4: Part I of Choice Awareness Training: Cultivating Strategic Freedom to Change

This part of Choice Awareness Training can be conceptualized as a curriculum of themes, the discussion of which helps clients cultivate a strategic, philosophical, ontological awareness of their freedom as a fundamental human condition.   This takes the form of a part-didactic, part-Socratic dialogue with the client about their capacity for choice, and, thus, change.  The following are themes and exercises that constitute this part of Choice Awareness Training.

Reframing the Addiction as a Habit, not a Disease

Facilitators take clients on a conceptual head-on collision with the Disease Model of addiction.  Addiction is reframed in the context of operant conditioning theory and the Disease Model of Addiction is challenged.  This is accomplished through the review of the history of the Disease Model of addiction (for excellent coverage of these topics, please, refer to Peele’s “Diseasing of America,” Schaler’s “Addiction is a Choice,” and Walters’ “The Concept of Addiction”).  The logical inconsistencies of the concept of addiction as a disease and of the 12 Steps are reviewed. 

In particular, facilitators should be prepared to recognize the following errors in logic.  Petitio principii is the logical fallacy of tautology in which the same premise serves as both the premise and the conclusion (Walters, 1999).  Facilitators need to familiarize themselves with the tautology of the loss of control argument (in which the loss of control serves both to describe and explain addiction), the prediction tautology (a problem drinker can never drink in moderation and any drinker that can drink in moderation is not a problem drinker), and the denial tautology (any disagreement with the Disease Model of addiction constitutes proof of disease) (Walters, 1999).

Review of Self-Change Literature

Clients are introduced to self-change literature, the study of the phenomenon of self-change among drug and alcohol users, an emerging empirical body of research that contradicts the postulates of the Disease Model of addiction.  The self-change literatures helps address the logical fallacy of the argumentum ad verecundian (an argument that involves an appeal to authority to establish credibility, in the case of the Disease Model of addiction, this argument involves an appeal to medical authority, whereas in the case of the 12 Step paradigm, the argument involves the appeal to the spiritual authority of the “higher power”) (Walters, 1999).  Studies show that self-change “appears to be the dominant pathway to recovery” (Klingemann et al, 2001, p. 21).  Facilitators present self-change statistics with a particular emphasis on the longitudinal stability of natural recovery.

Langer, in her 1989 book, entitled “Mindfulness,” shares the results of a study that supports the importance of exposing individuals in recovery to various conceptualizations of recovery.  In particular, Langer shares that in a study of forty-two patients attending an alcohol clinic, the individuals “who had been exposed to only one model of alcoholism” (early in their lives) “appeared to have developed mindsets so rigid that the options offered by therapy did not seem available to them,” whereas “those who had been successfully helped in therapy virtually always came from the multiple role-model group” (1989, p. 52).  Langer suggests that subscribing to a genetic/medical view of addiction constitutes a counter-therapeutic “premature cognitive commitment” to a particular model of recovery, and notes that “alcoholics who see the cause of their problem as purely genetic seem to give up the control that could help their recovery” (p. 51).  Helping clients review the findings of self-change literature introduces alternative views on recovery and safeguards against an unnecessarily fore-shortened clinical diagnosis.

Review of Client’s Personal Self-Change/Success Data & Challenging of  All-or-Nothing View of Self-Control

Furthermore, clients who express skepticism about the validity of self-change literature are encouraged to explore their own self-change data.  The clients’ belief in their powerlessness over addiction is likely to be a function of a) an uncritically adopted belief that they are powerless, a kind of iatrogenic ideological side-effects of past treatments that were informed by the Disease Model of addiction, and b) dichotomous/perfectionistic/all-or-nothing thinking that led clients to dismiss the partial success of their past self-change efforts. 

With this in mind, the Review of Personal Self-Change Data allows the client to learn from his successes rather than to continue to focus on his failures with an inevitable sense of loss of control.  More specifically, clients are encouraged to think of at least one precedent of controlling their desire to use.  It is simply inconceivable that a substance user had never to postpone his using, that he or she always used whenever he or she desired to use. 

