What Elephants Are in the Room? 房间里有什么大象?

A: 房间里有什么大象?
Fángjiān li yǒu shénme dàxiàng?
What elephants are in the room?

What elephants are in the room?

B: 你的意思是什么?
Nǐ de yìsi shì shénme?
What do you mean?

A: 我们都看到一些事情是真的 ,但是我们不讨论它.
Wǒmen dōu kàn dào yīxiē shìqíng shì zhēn de, dànshì wǒmen bù tǎolùn tā.
We both see a matter is true but we don’t discuss it.

B: 你的意思是我们看到它但我们回避它?
Nǐ de yìsi shì wǒmen kàn dào tā dàn wǒmen huíbì tā?
You mean we see it but avoid it?

A: 是的.
Shì de.
Yes.

B: 如果我们讨论大象,我们可能会打架!
Rúguǒ wǒmen tǎolùn dà xiàng, wǒmen kěnéng huì dǎjià!
If we talk about the elephants, we may fight!

A: 如果房间里有大象,我们已经在打架了,所以只是沉默.
Rúguǒ fángjiān li yǒu dà xiàng, wǒmen yǐjīng zài dǎjiàle, suǒyǐ zhǐshì chénmò.
If elephants are in the room, we are already fighting, just silently.

B: 好吧.
Hǎo ba.
Okay.

A: 我对你是好意。你对我是好意。加油,我们可以做到. 告诉我. 我们的最大的大象是什么?
A: Wǒ duì nǐ shì hǎoyì. Nǐ duì wǒ shì hǎoyì. Jiāyóu wǒmen kěyǐ zuò dào! Gàosù wǒ. Wǒmen de zuì dà de dàxiàng shì shénme?
I have good intentions towards you. You have good intentions towards me. Come on, we can do this. Tell me. What is our biggest elephant?

B: 好啊. 我非常欣赏你. 你知道我们有时候…
Hǎo a! Wǒ fēicháng xīnshǎng nǐ. Nǐ zhīdào wǒmen yǒu shíhòu…
Okay! I appreciate you so much. You know when you and I sometimes…

Author: Anne Giles

Tian Gan contributed to writing and editing this post.

This post includes 对 duì  and 知道 zhīdào, meaningful words on our list of universal human concepts.

If you are a user of Mandarin Blueprint, this post’s content may be helpful in learning these characters:

Phase 1 Level 1 Character #11 什 shén
Phase 3 Level 15 Character #161 大 dà
Phase 4 Level 22 Character #305: 道 dào
Phase 5 Level 33 Character #518 知 zhī

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. In hopes of fostering empathy and understanding, the series features dialogues about universal human concepts in simplified Chinese characters, pinyin, and English. Posts in the Meaningful Words series are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

Submissions are read and edited by people proficient in Mandarin Chinese before publishing. Since the publisher is a beginning student of Mandarin Chinese, changes made may introduce new, undetected errors. Since posts use simple vocabulary to convey complex ideas, ambiguity may result. Posts are estimated to be 95% correct in terms of typography, vocabulary, grammar, and clarity.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Might Both Be True? 可能两者都是真的

这一部分的我: 我要和我不要. 两者都是真的.
Zhè yībùfèn de wǒ: Wǒ yào hé wǒ bùyào. Liǎng zhě dōu shì zhēn de.
>>This part of me: I want and I don’t want. Both are true.

In both may be synergy那一方的我: 是真实的。这就是做人的辩证法。
Nǎ yībùfèn de wǒ: Shì zhēnshí de. Zhè jiùshì zuòrén de biànzhèngfǎ.
>>That part of me: True. This is the dialectic of being human.

这一部分的我: 我想跟人待在一起和我想一个人. 我害怕亲密的关系, 我也渴望亲密的关系.
Zhè yībùfèn de wǒ: Wǒ xiǎng gēn rén dài zài yīqǐ hé wǒ xiǎng yīgè rén. Wǒ hàipà qīnmì de guānxì, wǒ yě kěwàng qīnmì de guānxì.
>>This part of me: I want to be with people and I want to be alone. I fear intimacy (to be close) and I long for intimacy.

这一部分的我: 我想跟人待在一起和我想一个人. 我害怕亲密的关系, 我也渴望亲密的关系.

那一部分的我: 如果一个人和另一个人都知道他们的这些部分, 他们可以一起用辩证法  谈判.
Nà yībùfèn de wǒ: Rúguǒ yīgè rén hé lìng yīgè rén dōu zhīdào tāmen de zhèxiē bùfèn, tāmen kěyǐ yīqǐ yòng biànzhèngfǎ  tánpàn.
>>That part of me: If one person and the other person both know these parts of themselves, together, they can negotiate the dialectic.

这一部分:当我想要一些东西的时候, 我现在就要! 我不要谈判!
Zhè yībùfèn: Dāng wǒ xiǎng yào yīxiē dōngxī de shíhòu, wǒ xiànzài jiù yào! Wǒ bùyào tánpàn!
>>This part: When I want something, I want it now! I don’t want to negotiate!

