Addiction Exchange
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Volume 3, No. 6: Denial Management Counseling
April 16, 2001
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Welcome to Addiction Exchange, a forum for the exchange of clinical practice and research information among clinicians, scientists, educators, and administrators in the field of addiction. This issue is the second by guest author Terence T. Gorski, who reviews his keynote presentation on Denial Management, presented at the VAADAC 2001 Conference, March 27-29 in Richmond, VA.
Denial is a serious problem that can cause relapse. Many therapists are looking for an effective system for interrupting denial and refocusing clients upon dealing with their addiction. This article will review the basic components of a system called Denial Management Counseling (DMC) (1). Definition of Denial
Denial is a normal and natural psychological defense that has both benefits and disadvantages. The benefit is that it temporarily removes the pain caused by consciously confronting a serious problem and creates the illusion that the problem is being solved. The biggest disadvantage of denial is that it blocks recognition and problem solving.
Denial results from the natural tendency to avoid the pain caused by recognizing the presence, severity, and responsibility for dealing with serious problems. When denial is activated, clients start using a set of automatic and unconscious thoughts, feelings, urges, actions, and social reactions that defend against the pain of recognizing the problem (2). DMC teaches clients how to recognize and change these thoughts, feelings, and behaviors.
Operational Definition Of Denial Denial
is a set of automatic and unconscious ….
T = Thoughts
F = Feelings
U = Urges
A = Actions
R = Social Reactions
That defend against the pain of recognizing the presence, severity, and
responsibility for dealing with a serious problem
The Levels of Denial
Denial operates at four different levels:
Clients in level 1 denial lack accurate information or have internalized wrong information about addiction and its related problems. The intervention is to provide new and more accurate information about addiction that will help them see new alternative solutions.
Clients in level 2 denial are consciously defensive. Whenever they start
thinking or talking about their alcohol or drug use, an internal argument
erupts in their mind. The argument is between the addictive self that
wants to keep drinking and drugging and the sober self that wants to stop.
The intervention is to use inner dialogue techniques to consciously examine
and resolve the conflict.
Clients in level 3 denial are unconsciously defensive. They automatically and unconsciously evade and distort information in a way that guards them from the pain of knowing they are addicted. The intervention is to teach clients about the common denial patterns and use self-monitoring and directive feedback in sessions to expose the denial patterns.
Clients in level 4 denial are delusional. They maintain the belief that they are social drinkers and recreational drug users in spite of overwhelming and undeniable evidence of serious problems. Because they are delusional, they usually do not respond to the denial management methods used for levels 1, 2, and 3 denial. The delusions are often linked to brain dysfunction caused by the effects alcohol or drug use, or to coexisting mental or personality disorders. As these conditions are treated and begin to remit, these clients usual drop into lower levels of denial that can be managed in counseling.
Levels Of Denial
1. Lack of Information
Wrong information about addiction and recovery
2. Conscious Defensiveness
Knowledge that something is wrong but refusal to face the pain of
knowing
3. Unconscious Defensiveness
Automatic evasion and distortion that guards against severe pain and helplessness
4. Delusion
Deeply entrenched mistaken beliefs held in spite of overwhelming evidence
that they are not true
The Denial Patterns
There are twelve common denial patterns used by clients who enter
counseling and therapy. These can be divided into the Big Five and the
Small Seven. The following paragraphs give the name of each denial pattern
and the dominant theme of its related self-talk. Once these self-talk
patterns are identified, they can be exposed and challenged using traditional
cognitive therapy methods.
The Big Five denial patterns are: (1) Avoidance (“I'll talk about anything but the problem!”); (2) Absolute Denial (“No, not me!”); (3) Minimizing “It’s Not That Bad!”); (4) Rationalizing (“I Have A Good Reason!”); and (5) Blaming (“It’s Not My Fault!").
The Small Seven denial patterns are: (6) Comparing (“Because others are worse than me, I don’t have a problem”); (7) Manipulating (“I’ll Only Recover If You Do What I Want!”); (8) Scaring Myself Into Recovery (“Being afraid of the consequences of drinking and drugging will keep me sober!”); (9) Compliance (“I’ll say anything you want to hear if you leave me alone!”); (10) Flight Into Health (“Feeling better means that I am better!”); (11) Strategic Hopelessness (“Since nothing will work, I don't have to try!”); and (12) The Democratic Disease State (“I have the right to drink and drug myself to death!”).
The Denial Management Systems
Denial Management Counseling (DMC) consists of three related systems:
The DMC Interactional Process is a strategy for therapeutic communication that can be used when talking with clients who are exhibiting strong denial and treatment resistance. When using this strategy, therapists recognize when clients start using denial. They shift the focus of the session from trying to solve the problem to exposing the denial and showing clients how to manage it (3).
The DMC Clinical Exercises are a series of structured tasks which can be used as the basis of a standard treatment plan for use in individual or problem-solving group therapy. This sequence of exercises teaches clients how to understand, identify, and manage their own denial (4).
The DMC Psychoeducational Program (also called Denial Self-Management Training) is a standardized education program for denial management that can be taught classroom style to people who are having trouble recognizing and managing their denial. When taken together, these three DMC systems provide a structure for building a comprehensive approach to managing denial and resistance that can be used by individual clinicians or as the foundation of a comprehensive denial management program.
To learn more about DMC and other Gorski-CENAPS Corp. training, consultation and publications, go to http://www.cenaps.com/.
References (1) Gorski, Terence T., with Grinstead, Stephen F., Denial Management and Counseling, Professional Guide, Herald House Independent Press, Independence, MO 2000.
(2) Beck, Aaron T., Wright, Fred N., Newman, Cory F., Liese, Bruce S., Cognitive Therapy of Substance Abuse, The Guilford Press, 1993
(3) Amodeo, M., Liftik, J., Working Through Denial in Alcoholism. Families in Society: Journal of Contemporary Human Services, 71(3): 131-135, 1990. (107440)
(4) Gorski, Terence T., with Grinstead, Stephen F., Denial Management Counseling Workbook, Herald House Independent Press, Independence, MO 2000.
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