in the stomach, mouth dryness, or a vaguely nervous feeling.
Triggering thoughts can include imagining how good it would feel to use alcohol or drugs,
remembering drinking times past, planning how to go about getting a drink or drugs, or thinking “I
need a drink.”
4. Craving and urges are time-limited, that is, they usually last only a few minutes and at most a few
hours. Rather than increasing steadily until they become unbearable, they usually peak after a few
minutes and then die down, like a wave. You can “surf” over them. (For skiers, the image of skiing
over or around moguls without falling might be better.)
5. You win every time you surf (ski) over an urge without drinking. Indulging an urge only feeds and
strengthens it. On the other hand, when you learn how to cope with them, urges become weaker and
less frequent over time.
6. This raises the last important point: you are not helpless in the face of craving or urges to drink:
rather there is something you can do about them. It’s like learning to ski the moguls or surf the
5.3b. Discovering and Coping with Trigger Situations
A first step is to identify the particular cues
or situations in which the client experiences urges or craving. Ask your client to describe
recent situations in which he or she experienced craving or an
urge to drink. (Note: Some clients do not identify with the
term “craving” but will talk about weaker and stronger urges
to drink. For others, “craving” is a meaningful term that
describes their experience. Use the terminology that is
comfortable for your client.) Ask:
What specifically was the experience like? How did the client know that she or he was having an urge
to drink, or was craving? Was it a thought, a physical sensation, an emotion ....?
What was happening just before and during the experience? Where was the client - with whom -
doing what? What was going on; what did the client see, hear, smell, taste, feel?
What happened after the experience or urge or craving? Did the client drink? If not, how did the
client succeed in staying sober? What did the client think, feel, etc. afterward?
Be aware that talking in detail about a craving experience can itself trigger sensations of urge or craving. This
is not something to fear - in fact it can be a good opportunity. It is wise, however, not to start this process at
the end of a session, before you have time to discuss and debrief it. Check in with your client periodically
during the sessions of this module to find out whether he or she is experiencing urges or craving right there and
The point of this step is to identify urge triggers so that you can plan coping strategies for them. Most
likely there will be multiple cues that can trigger urges, so make a list of higher-risk situations. The New
Roads exercise from Phase 2 (Triggers column) may give you some good material here. The best initial source
is likely to be the client’s own recollections of situations in which craving or urges occurred, even though the
client may not know initially what it was about the situation that triggered a desire to drink. Some common
external triggers include:
Exposure to alcohol itself
Seeing other people drinking
Contact with people, places, and things previously associated with drinking (such as drinking
companions, parties and bars, watching football on TV)
Particular days or times of day when drinking tended to occur (getting home from work, weekends,
Stimuli previously associated with withdrawal (hospital, aspirin, morning).
Other triggering stimuli are internal rather than external (though none of them are eternal). These can be
puzzling to the person because they do not seem to occur in predictable situations, but “just pop up.” Some
Particular types of emotions (such as frustration, fatigue, feeling stressed out). Even positive emotions
(elation, excitement, feelings of accomplishment) can be triggers.
Physical feelings (feeling sick, shaky, tense, having a headache). These are often misattributed; they
occur for a reason that is not immediately apparent to the person (e.g., normal anxiety, high or low
blood sugar, caffeine intake), and are misinterpreted as craving, withdrawal, or a “dry drunk.”
5.3c. Monitoring Urges
Some triggers are hard to recognize through in-session discussion, and for this and other reasons self-
monitoring of urges can be a useful procedure. Blank urge monitoring cards are shown on the next page,
along with an example of a partially completed monitoring card below.
As with any home assignment, first provide a rationale for urge monitoring. Describe benefits that are
likely to be meaningful to your individual client (better self-awareness, greater self-control, feedback of
improvement, etc.). Better still, ask your client how keeping these records for a while might be beneficial
(elicit self-motivational statements). Set a time limit on the monitoring (usually 2-3 weeks), at the end of
which you will reevaluate together what has been learned and whether it is useful to continue.
Make it easy. Give your client self-monitoring cards. Form bb can be photocopied onto card stock,
from which cards can be trimmed out for clients.
Reference: Form bb
Documents you may be interested
Documents you may be interested