那一部分: (笑着) 当然! 另一个人也一样的!
Nà yībùfèn: (Xiàozhe) Dāngrán! Lìng yīgè rén yě yīyàng!
>>That part: (Laughing) Of course! The other person is the same!

这一部分: 哦. (笑着) 好吧.
Zhè yībùfèn: Ó. (Xiàozhe) Hǎo ba.
>>This part: Oh. (Laughing) Okay.

那一部分: 我觉得你在想,”是我还是他们.” 如果两者都有呢?
Nà yībùfèn: Wǒ juédé nǐ zài xiǎng,”Shì wǒ háishì tāmen.” Rúguǒ liǎng zhě dōu yǒu ne?
>>That part: I think you are thinking, “It’s me or them.” What if it’s both?

这一部分: 两个都是?
Zhè yībùfèn: Liǎng gè dōu shi?
>>This part: Both?

那一部分: 你知道 “协同作用” 吗? 整体比所有的部分更大?
Nà yībùfèn: Nǐ zhīdào “xiétóng zuòyòng” ma? Zhěngtǐ bǐ suǒyǒu de bùfèn gèng dà?
>>That part: You know “synergy”? The whole is greater than the sum of the parts?

这一部分: 我知道这个.
Zhè yībùfèn: Wǒ zhīdào zhège.
>>This part: I know this.

那一部分: 所有的一个东西不总是真的. 所有的另外的东西不总是真的.两个东西有的时候都是真的. 他们重叠的地方可能有协同作用. 关于你想要的, 可能你从谈判得到的比自己一个人更多.
Nà yībùfèn: Suǒyǒu de yīgè dōngxī bù zǒng shì zhēn de. Suǒyǒu de lìngwài de dōngxī bù zǒng shì zhēn de. Liǎng gè dōngxī yǒu de shíhòu dōu shì zhēn de. Tāmen chóngdié dì dìfāng kěnéng yǒu xiétóng zuòyòng. Guānyú nǐ xiǎng yào de, kěnéng nǐ cóng tánpàn dédào de bǐ zìjǐ yīgè rén gèng duō.
>>That part: All of one thing is not always true. All of the other thing is not always true. Both are true sometimes in some ways. Where they overlap lives the possibility for synergy! About what you want, perhaps from negotiating you can receive more than from being alone.

这一部分: 我没想到那个
Zhè yībùfèn: Wǒ méi xiǎngdào nàgè.
>>This part: I didn’t think of that.

你和我一起谈判这件事情. 我们一起明白. 可能你和另一个人可以做一样的事情.
Nǐ hé wǒ yīqǐ tánpàn zhè jiàn shìqíng. Wǒmen yīqǐ míngbái. Kěnéng nǐ hé lìng yīgè rén kěyǐ zuò yīyàng de shìqíng.
>>That part: You and I, together, negotiated this matter. We, ourselves, together understand. Perhaps, you and the other person can do the same!

这一部分: 好啊! 现在, 我明白了. 我会尝试的!
Zhè yībùfèn: Hǎo a! Xiànzài, wǒ míngbáile. Wǒ huì chángshì de!
>>This part: Okay! Now, I understand. I will try!

. . . . .

这是一个人的 内在智慧进行内在对话的例子.
Zhè shì yīgè rén de nèizài zhìhuì jìnxíng nèizài duìhuà de lìzi.
>>This is an example of an inner dialogue with one’s inner wisdom.

Author: Anne Giles

Depeng, Benfang Wang, and Tian Gan contributed to writing and editing this post.

This post includes 知道 zhīdào, a meaningful word on our list of universal human concepts.

If you are a user of Mandarin Blueprint, this post’s content may be helpful in learning these characters:

Phase 4 Level 22 Character #305: 道 dào
Phase 5 Level 33 Character #518 知 zhī

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. In hopes of fostering empathy and understanding, the series features dialogues about universal human concepts in simplified Chinese characters, pinyin, and English. Posts in the Meaningful Words series are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

Submissions are read and edited by people proficient in Mandarin Chinese before publishing. Since the publisher is a beginning student of Mandarin Chinese, changes made may introduce new, undetected errors. Since posts use simple vocabulary to convey complex ideas, ambiguity may result. Posts are estimated to be 95% correct in terms of typography, vocabulary, grammar, and clarity.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

What Do You See? 你看到什么?

老师问:你看到什么?
Lǎoshī wèn: Nǐ kàn dào shénme?
Teacher: What do you see?

Do you see the fish or the fish tank?

美国学生:不同颜色,不同大小,不同种类的鱼在游玩.
Měiguó xuéshēng: Bùtóng yánsè, bùtóng dàxiǎo, bùtóng zhǒnglèi de yú zài yóuwán.
American student: Fish of different colors, different sizes and different kinds are swimming.

中国学生:珊瑚,水草,沙石,鱼在游.
Zhōngguó xuéshēng: Shānhú, shuǐcǎo, shā shí, yú zài yóu.
Chinese student: Reef, water grass, sand and fishes swimming.

我们看事情的角度不一样.
Wǒmen kàn shìqíng de jiǎodù bù yīyàng.
We see things from different angles.

研究表明,亚州人尤其是东亚人和欧美人看问题角度很不同,美国人比较注意个体,东亚人比较注意群体和整体.
Yánjiū biǎomíng, yà zhōu rén yóuqí shì dōng yǎ rén hé ōuměi rén kàn wèntí jiǎodù hěn bùtóng, měiguó rén bǐjiào zhùyì gètǐ, dōng yǎ rén bǐjiào zhùyì qúntǐ hé zhěngtǐ.
Research shows that Asians, especially East Asians, see things differently from Euro-Americans. Americans pay more attention to individuals and east Asians pay more attention to the whole group and the big picture.

知道了这一点,我们在交流的时候就应该多从注意站在对方的角度上看问题。
Zhīdàole zhè yīdiǎn, wǒmen zài jiāoliú de shíhòu jiù yīnggāi duō cóng zhùyì zhàn zài duìfāng de jiǎodù shàng kàn wèntí.
Knowing this, we can improve our communications by thinking more from the other’s perspective.

Author: Sofia Zhang-Midkiff, M.B.A.

Sofia Zhang-Midkiff brought to our awareness the research on ways of seeing using the metaphors of fish and fish tanks. We contributed to this dialogue about this idea here.

This post includes 知道 zhīdào, a meaningful word on our list of universal human concepts.

If you are a user of Mandarin Blueprint, this post’s content may be helpful in learning these characters:

Phase 4 Level 22 Character #305: 道 dào
Phase 4 Level 25 Character #368 鱼 yú
Phase 5 Level 33 Character #518 知 zhī

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. In hopes of fostering empathy and understanding, the series features dialogues about universal human concepts in simplified Chinese characters, pinyin, and English. Posts in the Meaningful Words series are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

Submissions are read and edited by people proficient in Mandarin Chinese before publishing. Since the publisher is a beginning student of Mandarin Chinese, changes made may introduce new, undetected errors. Since posts use simple vocabulary to convey complex ideas, ambiguity may result. Posts are estimated to be 95% correct in terms of typography, vocabulary, grammar, and clarity.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

What Answers Help? 什么样的回答有帮助?

A: 当你问你的父母, 宝宝从哪里来? , 他们回答什么?
Dāng nǐ wèn nǐ de fùmǔ bǎobǎo cóng nǎlǐ lái, tāmen huídá shénme?

When you asked your parents where babies come from, what did they answer?

What answers help?B: 我的父母是中国人. 他们说, “我们走自路上, 在路边我们看见了你. 然后, 我们把你带回了家.”
B: Wǒ de fùmǔ shì zhōngguó rén. Tāmen shuō, “Wǒmen zǒu zì lùshàng, zài lù biān wǒmen kànjiànle nǐ. Ránhòu, wǒmen bǎ nǐ dài huíle jiā.”

My parents are Chinese. They said, “We were walking down a road. On the side of the road, we saw you. Then, we picked you up and took you home.”

C: 我的父母是美国人。他们说, “母亲的一颗蛋和父亲的一颗种子结合在一起.  这是怎么做了宝宝.” 我还是孩子 . 我想, “做饭, 做宝宝, 好的. 但是, 一个鸡蛋?!”
Wǒ de fùmǔ shì měiguó rén. Tāmen shuō, “Mǔqīn de yī kē dàn hé fùqīn de yī kē zhǒngzǐ jiéhé zài yīqǐ.  Zhè shì zenme zuò de bǎobǎo.” Wǒ hái shì háizi. Wǒ xiǎng, “Zuò fàn, zuò bǎobǎo, hǎo de. Dànshì, yīgè jīdàn?!”

My parents are American. They said, “An egg from the mother and a seed from the father come together. That is what makes a baby.” I was still a child. I thought, “Cook food, make a baby, okay. But a chicken egg?!”

A: (笑) 这些答案都不是很有帮助!我想知道他们为什么不告诉我们事实?
(Xiào) Zhèxiē dá’àn dōu bùshì hěn yǒu bāngzhù! Wǒ xiǎng zhīdào tāmen wèishénme bù gàosù wǒmen shìshí?

(Laughing) Neither of those answers is very helpful. I wonder why they didn’t tell us the facts?

读者 朋友,你的父母是怎么回答的?什么样的答案会更有帮助、更真实呢?
Dúzhě Pengyou, nǐ de fùmǔ shì zěnme huídá de? Shénme yàng de dá’àn huì gèng yǒu bāngzhù, gèng zhēnshí ne?

Dear Reader, what did your parents answer? What would have been a more helpful and true answer?

Authors: Tian Gan and Anne Giles

This post was inspired by discussions of the cartoon 中国人和外国人
zhōngguó rén hé wàiguó rén.

Benfang Wang and Amy contributed to translating this post.

This post includes 想 xiǎng, 知道 zhīdào, and 事实 shìshí, meaningful words on our list of universal human concepts. The word  想 xiǎng is also featured here.

If you are a user of Mandarin Blueprint, the content may be helpful in learning these characters:

Phase 3 Level 13 Character #117 想 xiǎng
Phase 4 Level 22 Character #305: 道 dào
Phase 4 Level 29 Character #438 实 shí
Phase 4 Level 29 Character #452: 事 shì
Phase 5 Level 33 Character #518 知 zhī

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. In hopes of fostering empathy and understanding, the series features dialogues about universal human concepts in simplified Chinese characters, pinyin, and English. Posts in the Meaningful Words series are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

Submissions are run by people proficient in Mandarin Chinese before publishing. Since the publisher is a beginning student of Mandarin Chinese, changes made may introduce new, undetected errors. Since posts use simple vocabulary to convey complex ideas, ambiguity may result. Posts are estimated to be 95% correct in terms of typography, vocabulary, grammar, and clarity.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Fish or Fish Tank? 鱼还是鱼缸?

学生说:
Xuéshēng shuō:
The student says:

老师, 我听说美国人和中国人想的方式不一样.
Lǎoshī, wǒ tīng shuō měiguó rén hé zhōngguó rén xiǎng de fāngshì bù yīyàng.
Teacher, I have heard that American people and Chinese people think differently.

Do you see the fish or the fish tank?

据研究,当两人看到鱼缸里鱼的照片时,美国人看鱼,中国人看鱼缸。
Jù yánjiū, dāng liǎng rén kàn dào yúgāng lǐ yú de zhàopiàn shí, měiguó rén kàn yú, zhōngguó rén kàn yúgāng.
According to research, when both people see a photo of a fish tank with fish, American people see the fish and Chinese people see the fish tank.

如果我们看见 的不一样,我们怎么能 建立有意义的联系?
Rúguǒ wǒmen kànjiàn de bù yīyàng, wǒmen zěnme néng jiànlì yǒu yìyì de liánxì?
If we don’t see the same, how can we make meaningful connections?

老师说:
Lǎoshī shuō:
The teacher says:

我们既要看见鱼也要看见鱼缸。
Wǒmen jì yào kànjiàn yú yě yào kànjiàn yúgāng.
We need to see not only the fish but also the fish tank.

我们要看见每个人的情况而不是只看见一个群体.
Wǒmen yào kànjiàn měi gèrén de qíngkuàng ér bùshì zhǐ kànjiàn yīgè qúntǐ.
Rather than only see a group, we need to see each person’s situation.

Authors: Depeng and Anne Giles

Research on seeing fish and fish tanks, thanks to Sofia Zhang-Midkoff:

This post includes 想 xiǎng, a meaningful word on our list of universal human concepts. The word  想 xiǎng is also featured here.

If you are a user of Mandarin Blueprint, the content may be helpful in learning these characters:

Phase 3 Level 13 Character #117 想 xiǎng
Phase 4 Level 25 Character #368 鱼 yú

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. The series features dialogues about universal human concepts in Mandarin Chinese and in English. Posts in the Meaningful Words series are here and posts related to Mandarin Chinese are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

Image: iStock

Anne Giles, M.A., M.S., L.P.C., is a student of Mandarin Chinese and also a mental health counselor, able to provide counseling services only to residents of the Commonwealth of Virginia, U.S.A. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

What Do You Think? 你怎么想?

This video by Benfang Wang features 想 xiǎng, a meaningful word on our list of universal human concepts.

Benfang Wang’s Mandarin Chinese learning materials include artificial intelligence technology. To access Benfang’s “All about 想 xiǎng” AI materials, register for a free account through Benfang’s Edugo.ai portal. Then follow this link to Benfang’s Edugo.ai materials, log in, and scroll down to Lesson 10.

Please find Benfang Wang on italki, YouTube, and Facebook.

If you are a user of Mandarin Blueprint, the video’s content may be helpful in learning these characters:

Phase 3 Level 13 Character #105 来 lái
Phase 3 Level 13 Character #117: 想 xiǎng
Phase 3 Level 14 Character #131: 起 qǐ
Phase 4 Level 25 Character #359: 出 chū

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. The series features dialogues about universal human concepts in Mandarin Chinese and in English. Posts in the Meaningful Words series are here and posts related to Mandarin Chinese are here. If you are interested in writing for the Meaningful Words series, please see these submission requirements.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

How About You? 你呢?

如果没有什么是违法的,你会做什么?
Rúguǒ méiyǒu shén me shì wéifǎ de, nǐ huì zuò shénme?
If nothing were illegal, what would you do?

How about you? 你呢?

