Black or White Thinking

January 14, 2015

2015/01/img_0883.jpg
By Terence T. Gorski
Author (The Books of Terence T. Gorski)

Black and white thinking, also known as all-or-nothing thinking, is the failure to bring together both positive and negative qualities of the self, other people, and the world into a cohesive and realistic whole.

It is a common defense mechanism used by many people that allows them to lock onto one aspect of things while blocking out others. This can make the world appear more manageable and comprehensible.

In reality, apparent opposites often live together in the real real world. Here are some examples.

The world is both …
– Good and evil;
– Loving and cruel;
– Safe and dangerous;
– Understandable and incomprehensible.

In reality, it is all of these things and much more all at the same time. What we see depends upon where we look and what point of view we choose to take.

Never underestimate our ability to lock onto to some things and block out other things based upon our belief in the truth.

It provides great comfort to shrink the world into something small and manageable. This can work in times of great stability. During times of great and radical change it is important to be able to view reality as it is, not as we would like it to be.

Read more about how black and white thinking can hurt us and what we can do about it.

Learn more about Cognitive Restructuring for Addiction. This is practical workbook and guide making cognitive restructuring tools readily available to both therapists and recovering people.

The Books of Terence T. Gorski)


Evidence-based Practice: An Elusive Ideal

June 13, 2014

20140613-081936-29976366.jpg
There is a strong movement toward evidence-based practice and a new buzz-word, evidence-based leadership. is becoming popular. The evidence-based movement involves the complex process of:

1. Figuring out what treatment practices have positive effects on treatment outcomes;

2. Encouraging professionals to use evidence-based principles and practices by encouragingly the use of continuous quality improvement;

3. Promoting a culture of creativity, growth and change within a consistent structure while avoiding cumbersome regulations that fail to add value to the process of patient care.

Evidence-based practice is becoming very complex stuff which, unfortunately, is placing many more levels of complexity between leadership and patient care. The following article reflects, in my opinion, why the evidenced-based movement is struggling.

– The idea of evidence-based practice is becoming way to complex.

– The evidence for what works and what doesn’t work is very weak.

– Different professional cultures fail to effectively communicate and collaborate.

There is the misconception that we know what works and need to force regulations into place that add little or no value to clinical practice.

The comes ideas of evidence-based practice is replacing the idea of simple applied research systems processes once called continuous quality improvement.

It might be helpful to ask both professionals and patients to describe in plain English what they found to be helpful and not helpful in their experience of the treatment process.

For better or worse, here is a description of the complexities of the evidence-based treatment. In my opinion the ideas are far too complex to be practically implemented and the “evidence-based ideal” is placing additional levels of complexity between leadership and patient-care.

The challenge is to simplify the process for real-world application. I still prefer the idea of continuous quality improvement based upon systematic measurement of concrete outcomes close to the the level of patient care that involves patient self-measurement, clinical professional measurement of the same factors, and administrative measurement of treatment plan implementation and incident reporting. The system has been implemented and validated in addiction and mental health programs and requires limited investment.

The USA government has developed and field-tested proven methods for implement CQI in addiction and mental health programs.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483604/pdf/v007p00149.pdf

Cognitive Restructuring for Addiction is an evidence-based practice that can be implemented in the real world and its effectiveness monitored with CQI methods in a cost effective way. Simple measurement of the patients ability to use the five core cognitive restructuring skills (Thought Management, Feeling Management, Urge/Motivational/Craving Management, Behavioral Recovery Skill Acquisition, and Relationship management. It is a skill based model and the ability of recovery people to learn and use the skills can be measured. Knowing how to use the skills, however, is no guarantee they will be used consistently in recovery. These skills also lend themselves to self-monitoring, an evidence-based cognitive-behavioral therapy technique shown to enhance positive change.

References for Continuous Quality Improvement (CQI)

Deming, W. E. (2000). Out of the crisis. Cambridge, MA: MIT Press.

Gustafson, D., & Hundt, A. (1995). Findings of innovation research applied to quality management principles for health care. Health Care Manager Review, 20(2), 16–33.

Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). San Francisco, CA: Jossey-Bass. NIATx. (2008). CQI model. Retrieved August 26, 2009, from http://www.niatx.net

GORSKI BOOKS: www.relapse.org

Cognitive Restructuring for Addiction


Using Cognitive Restructuring for Addiction (CRFA) 

June 11, 2014

CENAPS_CRFA_ArrowBy Terence T. Gorski, Author
The Cognitive Restructuring for Addiction Workbook 

There is a simple formula for applying cognitive restructuring principles to nearly any problem. Here is how it works:
Write down both a title and a description for the problem. Here’s an example:
Title: Frustrated With My Job
Description: I know that I am in trouble with my recovery when I keep getting upset by little frustrations at work that I can usually handle well.
NOTE: Don’t use the exact same words in the title as in the description. Using different words forces your brain/mind to understand the problem on different level and from  different point of view. 
Start the TFUAR Analysis by completing the following statements: 
T = Thinking: When I am experiencing this problem I tend to think …
F = Feeling: When I am experiencing this problem I tend to feel …
U = Urges (Motivations): When I am thinking and feeling this way I tend to have the self-defeating urge to …
A = Action: When I experience that self-defeating rugs what I actually do that usually fails to solve the problem is …
R = Reactions: When I take this action other people tend to react to me in ways that make the problem worse by …
Complete the TFUAR Analysis Process by answering the following questions: 
T = Thinking:  What is another way of thinking that could help me approach this problem in a more effective wash?
F = Feeling: If I were to start thinking that way how would it change what I was feeling? Would that change in feeling help me approach this problem in a more effective wash?
U = Urges (Motivations): if my feelings changed in that way, how would my urges (motivations) to act out my old self-defeating behaviors change?
A = Actions: If my urges/motivations changed in that way, what new actions could I take that would help me to deal with this problem in a  more effective way?
R = Reactions: If I used the new actions, how would the reactions of others be likely to change in a way that would help me approach the problem in a more effective way?
By using this process of TFUAR Analysis over and over again every time you experience a problem, you will begin to develop new and more effective habits for dealing with problems.
For more I information on using cognitive restructuring in your life get The Cognitive Restructuring for Addiction Workbook and use it as the basis of a discussion group with other people you know who are committed to personal growth and development.

introduction to The GORSKI-CENAPS Model of Addiction, Recovery, and Relapse

August 6, 2010

This blog will give a brief and easy to understand description of addiction, recovery, and relapse prevention for addiction and related problems.

Addiction is a biopsychosocial disease with profound spiritual consequences.

  • BIO means “biological” or pertaining to the physical actions of the body.
  • PSYCHO means psychological and pertains to the actions of both the brain (the hardware of thinking, feeling, and acting) and the mind (the nonphysical software that programs the actions of the brain).
  • SOCIAL pertains to the complex interactions that we have with other people, things, and systems. The social dimension also includes culture which is the basis for deep feelings of either belonging or alienation – feelings of being a part of or apart from.

Added to this mix is the complex interaction between addiction and spirituality. For the purpose of this blog, SPIRITUALITY pertains to our search for a meaning and purpose in life that is larger than ourselves. It is, in Twelve Step language, the search for a power greater than ourselves that will give us the courage, strength, and hope to go on in spite of hardship and adversity. Spirituality is the power that gives us the ability to go on even in the face of our inevitable death.

As you can see we will be covering a lot of territory – so keep coming back.

You can review my published materials and inorfmation on training and consultation at http://www.cenaps.com.


%d bloggers like this: