The road to recovery: journeys and relapse risk maps

When I first came into the substance misuse field, I read Marlatt and Gordon's voluminous Relapse Prevention.Therapists need orientation like anyone else. Hoping to find the key to unlock addiction, I came away with more questions than answers.

When the fog of theory and research settled, what stood out was their use of metaphors. Most memorable of all was their idea of relapse as a journey (with choices, turn-offs and crossroads to name but a few).This journey is made up of events, containing strong images of 'urge surfing' to counter cravings and a visual map illustrating the story of, for example, a gambler's release.

As a consequence I left wondering if these aspects could also help my patients.

Images have a habit of 'sticking' in the mind. Images are also associated with the 'right side' of the brain - which is associated with emotion, space and creativity.

In my early interventions on a residential group therapy programme, I used a form of psychodrama, whereby individuals would use and construct journey metaphors, warning signs and the like. Similarly, art therapy colleagues used images as a central technique of exploration.

As a result of my own journey I developed a series of 'relapse risk maps' - a hybrid technique in individual and group therapy.

Relapse risk maps

The use of relapse maps clearly fits with the relapse prevention approach, but is also compatible with other approaches: they can facilitate motivational work, psychodynamic exploration, solution-based therapy and so on.

I recall the surprise of a couple looking at their own picture when I invited them to draw the places around their home they associated with alcohol.At the end of the day, such maps are simply a way of encouraging dialogue and entering into a client's world.

Explaining the idea of maps to clients, I use the analogy of 'doing a home visit without the visit'. Things and activities might come to light that ordinary talking alone cannot accomplish.

This need not be a one-off, since the therapist can return to and...