善良的人说:我会毫不犹豫地去帮助摔倒的老太太。
Shànliáng de rén shuō: Wǒ huì háo bù yóuyù de qù bāngzhù shuāi dǎo de lǎo tàitai.
A kind-hearted person would say: I would help the old lady who fell down without hesitation.

强盗说:我会正大光明地去洗劫银行。
Qiángdào shuō: Wǒ huì zhèngdà guāngmíng de qù xǐjié yínháng.
A robber would say: I would openly rob a bank.*

司机会说:我可能会把车开得更快些.
Sījī huì shuō: Wǒ kěnéng huì bǎ chē kāi dé gèng kuài xiē.
A driver would say: I would drive the car faster.

我说:我会继续留在美国学习。
Wǒ shuō: Wǒ huì jìxù liú zài měiguó xuéxí.
I say: I would continue staying in the United States to study.

你呢?
Nĭ ne?
How about you?

Author: Tian Gan

 

“Ni Ne?”, the video accompanying this post, was created by Benfang Wang. Please find Benfang Wang on italkiYouTube, and Facebook.

Benfang Wang’s Mandarin Chinese learning materials include artificial intelligence technology. To access Benfang’s “All about 想 xiǎng” AI materials, register for a free account through Benfang’s Edugo.ai portal. Then follow this link to Benfang’s Edugo.ai materials, log in, and scroll down to Lesson 10.

*正大光明 zhèngdà guāngmíng is a phrase that can be translated into English as “conscientious, frank, upright, and open-minded.”

If you are a user of Mandarin Blueprint, the content may be helpful in learning these characters:

Level 38 Character # 639 良 liáng
Level 44 Character # 864 善 shàn

Included in this post is 善良 shànliáng, a concept on our universal human concepts list.

This post is part of our Meaningful Words 有意义的词 yǒu yìyì de cí series. The series features expression of universal human concepts in Mandarin Chinese and in English in hopes of helping people make meaningful connections 建立有意义的联系 jiànlì yǒu yìyì de liánxì. Posts in the Meaningful Words series are here and posts related to Mandarin Chinese are here. If you are interested in writing a Meaningful Words post, please see these submission requirements.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Universal Human Concepts

To the best of my ability to discern and express them, below is a list of fundamental, universal human concepts that, if people can become aware of them, can help them live humane, skillful lives, regardless of language. If they can use these concepts in words, they may be able to connect more skillfully and meaningfully with each other.

Kindness for all

Simple language summary

If people are kind to themselves and others, and aware of themselves and others, they can gently become aware of many components of their inner lives and their interactions with others. This awareness offers the ability to make conscious decisions about potentially helpful ways to speak, act, relate, and work, increasing the likelihood of optimal results for self and others.

List of concepts

These concepts, and related ones, are listed below and defined in Chinese and English. To assist early learners of Mandarin Chinese, after the Chinese character is listed the pinyin, then a literal, one-word translation into English of each character, then an English translation in bold. Explanatory words are included but are not in bold.

善良 shànliáng | good very good | kindness
自我善良 zìwǒ shànliáng | self I good very good | self-kindness
对别的人善良 duì bié de rén shànliáng | towards other people good very good | kindness towards others
意识 yìshí | meaning knowledge | awareness, consciousness
自我意识 zìwǒ yìshí | self I meaning knowledge | self-awareness
对别的人意识 duì bié de rén yīshí | towards other people meaning knowledge | awareness of others
感觉 gǎnjué | feel become aware of | feelings
想法 xiǎngfǎ } think method } thoughts
头脑 tóunǎo | head brain | mind; not the same as thoughts
大脑 dànǎo | big brain | brain; not the same as thoughts
事实 shìshí | affair/matter reality | facts
对 / 对抗 duì / duìkàng | towards | versus/vs.
信念 xìnniàn | believe think | beliefs; not the same as facts
需要 xūyào | need want } needs
想要 xiǎng yào | think want | wants
偏好 piānhào | bias want } preferences
价值观 jiàzhíguān | price value sight | values
优先级 yōuxiān jí | excellent first level | priorities
同理心 tóng lǐ xīn | alike reason heart } empathy
同情 tóngqíng | alike feeling | sympathy; not the same as empathy
理解 lǐjiě | reason separate | understanding
做选择 zuò xuǎnzé | make choice pick with hand | to make
a choice
决定 juédìng | decidedly set | to decide
方法 fāngfǎ | square/direction, law/method/way | method, way
优化 yōuhuà | optimize
做到最好 zuò dào zuì hǎo | optimization, make best
(Instead of trying to work harder, seeking ways to work better/more efficiently.)
协同作用 xiétóng zuòyòng | association alike/together do use | synergy = greater than the sum of the parts
判断 pànduàn | to sentence to cut off | judgment | Judgment is a soul-killer and a destroyer of possibility.
内在智慧 nèizài zhìhuì | internal at intelligence wisdom | inner wisdom; results from dialectic/synergy of awareness of feelings and thoughts
战略 zhànlüè | fight summary | strategy
技能 jìnéng | skill can | skills
连结 liánjié | link knot | a sense of feeling connected as humans in meaningful ways
一种存在方式 yī zhǒng cúnzài fāngshì | one type deposit at direction system | a way of being

An earlier version of this list as a .pdf is here.