The facilitator explores clients’ abstinence histories, times when they had to wait until the next day to use because they had to “pee in the cup,” and they could not afford another dirty urine out of fear of losing employment or violating the conditions of their parole.  Facilitators may focus on the times when the clients wanted to use but had no financial means to cop the drug and, therefore, had to figure out ways to get money be it by stealing, or taking the TV or their car stereo to the pawn shop, or by doing some work to get the money. 

The review and verbalization of these use-postponement precedents is significant in that each such episode demonstrates to the client that – regardless of the intensity of their urges – they had been able to control their behavior for varying periods of time on numerous occasions.   The conclusion – as logically inevitable as it may seem – is likely to require additional processing.  The client should be assisted to appreciate the meaning of these brief and not-so-brief periods of abstinence: they have, in fact, exercised control over their using behavior.  If they can control an urge for a brief duration of time, they can control it for any duration of time, given the proper motivational incentive, and, particularly, when augmented with more than intuitive skill-power and self-regulation tools.

In review, the idea behind this particular strategy is to de-dichotomize the all-or-nothing cognitive distortion: just because the clients could not control their using behavior all of the time, it does not mean that is not controllable, as evidenced by the numerous times in the life of any substance user when he or she does, in fact, succeed in controlling their using behavior for some duration of time.  The consistent objection that is voiced at this point is a sudden re-interpretation of the problem: whereas in the past the problem was conceptualized behaviorally (drinking or drugging, using behavior), now it is re-interpreted cognitively as a problem of the constant craving.  In particular, the clients concede that, yes, they now realize that, assuming adequate motivation, they can control their behavior, what they cannot control, however, is the desire to use.   This objection, if voiced, is the opportunity to normalize and de-pathologize the fact of the craving.  Drug and/or alcohol craving can be re-interpreted as a perfectly legitimate desire for relief of stress, for a sense of well-being, that can be fulfilled in psychologically-, legally-, physically-, and financially-safer ways.  Craving for a relief or well-being is, therefore, portrayed as a normal vital sign, a human response to the intermittent reality of pain and suffering.

Discussing the Implications of the Disease-Model Explanatory Style

Individuals with a pessimistic explanatory style develop a sense of helplessness and give up in the face of failure or extreme challenge (Satterfield, 2000).  The disease concept of addiction is a paragon of the pessimistic explanatory style.  The attribution theory research defines pessimistic explanatory style as a causal model that attributes the causes of a negative event to internal, stable, and global factors (Abramson, Seligman, & Teasdale, 1978). The disease model of addiction encapsulates all three.  A sense of powerlessness, therefore, is a logical by-product of the pessimistic explanation of addiction as a disease and constitutes learned helplessness.  Choice Awareness Training, in a manner consistent with positive psychology, helps clients appreciate that learned helplessness is not factual helplessness, and helps clarify the distinction between feeling helpless and being helpless.

Tackling the Issue of the Pre-Disposition

The notion of a pre-disposition is often misunderstood by clients.  Pre-dispositions pre-determine certain needs, not the specific means with which these needs are met. If a person is predisposed for anxiety spectrum disorders, he or she has at least four options to self-regulate: 1) psychological self-help, 2) psychopharmacology, and 3) chemical self-help through substance use (as a form of self-psychiatry). 

Facilitators work to counter the fatalistic understanding of the notion of pre-disposition, reinforced by the fear-mongering Disease Model of addiction, and help clients realize that whatever pre-dispositions they might have, they are still fundamentally free to choose a particular method for addressing any biological, genetic, or chemical deficits that they might have.

Taking on the Issue of Addictive Personality

The notion of Addictive Personality failed to acquire empirical support in over half a century of scientific investigation (Miller and Rollnick, 1991).  Clients are helped to see that the pathologizing connotation of “addictive personality” is merely a function of social stigma attached to a given appetite.  Furthermore, with the word “addiction” seen in the context of operant conditioning, the very construct of “addictive personality” can be reframed as “habit-forming personality,” which, of course, is universally possessed. 

Discussing Habit Formation

If “addiction” is to be effectively re-conceptualized as a habit, not a disease, discussion of the process of habit formation is of paramount importance.  Discussion of habit formation (of habit psychology) offers a normalizing, validating, explanation of how over-learned habits can lead to a sense of loss of control, without the counter-therapeutic externalizing that stems from the notion that has no control because of a presumed disease of addiction.

Habits have been often referred to as “second nature.”  The notion of “second nature” is a semantic gold mine that holds a phenomenological clue to the mystery of the sense of loss of control.  Tengan (1999), in clarifying Lonergan’s teachings on habit formation, notes that “a habit gives an inclination to an otherwise indeterminate potency (the will),” and, as a result, “predetermining us to act in certain directions” (p.97).  Consequently, what was once a novel, mindful, idiosyncratic response pattern becomes an over-learned natural default.  

In its defaulted-ness, the acquired response pattern becomes automatic, it serves as an energy conserving short-cut.  Barrett, as far back as 1911, likened the “automatism” of habits to a state “arrived at by the will when it functions evenly, simply, and regularly in a manner more or less independent of conscious attention” (1911, p. 105-141). Llinas (2001), “a founding father of the modern brain science,” writing ninety years later, used, instead, the term Fixed Action Patterns to describe modules of activity “that liberate the self from unnecessarily spending time and attention on every aspect of motor and non-motor activities” (p. 134).  Llinas states clearly that the rationale behind Fixed Action Patterns is “the economizing of choices” (p. 144).  Whether we refer to the habits as autopilots, or schematic behavior, or second nature, or learned behavior, or fixed action patterns, this automatization “liberates” us from having to make an infinite number of minute choices.  As any default, this automatization spares the mind the work of any unnecessary deliberation or decision-making, thus creating the phenomenological sense of loss of control.  In a sense, a “second nature” response pattern is experienced as “happening” to the person rather than “being executed” by the person.  This kind of resource-saving automatization is a hallmark achievement of the human mind.  Auto-piloting or automating of various cognitive-behavioral-affective routines enables human mind to multitask as it plows through the never-ending environmental bombardment of stimuli.  The loss of the sense of control (or of the sense of agency) is the cost of this optimization.

As a side note, clients are offered to examine how their uncritical acceptance of the Disease Model of addiction, in a way, represents an attempt to economize.  After all, the concept of a disease (“I am doing this because I am sick) is a simple emotional conceptualization to be contrasted with a cognitively harder concept of a habit (“I am doing this because I have been conditioned to do this”).

Clients are helped to appreciate the fact that the momentum of the habit, its baseline behavioral orientation, its default inclination, its automaticity with its accompanying sense of “loss of control,” does not, in and of itself, negate the underlying fundamental freedom to choose same or alternative course of action.  As noted above, just because an action feels “out of control,” it does not mean that it is, in fact, beyond control. 

Lonergan described this momentum or force of the habit as the “antecedent willingness” or “unwillingness” to act in a particular manner.  The “antecedent” qualifier in Lonergan’s explanation is synonymous with an inclination or a default orientation towards a specific response, given a particular stimulus.  The “antecedent willingness” is that phenomenological pull or drive or action-urge that predetermines a response.  It should be noted and reiterated, however, that pre-determination does not equal determination.  Tengan’s (1999) use of the term of “voluntary habits” therefore can be understood as meaning that while, in retrospect, the execution of a habitual response might be remembered as an involuntary action, no habit is truly involuntary since any habit can be voluntarily overridden by an act of free volition (p. 96).

Consequently, any habit can be likened to pseudo-involuntarism or pseudo-choicelessness, to coin a couple of terms.  Explicit discussion of how habits are experienced as involuntary defaults while being entirely within the potential control of the individual is likely to produce a self-accepting sigh of relief when clients realize that they never lost the control but that they merely neglected it.

Discussing the Power of Context (the Placebo Effect)

Clients, indoctrinated by the Disease Model of addiction, may be both curious and stunned to know that the degree of intoxication is contingent on drinker’s expectations and can be manipulated by modifying drinker’s/user’s expectations (Langer, 1989).  On the basis of a review of many investigations, Langer notes that “thoughts may be a more potent determinant  of the physiological reactions believed to be alcohol-related  than the actual chemical properties of alcohol” (p. 183), and, in summarizing the findings of Shepard Siegel, Langer notes that “the failure of tolerance on the day of the overdose is a function of context,” noting that overdoses are more likely in the unfamiliar environments. 

Langer summarizes: if context has the power to change both the degree of intoxication, the severity of withdrawal symptoms, and even the effect a drug overdose, then “addiction may be more controllable than is commonly believed” (1989, p. 184).  Presenting clients with the discussion of the power of situational factors offers clients much food for thought as they begin to rethink the presumed medical determinism of their addiction.

Psychoneuroimmunology as Evidence of Mind’s Power over the Disease of Body

Another obvious data source to be angled against the sense of powerlessness that is secondary to uncritical acceptance of the disease model of addiction is literature on the mind-body connection.  The very thrust of medicalizing addiction is to call a behavioral problem a body problem.  Yet even a body problem is not immune to the solutions of the mind. 

A brief sampling of psychoneuroimmunology findings can go far in helping clients who cling to the disease model to enhance a sense of control and freedom-to-change.  The evidence that mind can and does solve the problems of the body is abundant enough to roll with the resistance by granting the disease model of addiction a status of “fact,” while still having irrefutable and choice-enhancing arguments to augment the client’s sense of efficacy.  The following is a sample of the sort of facts that may help convince a disease-indoctrinated substance user of the  “curability” of the incurable.

Paul Pearsall, Ph.D., in his 1987 book Superimmunity, describes the textbook example of a serious skin condition, congenital ichthyosiform erythrodemia, which is characterized by a hardening and blackening of the skin, being successfully resolved within 5 days of hypnosis by Dr. Mason.  Pearsall writes that “all major dermatology textbooks report no known cure for this terrible disease” (p. 9).  Yet, the fact remained that a bona fide medical problem that had been previously considered incurable was, in fact, curable through a psychological pathway.  Dr. Mason’s results were subsequently documented in the British Medical Journal.

Pearsall, a non-physician, reports a mind-body “miracle” in the course of which “a positive Montoux reaction (a reddening and swelling of the skin at the site of the injection of a small amount of tuberculin) was produced through injection of water by suggesting that the water injection was really tuberculin” (p. 10). Ivan Roitt, professor and head of departments of immunology and rheumatology research at the University College and Middlesex School of Medicine, in his 1991 book Essential Immunology, confirms this “popular observation concerning modulation of the delayed-type hypersensitivity Mantoux reaction in skin by hypnosis” (p. 169).

Pearsall reports other research in which a “woman experiencing a severe hay fever reaction to pollen for 12 years was helped to imagine herself free of symptoms. She became completely free of her symptoms for the first time” (p. 10). Imagine what your substance use client can do with his habit-disease if he or she cannot only imagine but evidence his freedom!

The sample of mind-body connection “miracles” above is but an extremely cursory fact-mining. I dove into one book and yanked out several facts that question the depressogenic notion of substance use incurability.  If patients with cancer cannot only go into remission but be, in fact, pronounced “cured,” why can’t patients with habit problems?  Facilitators that plan to use mind-body connection as an argument against the presumed incurability of the psychological (habit) problem of substance use are encouraged to bring a handful of books or articles from the field of psychoneuroimmunology or psychoimmunology and let clients browse, if they wish.

