TECHNIQUES | RELAPSE PREVENTION
THESE MAPS LEAD TO TREASURE
Asking clients to picture risks and resources for recovery from drug and alcohol
problems reveals these motivators in a way written words cannot, psychologist and
psychotherapist Martin Weegmann � nds – and it burns the images onto clients’ eyes.
I was inspired to use ‘relapse risk maps’ after
reading Marlatt and Gordon’s 1985 classic, Relapse
Prevention, where a gambler’s lapse is sketched in
diagrammatic form. Relapse prevention has other
fi gurative features, such as ‘urge surfi ng’ or the
metaphor of recovery as journey.
As such sketches and metaphors appealed to
my creative and visual side, I thought it could be
the same for my clients.
Not only this, but in my clinical work I was
impressed by the sheer circumstantial, relational
and aff ective complexity of lapse/relapse processes,
which could not be captured in linear models or
retrospective reporting.
Such complexity is acknowledged in reformulations
of the original relapse-prevention
model (Witkiewitz & Marlatt 2004). Maps are a
method of capturing, in detail, those often messy
and unobserved circumstances of drug/alcohol
use. Th ey encourage a vital, ecological view of
addiction which considers those realities beyond
what is happening in the skin or mind of the
individual user.
Maps blur any absolute supposed division
between factors ‘internal’ to clients or ‘external’
(for example, Moos et al 1990). Context is all.
So I regularly engage my clients in guided
exercises to construct personal maps of their
situations, and not only in response to relapse
(Weegmann, 2005). Maps can be done individually
and in groups, where a map done by one is seen
and commented on by all.
My practice evolved from ‘risk maps’ per se
to more balanced ‘recovery maps’, highlighting
the positive resources which clients have in their
environments. In practice, maps usually contain
both risk and protective elements.
DEFINING MAPS.
Maps are visual aids, which provide a bird’seye
view of a client’s situation: their home,
neighbourhood and the places, people and
activities in which they are normally engaged.
A kind of social-psychic geography, I use the
analogy of ‘doing a home visit without moving’.
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ADDICTION T DAY
Maps appeal to the imagination, encourage
visual learning, elicit detail and promote play in
the therapeutic relationship.
Useful as an instrument of assessment,
maps are equally helpful to therapy, as they can
be drafted, edited and compared in the light of
client progress. Maps can bring to light some
things which might not otherwise be seen or used.
Philosopher Wittgenstein (1953) spoke of about
“noticing an aspect” and “aspect blindness”. Maps
prompt clients to look again at their lives, seeing
and noticing things diff erently.
PRACTICALITIES.
Th e rationale to a client consists of something
on the lines of: “It can be helpful to do a visual
sketch, like a bird’s eye view of someone’s living
situation. It might help us to see important things
going on around you and give me an insight into
your living spaces. I’m happy to show you how to
start and then you can guide me as to what to put
down. Are you OK for us to try this?...
“OK, using this piece of paper, the easiest
place to start with is home. So, I’ll draw your
fl at fi rst and then we’ll gradually add the places,
people and activities that you might go to, meet
or do in any given week……” .
As the map is built, I elicit imaginative
captions from the client. What would they call
home – or any central point of their life, eg:
As the sketch unfolds, clients take to the idea,
but need prompts, such as “Who else do you see?
Let’s put in the dealers or fellow drinkers. Do you
see any non-using friends? Where is family?
Where else do you go? What happens on
WWW.ADDICTIONTODAY.ORG
weekends?” It is important to detect areas of
client ambivalence, as in the next example:
High-risk emotions and longings can be
pictured as below:
Similarly for positive resources, a client is
asked to give headings or associations, as below:
Once drafted, a person gives an overall title to their
map, which is photocopied and handed to them. Titles
have included “Going Straight Map”, “My Day to Day
Map”. I invite clients to do to an improved version of
the map at home and bring it back.
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