Image: iStock

The list is informed by my knowledge, training and experience as a scholar, educator, counselor, learner of Mandarin Chinese, and person. I created this content in consultation with multiple individuals proficient in Mandarin Chinese. All errors are mine.

Anne Giles, M.A., M.S., L.P.C., is a student of Mandarin Chinese and also a mental health counselor, able to provide counseling services only to residents of the Commonwealth of Virginia, U.S.A. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Outline of an Initial, Evidence-Informed Treatment Plan for Substance Use Disorder

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

“Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.”
National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health (NIH), 2018

Treatment Plan Goal: To assist individuals in living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society.

Objectives listed in priority order:

1 – Medical Care

  • Physical exam and diagnostic lab work
  • Assessment for suitability for medications for:
    – Substance use disorders (SUDs), including nicotine replacement therapy
    – Co-occurring mental illnesses
    – Physical illnesses
    – Physical pain
    – Sleep disturbances
    – Nutrition and diet
    – Assessment for neuroatypicality: sensory sensitivity and under-sensitivity (Unbroken Brain, Chapter 4); attention challengesautism spectrum
  • Assessment for suitability for follow-up care, additional treatment, and referrals

2 – Mental Health Care

Mental Health Assessment

  • Trauma (2/3 of all people with SUDs have experienced trauma)
  • Co-occurring mental illnesses (over 1/2 of all people with SUDs have at least one co-occurring mental illness)
  • Current stressors
  • Needs assessment

Counseling

3 – Support Services

  • Connect individuals with social services agencies to assist with current stressors and needs: employment, housing, transportation, child care, legal issues, etc.
  • Income: Assist individuals with finding jobs or applying for disability benefits.

4 – Social Support

  • Interests and preferences assessment
  • Experimentation with diverse interest groups, clubs, religious groups, support groups and/or other sources of social connection based on individual interests and preferences

. . . . .

The content of this treatment plan is based on a synthesis of extensive literature reviews that I and Laurel Sindewald have conducted on substance use disorders and their treatment. The treatment plan is highly informed by Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released in November, 2016.

The Surgeon General’s Report is current as of November, 2016, with these exceptions: In terms of treatment effectiveness, research data does not support inclusion of 12-step approaches or rehab, nor does it support inclusion of naltrexone, or extended release naltrexone, as a primary treatment for opioid use disorder, equivalent to methadone and buprenorphine. Naltrexone may be contraindicated for those with liver disease and can be associated with depression. According to Buchel et al., November, 2018, “blocking opioid receptors decreases the pleasure of rewards in humans.”

We link to primary sources reporting research data as available, and authoritative secondary sources that cite multiple primary sources. Our reports are here. Since nearly every word in this post could be linked to a source, I have only linked to sources for terms or concepts that may be unfamiliar to some. Feel free to contact me with questions or feedback.

The goal of substance use disorder treatment is to assist individuals with living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society. A treatment plan describes how a person hopes to reach this goal, or to get help with reaching this goal, through specific steps, termed objectives.

Above is a brief outline of evidence-based treatment components for an individual beginning treatment for substance use disorder.  This treatment plan is evidence-informed, not evidence-based, because it, as a stand-alone protocol, has not been subject to research.

I define evidence-based treatment as what research reports works for most people, most of the time, better than other treatments, and better than no treatment. Specifically, that means the treatment is supported by numerous, peer-reviewed scientific experiments with rigorous methods that include control groups, randomization of subjects to experimental conditions, and bias-free samples, with statistically significant results. Some treatments that are evidence-based to work for groups may not be helpful to a particular individual, however. It is an imperative that counselors and individuals continually monitor an individual’s condition and progress while engaged in treatment.

I contrast research data – the evidence resulting from research experiments – with “anecdotal data.” I define anecdotal data as an individual’s personal experience. Data from a sample size of one does not provide sufficient information from which a generalization can be made about a group or population. Principles believed to account for outcomes from inspirational individual stories, practitioner wisdom, or theories based on logic, cannot be safely applied to others without first subjecting those principles to rigorous research.

This report may also be of interest:

A Guide for Clinicians to Initial Treatment for Alcohol Use Disorder

Last updated 11/20/18

The views expressed are the author’s alone and do not necessarily reflect the positions of the author’s employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

A Guide for Clinicians to Initial Treatment for Alcohol Use Disorder

The Surgeon General’s report, Facing Addiction in America, released in November, 2016, recommends a multi-pronged approach to addiction treatment, in this priority order:

1) medical care, initially from a primary care physician (PCP), to be assessed for a) suitability for medications, b) co-occurring or underlying physical conditions that may be causing stress or distress, including physical pain, and c) co-occurring mental illnesses that may be causing stress, distress, or instability.

2) individual counseling;

3) recovery support services (RSS) to reduce life stressors. Based on clients’ individual preferences, recovery-specific support group attendance may be part of RSS.

Alcohol use disorder (AUD) is defined as a disorder of the organ of the brain which requires medical treatment. Given the nature of the substance, abstinence, rather than harm reduction, is the recommended long-term treatment goal for AUD. Unfortunately, unlike with opioids, no safe dosing of ethyl alcohol exists.

The cognitive functions a person with AUD and other substance use disorders would need for abstention are the very ones impaired by the disorder itself: choice, decision-making, and recognizing the need for change, planning for it, and executing it. The neurobiology of addiction compromises the brain’s basal ganglia, extended amygdala, and prefrontal cortex and, thus, under-sensitizes one to pleasure, over-sensitizes one to pain, automates use of the substance to feel normal, weakens decision-making abilities, magnifies emotional highs and lows and incapacitates the ability to regulate them, interferes with recognizing cause-and-effect relationships, and confounds the ability to make a plan and follow through with it.

“People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”
– Nora D. Volkow, M.D, Director of the National Institute on Drug Abuse (NIDA), quoted in What We Take for Granted

Other than with 1) medication and 2) time without exposure of the brain to the substance, brain structures and pathways impaired by AUD currently cannot be directly, immediately and efficiently treated for AUD. Therefore, individuals’ self-care efforts and counselors’ therapeutic efforts will focus on supporting abstinence rather than on attempting to directly treat the brain for addiction.

Alcohol use, even in small amounts, can compromise brain functioning and physical health. In those with alcohol use disorder, physical and behavioral symptoms can be life-threatening to themselves and others. Alcohol withdrawal can be a dangerous, deadly medical condition. Even nurses can be challenged by the symptoms. If a client needs emergency care, call 911. If a client needs urgent care, arrange for it.

The following guide applies to clients who are stable and not in need of urgent or emergency care.

Medical Care

Assist individuals with procuring health insurance and making appointments with medical professionals, beginning with the primary care physician (PHP). If the client does not have health insurance, query community sources for assistance.

(This is normally in the realm of case management rather than traditional clinical sessions, but helping the individual make the phone calls and appointments accommodates possible cognitive impairments associated with use and/or early abstinence. If it’s a personal fit for clinicians, they may consider accompanying individuals to medical appointments.)

Ask non-abstaining clients to keep a log of their consumption of alcohol.

Ask clients to make a rank-ordered list of physical symptoms that cause them stress or distress. (Include physical pain and issues with sleeping and/or eating.)

Ask clients to make a rank-ordered list of mental or psychiatric symptoms that cause them stress or distress.

Help clients compile this data: 1) consumption log (if applicable), 2) physical symptoms, 3) mental or psychiatric symptoms.

Coach clients in advocating for evidence-based treatment when they meet with their PCP. Few PCPs have time to stay up-to-date on the latest in addiction treatment given most work overtime to meet the demand for health care which exceeds capacity. Unfortunately, many PCPs continue to hold the belief that alcoholism is a personal, moral, mental, or criminal problem rather than a medical one.

In the brief appointment clients will have with PCPs, they need to try to make these things happen:

1) Ask to be assessed for medical management of tapering and for medical management of potentially dangerous withdrawal symptoms, including a cost-benefit analysis of the risks of outpatient detox vs. highly stressful and disruptive inpatient detox.

Evidence-based guides to self-tapering from alcohol do not exist. This source, however, may be a place to begin for patient and physician to co-create a tapering plan based on the individual’s alcohol consumption log. Attending rehab is not an evidence-based method for achieving abstinence from substances.

2) Ask to be assessed for medications that assist with abstinence, based on use as recorded in the log. For some patients, naltrexone can be prescribed prior to abstinence, potentially improving progress towards abstinence.. (Here’s an NPR story on naltrexone for AUD.)

3) Ask to be assessed for blood work and for other diagnostic assessments to begin to treat the top items on the list of physical symptoms, or to begin to find the origins of the physical symptoms that are most problematic. Present a copy of the physical symptoms list for reference.

4) Ask for a referral to a psychiatrist now to get on the wait list for an appointment (local wait is 6-12 months). Present a copy of the psychiatric symptoms list for reference.

5) Keep the end in mind, i.e. accomplishing the tasks above, and stay self-regulated if – unfortunately possible – moralistic, judgmental, admonishing, shaming or dismissive statements are made by medical professionals during the appointment, or if follow-up treatment is delayed.

6) Make an appointment now for a follow-up visit with the PCP.

“Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”
– Alan Marlatt

Prior to the appointment with the PCP, provide clients with copies of these summary reports on first-line medications for AUD to take with them to offer as reference material if needed:

Fewer than 10% of people with AUD are offered or receive medications to treat the illness. Scientifically sound studies of the comparative efficacy of naltrexone, acamprosate, disulfram and gabapentin do not exist, although one study does compare naltrexone and camprosate. Finding the right medication, or combinations of medications, for each individual takes time.

