Reflecting Discrepancies and Alcohol Abuse
BSHS 322

September 1, 2011
Kathy Roberts

The power to stop an addiction takes more than will power. It takes desire, want, and strategy. When possessing the ability to remove an addiction the individuals who are in this situation have a big load to take in. The strategies of overcoming, conquering, and not relapsing can give these individuals the confidence that they are craving to take the next step forward. The topic that will be discussed is using discrepancies to overcome alcohol abuse. What will be covered in the topic are the description of reflecting discrepancies, a brief review of the research addressing reflecting discrepancies, a description of the client's or staff member's behavior that will be addressed by reflecting discrepancies (hypothetical client), a description of the desired behavior that will replace the problem behavior, and a demonstration of using reflecting discrepancies with a client or staff person. The goals for this paper are to learn what discrepancies are and how one can overcome alcohol abuse by using discrepancies daily. Discrepancies are defined as change; a person can change his or her way of thinking if he or she has the right tools and motivation to do so. Most of the techniques used in reflecting discrepancies begin with listening to the clients. Discrepancies most likely appear as inconsistencies between two statements, between thoughts and feelings, between intentions and behaviors, and between verbal and nonverbal communication (Murphy & Dillon, 2003). According to Lynn Jones, when discrepancies are reflected to them, people turn around. So each of the techniques used in reflecting discrepancies are researched so that each helps the clients realize discrepancies and resolve inconsistencies. This leads to a better understanding for clients and helps them to move toward change. In alcoholism treatment motivational interviewing is used. The motivational therapist uses several techniques to help the patient to increase his or her motivation to change his or her behavior (Diclemente, Bellino, &Neavins, 1999). One technique that the motivational therapist uses is reflective listening; a form of paraphrasing that enables patients to more fully tell their stories and to believe that they are heard by the empathetic MI therapist (Diclemente, Bellino, &Neavins, 1999). According to Jones, “Motivational Interviewing is the process developed to prepare people for making challenging behavior changes” (Jones, 2007). Part of motivational interviewing is using the technique of reflecting discrepancies. Most believe that treatment of substance abuse is about denial. William Miller, Ph.D. says “that when he first started studying treatment approaches for alcoholics, he read that alcoholics are liars, in denial pathologically defensive and impossible to work with” (Jones, 2007). However, this is not always true and Miller found that reflective listening worked better than the approach of ‘you are an alcoholic, and you had better stop drinking’ (Jones, 2007). Using this approach made the patients believe that they were making choices about their lives. The research has shown that using techniques such as reflecting discrepancies is one of the most effective tools of motivating change in substance abusers. Discrepancies are shown in different forms during a counseling session. The discrepancy could be between what a client says and what the client’s body language is saying, it could be a direct discrepancy between two different pieces of information the client has spoken about, or it could be a discrepancy between information the client has given the clinician in the past and what the client is saying during a different session.One of the fields of counseling that discrepancies tend to occur in often is in the treatment of alcoholism. On the one hand…on the other hand, is a technique used often to reflect discrepancies that occur during a counseling session. This technique can be effective in indicating a discrepancy to a client immediately after the clinician has become aware of it (Murphy & Dillon, 2003). Using this technique with an alcoholic client could be set up by the client stating that he or she does not believe that he or she has a problem with alcohol, however, at the same time the client has been mandated by the courts to enter counseling because he or she was convicted of a sixth drunk driving offense. To point this discrepancy out to the client the clinician would say on the one hand you have said that you do not have a problem with drinking alcohol but on the other hand you have been mandated to treatment for a drunken driving offense. The “Columbo Approach” is based on the television show Columbo.According to Miller and Rollnick(1991)this approach is fairly unassuming and nonthreatening to a client. To use the Columbo approach with an alcoholic client a clinician would interject questions based on discrepancies that have been discovered during the time of the session. An example of this is the clinician knowing that the client previously had said that he or she hates the way he or she acts when drunk but has also stated that drinking excessively occurs at least twice a week. The clinician could say,“During the session last week you were really unhappy about the way you felt when you get drunk. I thought I also heard you say that you generally drink excessively at