Matthew Cuddeback, LCSW

One of the most powerful aspects of the decisions we make is when we experience the consequences of our actions. When we make a decision and feel that weight whether the result is good or bad, it helps us better understand the world around us and helps us assess whether we are acting in a way that is healthy for us or not. Consequences are incredibly important to understand, but sometimes we need help navigating this process as it can be tricky.

When we talk about natural consequences in the field of mental health, we are talking about how a decision you make is going to have consequences, some of them are manufactured and others are natural. A manufactured consequence would be something along the lines of because you cheated on a test in school and your mom found out, she forced you to tell your teacher. A natural consequence would be something more along the lines of because you drink alcohol in excess, you no longer have money to pay rent.

When discussing these natural consequences with clients, we often talk about what we call a “buffet of options.” What this refers to is the idea that sometimes we may not be aware or be mindful of the possible consequences of a decision. It can be a truly difficult and sometimes unfair way to learn a lesson when for example, you didn’t know that your time off you accrue during the year at work, does not roll over at the end of the year and it wasn’t written in a policy manual. So, we try instead to work with clients to look at all of their options and all possible consequences. For example, if I am working with a client who has been drinking alcohol in excess, I will discuss with them all their options. They could cut their use down or cut down on the types of alcohol they use. They could stop drinking all together, or they could keep going as is and make no change to their substance use. I offer all these options without judgement; you can keep going without making any change and I will not treat you negatively because you didn’t make the choice you think I would want you to.

I will then explore with my client the possible consequences of their choice, for each possible choice. If you cut down you will feel better about making progress, your loved ones will likely see this progress, you may also not be able to see some of your friends because they usual want to drink. You will save more money because you’re not drinking as much, etc. If you completely stop, you are going to feel unwell and anxious for a while, you may have to go to an inpatient program to get the treatment you need, maybe outpatient groups. Your loved ones will feel relief and so will you, etc. If you keep going without change your loved ones will continue to be frustrated and upset, you will continue to spend a lot of money on drinking. However, maybe you’re not ready to face the incredibly difficult work needed to make this change. You can continue to be at your current comfort level. You can continue to be around your friends and continue to have fun as you have been.

At this point, I remind my client they get to choose, and they know all the possible natural consequences. Let’s continue the above example and let’s say that this client chooses to continue to drink without making any change. I offer support and encouragement and assure them I will treat them no differently than if they decided to stop all together (treatment approach will change, but not the way we interact or my opinion of them.) The next time I meet with this client they tell me they were driving while intoxicated and got into a car accident, their car is ruined, and their license suspended. This means they may lose their job because their job requires them to drive, which has caused strain on their marriage. This is a brutal lesson, one that certainly I would not have wished for a client, but it does come from natural consequences, and of course my work with them would stay positive and supportive all along.

The reason these natural consequences are so valuable is because they carry so much weight and there is no scapegoat. Telling someone you will be disappointed with them if they choose to continue to drink and will withhold affection is manufactured and likely won’t have the same effect, though it can be understandable. It may make them mad at you, make them more defiant, maybe they think they can still make it up to you in other ways. However, not having a car or a license, or possibly losing your job? It’s much harder to be mad at anyone but yourself, nobody set that situation up for you. We respond to natural consequences differently and take them more seriously, which means they effect change more powerfully. It can be harsh but is also useful and sometimes necessary.