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January 17, 2008

RECOVERY MAPS: GUIDE CLIENTS...

... on their life path by drawing relapse and recovery 'maps'

Encouraging clients to draw ‘maps’ of their recovery can elicit information from the unconscious right side of their brains – Martin Weegmann steers us through

This article originally appeared in Addiction Today, March 2004.  It was prioritised on the list of archive articles to be uploaded to this website due to demand from drug and alcohol workers who regularly use it.

When I first came into the substance-misuse field, I read Marlatt and Gordon’s voluminous Relapse Prevention. Hoping to find the key to unlock addiction, I went away with more questions than answers... but at least with better questions.

When the fog of theory and research settled, what stood out most readily in my memory of the book was its use of metaphors – for example, the idea of relapse as a journey with signposts, roundabouts, turn-offs, crossroads and other choices. The book also used the image of ‘urge surfing’ to counter cravings and a visual of a map to illustrate the story of a gambler’s relapse. If these were the aspects which stood out for me, with all my psychological training, then perhaps such images might help patients.

Images can ‘stick’ and this could encourage thinking on the artistic and more unconscious ‘right’ side of the brain rather than the unemotional, rational ‘left’ side. Some art-therapy colleagues have used a version of this technique.

RELAPSE-RISK MAPS

Over the years, I have often used the technique of relapse maps in both individual and group therapy. Clearly, this fits with the relapse-prevention approach but is also compatible with other approaches: they can facilitate motivational work, psychodynamic exploration and solution-based therapy.

At the end of the day, such maps are simply a way of encouraging dialogue and entering into the client’s world: “doing a home visit without the visit”.

This need not be a one-off, since the therapist can return to and modify the map over time and invite discussion around “where next?” or “what are the sources of greatest risk?”. It can also be used in later abstinence, in which case I might call it a recovery map rather than merely a risk map.

HOW TO INTRODUCE MAPS TO CLIENTS?

Start by describing the principle to your client – that drawing a map gives us a bird’s-eye view of the client’s immediate relevant circumstances. From looking at it together, we can achieve a better sense of where the person lives, who they usually see, where are the dealers/fellow users, their sources of drugs or alcohol, and places of help and support.

I tend to take the lead the first time round, as clients can be inhibited if they think they must draw something. I ask for feelings associated with places – for instance, “describe your feelings about home in a few words”. I ask them to guide me as much as I guide them – “what else is important for you to put in the picture?”. If the picture lacks perspective – for example, it is depicted only in terms or risk or only in terms of recovery – I might redress the balance and ask clients to add the other side of the coin. I also ask them to put in the therapist or the clinic, with their feelings attached.

Finally, I ask them to give a title for the map, starting with their own name. “Indy’s lost in space” or “Sarah’s Routine” are shown in the two illustrations below. I encourage them, when they are at home, to draw their own version of the map and add other features as they think of them.

Recovery_map1

A world of using:

This map was by a heroin user – and it surprised him. Seeing what he was doing had a powerful effect, highlighting his immersion in drugs, and the users and dealers he could access. Indy added places like university and work which offered better prospects but were a real struggle to reach. Drawing the map helped him to face his minimisation and denial. Five years on, Indy’s map changed dramatically for the better.

Recovery_map2

Dry but not free?

Sarah’s map was completed after a year of sobriety. She had some fulfilling activities but the map brought home a sense of isolation. While she had ‘routine’, she did not feel close to others and could easily sit at home with her worries. Home life was a retreat from life, but therapy was a strong support. She recognised that more life or psychological development was important, but it frightened her – hence the routine.

CONCLUSION

Relapse-risk and recovery maps are a useful resource for clinicians. Borrowed initially from the relapse-prevention tradition, I have found these techniques useful at different ‘stages’ of recovery and within different modalities of treatment. They invite reflection on a person’s situation as it is and on that person’s next step in the journey. The travelling is, as always, as important – if not more so – than the destination.

Martin Weegmann is a clinical psychologist, group analyst and author of books such as The Pschodynamics of Addiction and Group psychotherapy & Addiction.  He worked for many years at the Gatehouse Drug Treatment Centre at St Bernard’s Hospital, Middlesex.

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