Choice Moratorium Exercise

Facilitators are encouraged to inter-lace the “fiber” of philosophizing with the “desert” of exercises.  One such exercise to offer is the Choice Moratorium.  The Choice Moratorimu exercises highlights the inevitability of choice.  Clients are challenged to not make any choices for a pre-specified period of time (e.g. one minute).  The exercise is followed with processing of the clients’ reactions and insights.  For additional instructions for this exercise, please, refer to Somov & Somova (2003).

The “Gun-Point Test” Hypothetical

The “Gun-Point Test” hypothetical compliments the discussion of the claim that a client has no control over drinking or drugging.  In this hypothetical, clients are asked to imagine a situation in which they have an intense craving and immediate access to the substance in question.  For many users, not yet convinced of the power of choice and of their potential skill-power (of craving control), this moment is well past any feasible self-regulatory “u-turn.”  If they are this far into it, with the drug in their hand, many will tell you that they are well on the way to use.  To complete the hypothetical, add the following twist:  allow the clients to imagine that someone put a gun to their head and stated: “You use – you die.”  Ask the clients: “Would you use at this point?”  Most clients, whether they will verbalize it or not, will admit to themselves that at a gun-point they would lay down the drug and walk away, not using it.

Ask the clients: “What does that mean?”  Prepare to face the inevitable counter-argument that “Yes, but… in real life no one is going to hold a gun to your head and tell you that if you use, you die.”  Counter-argue along the following lines: “The gun – an inanimate object – did not introduce the choice not to use to your life, the choice was there all along, it’s just that the presence of the gun helped you become aware of the choice.”  

The “Million Dollar Test” Hypothetical

The “Million Dollar Test” hypothetical is a variation on the theme of the “Gun Point Test.”  It can be used in much the same fashion to demonstrate the inevitability of choice.  As would be expected, in this vignette, the clients are asked to imagine being at a point of using and having an intense desire to use.  At this point, someone makes an offer they can hardly refuse: “you use – you get nothing; you put down the drug and walk away – you get a million bucks.”

A predictable but easy-to-counterargue argument is that “in real life, no one’s going to give you a million bucks for not using.”  Counter-argue by asking the client what their recovery and freedom is worth.  In this sense, any time the client passes on a drug offer he/she is enriched by priceless freedom, self-control, and clean and sober life on his/her terms.  Just like in the case of the Gun-Point metaphor, the Million-Dollar metaphor demonstrates that the choice not to use was there all along, but eclipsed by the motivation to use, until the choice to use was re-eclipsed by the incentive of wealth.  The incentive of wealth did not create a choice not to use, it simply brought the choice into focus.

The two metaphors described above are designed to address a substance user’s paralysis of self-efficacy when in the presence of the drug or drug-related paraphernalia.  While this paralysis of self-efficacy is technically a mirage of perception, it does have a phenomenological reality.  This reality is predicated on numerous precedents of trying to resist the urge to use but surrendering to it when in the proximity of the drug.  At this point, the clients have not yet reformulated their self-inefficacy or sense of loss of control as a function of conditioned, choice-unaware, mindless responding, and, in the absence of a better explanation, have primitively attributed the power to the drug.  The following discussion helps clarify the power hierarchy between animate (human) and inanimate nature.

Demystifying the Inanimate

Substance use clinicians often hear clients verbalize the aforementioned fatalistic attitude that “once I’ve got my hands on it (“it” here being the drug or the paraphernalia), I can’t stop.”  This fetishist reverence for the object is likely a reflection of the stimulus value of the paraphernalia objects with their over-conditioned “pull” to use.  As part of trying to “demystify the inanimate,” to highlight the passivity of the inanimate matter and its inherent dependence on the human agency, the facilitator might drop a pen down on the floor and compare the pen to an object of paraphernalia. 

If the clients had been already offered Exposure/Response Prevention type craving control craving, the facilitator may more accurately simulate the moment by, say, opening a packet with sweetener and line it up on the table.  The facilitator then discusses the intuitive physical reality of the fact that the simulated crack stem on the floor or the simulated line of cocaine or heroin on the table, in and of itself, cannot move or do anything on their own, let alone, control a human being.  This seemingly banal discussion resets the chain of command: we, the humans, have power over the inanimate drugs and drug-related paraphernalia, not the other way around.  It is the very breath that differentiates a human from a line of cocaine that is required for the inanimate substance of cocaine to become a substance use problem of a given human.  This discussion often results in such revelations as “I gave it (the drug or paraphernalia) too much power, power that it doesn’t really have over me.”  As obvious as this may sound to a non-using adult, the value of this kind of experiential “clarification” cannot be over-emphasized. 

Addressing the Language Trap

“I Can’t” versus “I Won’t”

In the first part of the Choice Awareness Training, explicit attention should be given to how substance use clients restrict their freedom-to-change with the wall of words.  Language structures perception and perception, for all intents and purposes, is reality.  The facilitators’ task is to help clients appreciate the interplay of language and a sense of freedom-to-change.  Case in point: individuals who have internalized the 12 Step dictum of powerlessness and bought into the Disease Model of addiction are prone to confuse the “I can’t” with the “I won’t.” 

As part of Choice Awareness Training, clients are encouraged to become aware of the distinction.  The “I can’t” statement negates the availability of a given option.  “I won’t” is a matter of motivation.  Whereas the “I can’t” is an acknowledgement of not having a choice to perform a given act, the “I won’t” is an act of choosing not to perform a given act. 

For example, after instruction in and practice of craving control, clients will be assisted with understanding that while there is not a craving they “cannot” control, there might be a craving they “will not” control.   While the former is an issue of choice awareness or skill-power, the latter is a function of motivation.  Consequently, the fundamental distinction between the “I can’t” or “I won’t” is the difference in freedom-to-change and reason-to-change: while one might be free to change from one state to another at any given moment, one might not choose to change because one might not be motivated to do so.  Confusing the “I won’t” with the “I can’t” is a process of self-deflation: each pseudo-“can’t” diffuses one’s sense of freedom and agency.

The Passive Grammar of Irresponsibility

“I am addicted,” is a form of constructivist self-incarceration.  This statement represents passive case grammar that, by definition, robs the person of a sense of agency.  To persons that embrace this view of their substance use the world is experienced as chaotic, hard to control, unpredictable; things happen rather than get done. 

In helping clients appreciate the choice-defeatist meaning of the phrase “I am addicted,” I have often made synonymous parallels with the phrase “I am hooked.” Being hooked means just that: being on a hook.  Like a fish lured by the glistening promise of a fake bait (the drug), the user convinces himself that he is on the hook of a fishing rod of addiction.   Yes, he can rigorously wiggle his tail and talk about “being sick and tired of being sick and tired,” but he can’t get off the hook, not himself, not without the merciful hand of a treatment provider or higher power.  That is the perceptual lot of someone who believes they are hooked.  But, I’d ask the client, who is holding the fishing rod of addiction?  Who is the owner of the hook? Who is reeling in the client across the turbulent and murky waters to the shore of oblivion?  The Inanimate Drug? The Indifferent Drug Dealer?  Hardly: the owner of the hook is the client’s own mind that has conceived of a notion of being without power to change.

Just like in the work of cognitive modification clients are to learn that no one can make them feel anything and therefore the passive grammar of “he made me mad” or “he made me sad” is continuously challenged, so does the passive grammar of substance user’s statement that he or she is “addicted” need to be challenged and processed for its phenomenological implications.

The Word “Addict” and Addict Identity

Self-identification as an “addict” or an “alcoholic” is an unfortunate legacy of the 12 Step movement.  While it is true that some clients use the term “addict” or “alcoholic” as a verbal short-cut to rapport building (as in “I’ve been through similar things, you don’t have to fear my judgment, I understand where you are coming from”), the majority of self-identified “addicts” or “alcoholics” feel a kind of disempowering chronicity of their condition that does more harm than good.

A 12 Step proponent will rush to object that self-identification as “addict” or “alcoholic” is primarily designed to heighten the client’s hypervigilance, to caution him or her to be on guard and watchful for any signs of lapse.   While partially reasonable, this type of vigilance boomerangs.  Clients come to distrust their thinking “because their best thinking got them here,” and come to fear their unconscious with its treacherous and sneaky “reservations.”  The result is a kind of Stalinist self-regime where one’s self becomes the “enemy of the people.”

It goes without saying that the “addict identity” stems from buying another dangerous combination of words, namely from the notion of “addiction as a disease.” Clients should be assisted with realizing that the “disease model of addiction” is a linguistic metaphor, and not the only one at that.  Other metaphors are possible.  For example, addiction could be metaphorically conceptualized not as a chronic disease but as an allergy.  Alternatively, and in the spirit of the Change Equation, addiction can be conceptualized as a chemical self-regulation autopilot, a kind of mindless execution of a less than optimal coping strategy.  With this in mind, the client should be assisted with a choice of the metaphor for their problem, with each metaphor being evaluated for its pro-change and anti-change qualities.

Such discussions often result in a realization that choosing “addict identity” (with the exception of rapport-building aspect) represents a wholesale surrender of choice.  Facilitators of Change Equation approach shall respect that constructivist choice, as long as it is consciously thought out, and point out that choosing not to choose is a choice as well, and congratulate the clients on yet another consciously made choice.  What shall clients call themselves instead of “addicts” or “alcoholics?”  In my opinion, their actual names or the pronoun “I” would suffice.  If clients do wish to categorize themselves in relation to substance use, the term “chemical coper” or “ex-chemical coper” provides conceptual continuity with the Change Equation philosophy.  By calling oneself a chemical coper, the person acknowledges the fact that substance use served the purpose of emotional self-regulation.  To call oneself an “ex-chemical coper” or “former chemical coper” allows the person to reiterate that they have now opted for a different coping pathway.

Discussing the Difference Between Difficult and Impossible

In facilitating client’s understanding of the sense of loss of control, it is helpful to explicitly address the incremental progression of the sense of the control as the person attempts a self-stopping behavior after initiating a habitual response sequence.  Zeigarnik (1938) demonstrated that a response sequence is harder to abort at the later sequence points of a given response than at the earlier sequence points.  Baumeister et al (1994) clarifies with the example of a sexual response: “refraining from sex is undoubtedly much easier if one backs away after (or before) the first kiss than if one waits to intervene until after an hour of passionate necking” (p. 21).  Clients should be helped to understand, however, that just because something is harder it is not necessarily also rendered impossible.  Given the awareness of the proper incentive or dis-incentive (e.g. the Gun-Point hypothetical), a person regains the choice to disengage from the target behavior.

Summary:  Freedom-to-Change is Ego-Syntonic

Phenomenologically, the outcome of this semi-didactic, semi-experiential Logotherapy designed to help clients appreciate that they are fundamentally free, and, thus, free to choose to change, is an ego-syntonic sense of liberation and a regained sense of being once again possibly in control of their lives.  This realization that one is free to choose and free to change is so empowering that once clients are provided with a logical framework to counteract the notion of disease-based determinism, they tend to hold on to this insight.  In this sense the realization of strategic freedom-to-change is much like learning to ride a bicycle: once understood, it requires no additional practice and it has no expiration date.  It is quite a different story with the tactical, here-and-now awareness of choices available to us in any given moment: the habit of falling existentially asleep and living on a cognitive-behavioral auto-pilot has to be replaced by a habit of waking yourself up.  That is the task of the second part of Choice Awareness Training that is discussed further below.