At risk for premature death from an acute state of AUD, many clients do not have time for trial-and-error experimentation. They may have complicating physical and mental disorders as well. An expert medical opinion, ideally from a physician or psychiatrist, is crucial. We may only have one chance to medically assist a client so we need the most informed, experienced medical advice we can access on the client’s behalf.

Counseling

According to research, individual counseling is more effective than group counseling in helping people with substance use disorders achieve and maintain abstinence. Cognitive behavior therapy (CBT) and related dialectical behavior therapy (DBT), are the therapeutic modalities associated with abstinence. (Here’s a helpful self-directed guide to DBT.) Stress, distress, and exposure to substance-related, environmental cues are the primary precursors for a return to use.

A fundamental skill a person with AUD needs to acquire to increase the likelihood of maintaining abstinence can be termed “self-regulation.” Individuals who can self-regulate emotions, cognitions, attention, as well as moderate ways of relating to self and others, may limit or prevent the escalation of stress or distress to the state of near-dissociation in which a return may occur.

Trained counselors can assist clients with AUD by assisting them with developing self-regulation skills. Therapeutic rapport can help mitigate the stress and distress inherent in therapy and treatment.

In individual counseling sessions, or group sessions if individual sessions are not available, or as a supplement to individual sessions – taking into account cognitive limitations resulting from recent use and/or early abstinence – clinicians can assist clients increase responsiveness (vs. reactivity) to stress and distress, thus to decrease the likelihood of a return to use. Helping clients develop self-regulation requires a shift from focusing on anticipated “people, places and things,” “triggers,” or “choices,” to focusing on using self-regulation in highly unpredictable circumstances, whether with a person, a trigger, or otherwise (see Kaye, et al., 2017).

Since an estimated 70% of people with substance use disorder have experienced trauma, clinicians need to assess for trauma and, if present, given the likelihood of only a few therapy sessions, attempt to provide evidence-based, brief trauma therapy. (Brief interventions are few in number and are still being researched.)

Since approximately half of people with substance use disorder have co-occurring mental illnesses, clinicians need to assess for co-occurring disorders, particularly severe mental illnesses (SMIs) which may qualify clients for additional services.

Since substance use disorder is a 24-7 condition and manifests outside the clinical setting, inform and coach clients on self-care practices that support abstinence.

Recovery Support Services

Query clients about what external factors cause stress and distress in their lives. Ask clients to rank order them, then ask what small improvement would decrease stress or distress in the top three. Take steps to make the improvements happen that are beyond the client’s personal resources or network of connections, or help the client to make them happen.

Assist clients with exploring diverse interest groups, clubs, religious groups, support groups and/or other sources of social connection based on their individual interests and preferences. A sense of belonging, bonding or attachment can be crucial to helping people recover from substance use disorder.

Invite clients to attend support groups. (Choices in the author’s locale for recovery-specific support groups, in order of estimated numbers of attendees per year, are Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery and Celebrate Recovery. Information on local groups is here.)

On a case-by-case basis, support group attendance may be helpful to some individuals with maintaining abstinence. Support group attendance is not, however, an evidence-based treatment for the medical condition of addiction, any more than support group attendance would be treatment for the medical condition of cancer, diabetes, or other dangerous medical conditions.

Connect clients with social services agencies to assist with current stressors and needs such as employment, housing, transportation, child care, and legal issues.

“Love, evidence & respect.”
– Maia Szalavitz, via Twitter, in response to the question, “What fights addiction?”

. . . . .

Given that only one in ten Americans with substance use disorder receives treatment, and the contact a clinician has with a client may be brief, even one-time only, this guide is intentionally brief. It is a work in progress. It is updated as the latest research on AUD is published and the author reviews it.

“Evidence-based treatment” refers to specific treatment protocols that research scientists, through rigorous research methodology, have found work for most people most of the time, better than other treatments, and better than no treatment. Research, by design, reports on groups, not on individuals.

This guide is comprised of evidence-based treatment components, rather than belief-based or theory-based components. This guide, as a whole, has not been tested by research scientists, and therefore it cannot be termed “evidence-based.” It is, however, meticulously researched to include what the latest research reports is most effective. It is intended for informational purposes only and is not a substitute for individualized medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

The intended audience is counselors and clinicians who provide care for people with alcohol use disorders. Individuals and family members investigating current, evidence-informed alcohol use disorder (AUD) treatment may find the content useful as well.

Disclaimer: The views expressed are the author’s alone and do not necessarily reflect the positions of the author’s employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

For further reading:

Outline of an Initial, Evidence-Informed Treatment Plan for Substance Use Disorder

Additional reports on substance use disorder research and treatment by Handshake Media are here.

Last updated 12/21/17