least twice every week. Can you make me understand how these two things fit together?” When using this approach the clinician needs to remember their voice tone with their client to avoid causing him or her to become defensive. Directly showing an inconsistency during a session is another technique that clinicians use to reflect discrepancies. This technique is very straightforward and to the point. Pointing a discrepancy out directly can be very confrontational, so doing so in a sensitive way will work better under most circumstances (Murphy & Dillon, 2003). For example if the client were to say that he or she knows that drinking is causing many troubles in his or her life and later says that the plans for the weekend is to tailgate at the ballgame for several hours before the game with a keg of beer. The clinician could state that he or she sees a direct inconsistency in what he or she is saying. Pointing out that earlier the client had admitted drinking was causing many of the problems that are happening in his or her life and that shortly after that he or she discussed plans that were going to include drinking to an excessive level. When the clinician says this it would be best that the clinician and client were at a point in there clinical relationship in which a direct statement like this would not cause the client to become defensive. Another method is to wait and see if a pattern of inconsistencies emerges from the dialog of several sessions. In doing this the clinician can build a stronger case for the client to see the inconsistency and also help the clinician convince the client of the need to change (Murphy & Dillon, 2003). An example of using this method with an alcoholic client would be to have several sessions both with the client alone and with the client’s family and friends. Some of these sessions should be held in the client’s home environment so the clinician can see how the client acts in a familiar place and surrounded by familiar people. During this process the clinician will hear many statements from the clients’ friends and family as well as from the client who may not be consistent.After gathering as much information as possible the clinician and the client would have another session to examine the inconsistencies, such as the client understating the amount that he or she drinks. Sometimes this might be more effective in the form of an intervention. The clinician could examine some of the inconsistencies that he or she has noticed with the family and friends of the client so that the inconsistencies are sure to come up during the session. This should be used only when the clinician has run out of otheroptions in an outpatient basis. Reflecting discrepancies is often used to help the client realize inconsistencies between his or her actions and thoughts, communication and body language, thoughts and feelings, and many others (Murphy & Dillon, 2003). Many people have difficulty understanding their issues. Turk (2002) asserts, "In this process, the patient becomes increasingly aware of how his or her current behavior conflicts with important personal goals” (p.75). Reflecting discrepancies can be used to increase functionality, motivate the client change a behavior issue, and assist client in aligning thoughts and feelings with his or her goals. Reflecting discrepancies can be used to increase client functionality by helping him or her to understand the relationship between his or her thoughts and actions and develop awareness on how to express him or herself constructively. Reflecting discrepancies can be used to motivate clients for behavior change because it places the client’s actions before and shows him or her how his or her actions may be working against his or her goals. This makes the client aware of his or her actions and motivates him or her to correct those actions without being offended. Reflecting discrepancies also can be used to help a client to learn how to express him or herself in a manner that correctly portrays his or her thoughts and feelings. There are a variety of participant problems that reflecting discrepancies can address. Three examples of issues that can be addressed are clients suffering from dishonesty, patients with body language issues, and people suffering from addictions. With the mentioned participant problems, reflecting discrepancies can be used to promote change in the individual. How change is promoted is based on the individual problem. For example, reflecting discrepancies can promote change in a person suffering from dishonesty by presenting conflicting statements to the participant. Reflecting discrepancies can address a patient with body language issues by developing awareness in the individual of how his or her body language may be sending a different signal than what he or she intended. Reflecting discrepancies can promote change in a person suffering from addictions by helping him or her to see how his or her actions may be sabotaging his or her ability to maintain sobriety. Developing the ability to stop drinking alcohol is a process that has been known to be extremely difficult for a variety of individuals. Because of the effects it has on people, he or she may not realize how it affects the people around them because they are in denial of their addiction. There are five stages of change that a person goes through;precontemplation (not considering change but can be educated to show benefits of change), contemplation (deciding to change by identifying barriers and support systems), preparation (experimental with small changes by developing goals and positive reinforcement), action (taking action to change by using positive reinforcement), and maintenance and relapse prevention (maintaining the new behavior over the longterm by using his or her support system) (“,”). These stages of change can be used in a variety of ways, sometimes making individualstake a step back before completing a new stage. Motivational interviewing can help individuals to know their readiness to take on a behavior and provide strategies that are useful to succeeding. Five principles of motivational interviewing are roll with resistance (helping a client to solve problems through situations of resistance of information that has been provided by the clinician), express empathy (this shows the client that the clinician understands his or her situation and helps the client through the process of change), avoid argumentation (arguing leaves no room for trust, to avoid this, changing strategies will ease confrontations), develop discrepancy (this can occur if the clinician can show the client the discrepancies between his or her behavior and goals), and support self-efficacy (clinicians supporting a client’s beliefs in his or her ability to change his or her behavior) (“,”).When using these principles its best to use precautions in using them because the clinician/client relationship needs to form and take shape to become strong and durable to form respect and trust with one another. Discrepancies consist of differences among a client or staff person’s behavior and expressed line of thought. Discrepancies may also occur when a client or staff person communicates two conflicting ideas or thoughts. The occurrence of discrepancies impede a person’s ability to identify the main contributors to his or her problem, including thoughts or beliefs that keep the individual stuck in a particular situation. Clinicians use a number of techniques to identify and communicate discrepancies to clients or staff members. Treating people with alcoholism requires careful attention to the techniques used to generate self-awareness by the individual. One technique commonly used to demonstrate discrepancies consists of identifying the discrepancies and describing them to the client or staff person. An example of this as it pertains to treating a client with alcoholism is a statement made by the client who his or her pattern of drinking is not hurting anyone else. The clinician may point out problems between the client and his or her family that have occurred as a result of the person’s alcoholism. Clinicians should use specific examples to help the client or staff person recognize how the statement conflicts with the individual’s reality (Murphy & Dillon, 2003).The clinician may use other techniques to highlight discrepancies. Clinicians must observe verbal and nonverbal behavior for cues to present or future discrepancies. A client or staff member may profess a desire to attend alcoholics’ anonymous (AA) meetings several times a week. Taken at face value, this sounds like a proactive approach to begin treating the disease. However, a clinician needs to pay attention to whether or not the client follows through in terms of behavior. If the client does not attend a meeting or does not attend the number of meetings he or she discussed that is a discrepancy (Murphy & Dillon, 2003).Once a clinician demonstrates one or more discrepancies to a client or staff person it is important he or she determines the level of understanding. A client needs to recognize what the discrepancy is and how the client has caused it. Then the clinician needs to make recommendations to the client for resolution. The clinician may point out the client expressed a desire to attend meetings but did not follow through. Achieving ones goals that were out of reach at one time can become within reach if the proper strategies are used. Most people have the desire and ability to stop; they just do not have the resources to help them. The topic that was discussed is using discrepancies to overcome alcohol abuse. The topics that were covered are the description of reflecting discrepancies, a brief review of the research addressing reflecting discrepancies, a description of the client's or staff member's behavior that will be addressed by reflecting discrepancies (hypothetical client), a description of the desired behavior that will replace the problem behavior, and a demonstration of using reflecting discrepancies with a client or staff person. The goals for this paper were to learn what discrepancies are and how one can overcome alcohol abuse by using discrepancies daily.

Reference
Diclemente, C. &Bellino, L. &Neavins, T. (1999).Motivation for Change and Alcoholism Treatment. Retrieved September 2, 2011, from http://www.thefreelibrary.com/Motivation+for+Change+and+Alcoholism+Treatm nt.-a059246571
Jones, L. K. (2007). Motivational Interviewing with Substance Abusers – The Power of Ambivalence.Social Work Today Vol.7(3)pg34. Retrieved August 19, 2011, from http://www.socialworktoday.com/archieve/mayjune2007pg34.shtml
Murphy, B. C., & Dillon, C., (2003). Interviewing in actions: Relationship, process, and change. (2nded). Pacific Grove, CA: Brooks/Cole.
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