Clinician's Corner: The Seven Challenges

THE SEVEN CHALLENGES

After directing a community-based counseling agency for several years, in 1989, I wrote a popular drug prevention book for parents called Saying NO is Not Enough. This prompted a local treatment organization in Tucson to invite me to start a drug program for adolescents for their residential facilities and outpatient services.

I proposed that a good adolescent program must be holistic (not narrowly focused on drugs), supportive of adolescent development (not trying to dictate behavior), and should incorporate decision-making (avoiding the widespread practice of expecting and demanding immediate abstinence). I hoped I could take something off the shelf and import it locally. However, looking around the country, I only found watered-down 12-step programs based on the adult disease model. So, to deliver what I advocated, I started writing and developing a program that I called The Seven Challenges.

At about the same time, the Center for Substance Abuse Treatment (CSAT) at SAMHSA also recognized the need to develop specialized programming for adolescents. They identified and conducted research on several exemplary programs around the country. While visiting Tucson, a CSAT program officer heard about The Seven Challenges and decided to roll us in as a comparison group. Our outcomes were comparable in terms of drug use and exceptional with regard to co-occurring conditions and trauma issues. CSAT started inviting me to present at numerous conferences. This contributed to the widespread adoption of the program in hundreds of sites across the country. Despite our success, we continually struggle to get additional research on the program and its various innovative components. I imagine many interesting and exceptional ideas being used locally get lost due to a lack of research.

Below are a few of the practices we developed in The Seven Challenges.

Mastery Counseling
Because understanding the motivation for drug use and evaluating its impact cannot be made without considering the context of individual life circumstances and experiences, there is a need for an integrated, holistic approach. This is especially important for adolescent clients because many of them are mandated to counseling and do not believe they have a drug problem. Holistic therapy allows clients to start with issues that legitimately concern them without being confined to a narrow focus on drugs. It can incorporate work on psychological problems and the numerous situational problems that typify adolescence, such as school, peers, and family. To support adolescents in the key developmental tasks of forming their own identity and preparing for adulthood, a high-quality holistic approach should empower young people to guide the direction of their therapy.
In response to these specifications, I developed Mastery Counseling. The idea is simple: People who want to gain mastery over their own lives pay attention to what is happening in their day-to-day experiences. They recognize and leave alone what is going well. What is not going well or as well as they would like it to be going is “an issue.” They confront their issues. In Mastery Counseling, therapists ask clients to identify and work on their issues using steps outlined in a systematic approach. This minimizes defensiveness because clients are not limited by an expectation that drugs must be the primary focus. At every session, young people work on something that troubles them and obtain problem-solving assistance. Success is reinforcing and dispels skepticism about counseling. Plus, there is no stigma: Everyone has issues. They are universal. Mastery Counseling is transtheoretical in that it serves as a framework for clinicians with diverse theoretical orientations.

The Challenge Process
In gaining mastery over their lives, individuals are faced with countless decisions, including about their drug use. Because adolescents are individuating and preparing for adulthood, they respond positively to therapy that empowers them, as in “You make your own decisions.”
Grounded in Irving L. Janis’s seminal research about decision-making, I developed the Challenge Process to help young people compare the harm and benefits from their drug use. The process incorporates measures to reduce shame and self-blame in one of the challenges and prepares young people for a future as adults with another (“…looking at where we seemed to be headed and where we wanted to go”).
The Challenge Process also helps young people face the adolescent developmental task of beginning to master formal operational thinking (logic) by learning to consider all the options and possible outcomes of their behavior. This facilitates fully informed decision-making. It also helps avoid the following frequent pitfall in adolescent counseling: Clients make harm-based decisions to change their drug use behavior (quitting to make the harm go away) without acknowledging drug benefits (pleasure and relief from pain) and realizing these benefits will also be gone. Lacking this awareness, young people are often blind-sided by urges and then relapse.

Individualized Support
The Seven Challenges introduces the designation of two types of drug problems.

1. Problems with drugs.

2. Problems with parents or the courts, or other authorities that happen to involve drugs.

Some clients have one problem or the other or both. This distinction has been constructive with adolescents who may be in an early stage of change in acknowledging drug problems but are quite willing to acknowledge problems with authorities and ready to take action. To support young people who have decided to take action (quit or set new limits), we introduced a check-in process called “Individualized Support” to monitor drug use and “close calls” at every session and provide help as needed with decisions to change.

The Journey
It has been a whirlwind. As The Seven Challenges became widely used, we had to figure out how to train and maintain fidelity. We needed to develop an affordable implementation process for community-based organizations, adaptable to diverse cultural groups, and instructive to counselors who sometimes had less than optimal training and experience. Because the courts mandate so many adolescent clients, we had to develop strategies to help therapists protect client interests, for example, by maintaining maximum confidentiality in the face of the court’s “need to know.” We had to work with court personnel to help them understand how therapy works and that changes are not simply motivated by the threat of sanctions. Over the years, we added a four-session Brief Challenges program. We also found that much of what we developed for adolescents is portable to an adult model, with a few significant modifications. We launched an adult version of The Seven Challenges in 2018.

NOTE: I’m a charter member of Division 50. All along, SoAP has been an invaluable resource for keeping abreast with the latest research in the field and influencing the evolution of The Seven Challenges program.
Robert Schwebel, Ph.D.
rschwebel@sevenchallenges.com
www.sevenchallenges.com
www.robertschwebel.com