Program Profile: TCU Mapping-Enhanced Counseling for Substance Users

This program consists of a cognitive technique for incorporating graphic visualization tools into the counseling process for substance users. The program is rated Promising. The mapping-enhanced counseling group showed a statistically significant reduction in positive drug tests for opiates and cocaine at the 6-month posttest, compared with the control group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

TCU Mapping-Enhanced Counseling (formerly known as Node-Link Mapping Enhanced Counseling) is a cognitive technique for incorporating graphic visualization tools, or “maps”, into the counseling process. Developed and researched at the Institute of Behavioral Research at Texas Christian University (TCU), mapping-enhanced counseling works to improve the counselor–client relationship in areas such as goal development, problem solving, treatment engagement, and communication. As such, mapping-enhanced counseling is not an intervention in and of itself, but an addition to the counseling experience, independent of the style or theoretical orientation of the clinician.

Target Population

TCU Mapping-Enhanced Counseling can be used with both male and female adults and adolescents in substance abuse treatment programs, including community-based, residential, and criminal justice programs.

Program Components

The three types of maps that can be used with clients are as follows:

1. Free or freestyle maps, in which ideas, thoughts, feelings, or other material is organized using “nodes” (boxes to capture key words or ideas) and “links” (lines that connect and show the relationships among the nodes). Free maps can be created between counselor and client in individual sessions or on an erasable board as part of a group discussion. In addition, clients can be taught how to create their own free maps as part of homework, journaling, or personal problem solving.
2. Guide maps, in which mapping templates are used to create worksheets for clients to complete, often using question prompts designed to help guide the client’s thinking about recovery issues such as steps needed to reach a goal or feelings that might lead to relapse. Guide maps may be used as a group activity, a homework assignment, or as an aid to self-study.
3. Information maps, in which completed map templates are used to communicate knowledge in “small bites” to help clients learn faster. Information maps can be prepared for groups or individual sessions by a counselor. Alternatively, clients working in groups can be assigned to create information maps based on what they learned in a particular session or from another information source.

Program Theory

Through mapping, nodes and links are created based on key ideas from conversations in counseling sessions to graphically capture the “gist” of these ideas for further discussion and processing. Maps help illustrate thoughts, feelings, actions, and goals and show how they are related or linked together. A “good” map is one that facilitates thinking and communication among all those involved. Mapping is based on cognitive-network models of long-term memory, employing a simple, active declarative grammar that capitalizes on spatial organization to increase understanding and memory. As such, mapping is a cognitive adjunct to effective counseling, not an intervention in and of itself (Dansereau et al. 1996).

Study

Dansereau and colleagues (1996) examined the posttreatment outcomes of node-link mapping in the counseling of clients in three publicly funded methadone maintenance programs in Texas.

Sampling took place between May 1990 and May 1992. During this time, 696 opioid-addicted individuals were admitted to the three clinics. This study randomized the 304 clients who remained in treatment for at least 6 months to node-link mapping counseling (n = 157) and to a control condition (n = 147) that consisted of standard counseling. The overall study sample was 40 percent white, 38 percent Mexican American, and 22 percent African American. The sample was 66 percent male, and 80 percent of the treatment group and 85 percent of the comparison group used heroin daily. At baseline, there were no statistically significant differences between the mapping-enhanced counseling treatment group and control group.

In addition, half of the counselors at each of the three sites were randomly selected to receive training and workshops on node-link mapping. The remaining counselors in the control condition received a general skills-refresher training. In the treatment group, maps could be produced in individual or group counseling sessions, with maps from group sessions generally being produced once per session to solicit client input and guide discussion. Mapping procedures were monitored periodically, and counselors’ session notes and activity reports were reviewed.

The study measured the participants’ drug use through urinalysis results. Repeated measures multiple analyses of variance (or MANOVAs) were used to explore the influence of counseling procedures (mapping and standard) on participants’ drug use, looking specifically at opiates and cocaine. The study authors conducted subgroup analyses based on the ethnicity of participants.

Primers on how to incorporate mapping into clinical practice, as well as collections of ready-to-use guide maps covering a variety of recovery topics are available for free download on the Institute of Behavioral Research (IBR) at Texas Christian University (TCU) site.

In addition to free, downloadable resources, customized training workshops of varying lengths can be arranged to meet a program’s needs and interest. For costs and information about training for TCU Mapping-Enhanced Counseling, please contact the Training and TA Provider located in the Program Snapshot.

Subgroup Analysis

A major focus of the study by Dansereau and colleagues (1996) was to examine the differential effects of TCU mapping-enhanced counseling on different ethnicities. The study showed that at intake, and throughout the study, African American clients had higher rates of positive urines for cocaine. However, the TCU mapping-enhanced counseling treatment seemed to be comparatively more effective for both Mexican Americans and African Americans, than for white participants. While there were no statistically significant differences for white participants between treatment conditions in positive urines for cocaine, mapping-enhanced counseling had a statistically significant effect in reducing cocaine use for Mexican Americans. Additionally, there was a statistically significant increase in motivation for both Mexican American and African American mapping-enhanced counseling clients, compared with those receiving standard counseling.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: