Session Twelve

Posted: August 20, 2014 in Uncategorized

Discuss the complexity of working with clients who are also pregnant. How would a pregnancy change your approach to treatment? What issues might come up for you as a counselor? How might you talk about these risks with your client? How would you respond if your client continued to heavily drink or use substances while pregnant?

Working with a pregnant client who is actively using can be especially challenging. The pregnancy may be viewed by the client as a major motivator for change or as another way they have been victimized. Views of pregnancy range broadly among all parents. This is true among substance abusing parents as well. I would share openly the risks of continued use to the unborn child. I would work to deliver these risks in a nonjudgmental way. Belittling or judging the client serves no therapeutic purpose and places the client and the unborn child at even greater risk. As a counselor, I would need to keep a close watch on my potential bias as a parent. My personal views should not cloud my duty to serve my client. If the pregnant client continues to use during her pregnancy, I will likely have a duty to warm and need to report the abuse to child protective services.

What does it mean to you to advocate for clients and challenge bias? How do you feel about taking on that role? Is that a role you expected to take on as a counselor? Are there some groups for whom it would be harder or easier for you to advocate for? Does that reflect on your own beliefs and values? How so?

I believe that my role is to support and advocate my clients on an individual basis. My role is not to encourage clients to submit to anyone else’s, but to maximize his or her own unique potential. If I am working with a client with a different belief set than mine and it does not harm the client or others, I am comfortable supporting the client as they engage in the advocacy effort. This does not mean that I need to necessarily support the effort from a personal standpoint. However, I work to provide my unconditional support for my clients. This does not waiver when he or she may have differing beliefs and values. I belief that reflects on my belief of self-actualization. Again, I see my role as a helper. I aim to help my clients achieve his or her goals, not mine.

Using the Blog References, find and specifically report on at minimum of four websites that you could use for information regarding gender and/or LGBT issues in addictions counseling. Give a minimum of one paragraph of explanation for each site listed. – Community United Against Violence
CUAV was founded in 1979. The group works with the LGBTQ communities to help them eliminate violence and oppression. In addition to offering services designed to heal abuse victims, CUAV seeks to break cycles of repeated violence. CUAV hopes to develop safe communities in which anyone can live. – COLAGE
COLAGE seeks to build support networks within LGBTQ communities. The group was founded in 1988. These networks provide a safe and developmental framework in which individual experiences are valued. An emphasis of respect is placed upon youth between the ages of eight and eighteen. COLAGE is in favor of social justice. – Human Rights Campaign
The Human Right Campaign was founded in 1980. The group now states that it has over 1.5 million members. The group seeks to achieve equality for the broader LGBT community. The group encourages support from all Americans. The group takes pride in its work to raise the legal status of gay marriage. – Ontario Consultants on Religious Tolerance
This group seeks equal treatment and respect for all religions. OCRT expresses an appreciation for all humans simply because they are human. OCRT is anti-discrimination of any sort. Freedom of speech and personal freedoms are also key components of the group’s mission. Education is viewed as a key method to overcome bias.


A Family Tradition

Posted: August 16, 2014 in Uncategorized

As a child, I remember preparing for visits from my maternal grandmother. In addition to a quick debriefing from my mother about discouraged conversations, part of the process was diluting the bottles of bourbon. Mixing in a touch of water and iced tea powder could make a difference in the amount of drama during her visit. I also remember my father having friends over and making my way from room to room to watch the adults drink more and more beer. Right before my parents told me and my brothers that two happy homes was better than one unhappy home, I remember my mother being rolled out of our house and into an ambulance after she overdosed on her “medicine”. I was eight-years-old.

As a teenager, I was home alone or with a brother or two for a few hours every afternoon. Instead of iced tea, I mixed rum with bourbon. I drank these awful concoctions of liquor and listened to Jim Morrison sing about “the other side”. At school, I hung out at “freak hill” with the metal-heads and stoners. Not surprisingly, I knew several ways to turn seemingly harmless objects into smoking tools. I admit to making several poor decisions during my teenage and young adult years, but it could have been much worse. Even at my most baked stage, I recall knowing where to draw the line and I knew that this was a temporary thing. Spending my time with peers who lacked all insight, judgment, and motivation grew tiresome and boring. I have not made one of those “poor decisions” in over twenty years. I am acutely aware that I put myself in danger and that with a couple twists of fate my life may be completely different.

At the hospital and in the juvenile detention I come across young people that remind me of myself at that age. I do not preach or tell “back in the day” stories. I hope to help them have their own epiphanies as I know that is where change can occur.

I did not have positive models for drug and alcohol abuse. Somehow and some way, something inside of me kept me from traveling too far down a dark road. I now have two teenaged children. I began talking with them about the dangers of drugs and alcohol at an early age. As they aged and as appropriate, I shared more family and personal history. My kids are aware that I grew up in a different environment than theirs and that I did not always make wise decisions. My kids also understand why we place flowers on my mother’s grave.

Running on Empty

Posted: August 2, 2014 in Uncategorized

I value endurance and perseverance and at times, I have tested my ability for both. As I begin to feel overwhelmed, I hunker down and take on something else. I am only now beginning to accept the limits of time and ability. Running has been an incredible activity for me. I have learned how to shut down doubt and keeping moving forward. I have also learned how to ignore warning signs of trouble ahead and end up injured. The physical injury may be tendonitis and the mental injury is stress and anxiety.

When I completed the graduate program in counseling, I had an internship at a substance abuse clinic, a challenging final class, and I was working “full-time plus” at my job as my boss was on maternity leave. I knew that it would be a challenging time, but I filled myself with self-talk and charisma. Running had taught me the value of training, dedication, and orientation towards goals. I knew that I would need similar dedication to get through these four months.

I remember this time as always doing something. I had no idle time. I was up at 3:30am to make it to the methadone clinic before 4:45am. When I finished at the clinic, it was off to work and the drama that waited for me there. Next came class, events at the kids’ school, and everything else that life threw at me. I felt overwhelmed and anxious. I had a fear that I would forget to do something and that somehow I would either fail my internship or get in trouble at work. I needed to “pull it together” and keep moving towards the finish line of late December. I used running strength and metaphors to coach myself as I began to slip.

As I ran on empty, I stopped doing the one thing that brought me comfort and peace. I stopped running. This was my self-care activity and I quit doing it when I needed it most. In retrospect, it is like being too busy driving to stop and get gas. I eventually finished my internship and graduated from the counseling program. I never got in trouble at work. I do hope that I learned a lesson from this time. Self-care is not just for the “easy” times. When I become stressed, I have a tendency to overuse my endurance resources. I still slip up from time to time, but I am getting better at knowing my limits and remembering to get gas.

Twelve Steps

Posted: July 27, 2014 in Uncategorized

How does 12-Step facilitation of treatment relate to your personal theory of life? What parts could you integrate if desired?

As I review the 12-Steps, two key components seem to match most closely with my philosophy of life. I believe that we become more congruent and ultimately healthier if we are honest and seek insight into our thoughts and behaviors. Steps 1, 4, and 10 seem to encourage honesty, reflection, and personal insight. I think that taking the time to ponder and question our maladaptive motivations provides great opportunity to change. I understand and appreciate the remaining nine steps, but I believe that without Steps 1, 4, and 10 the other steps may be superficial and lack depth. As I age, I find it easier to admit when I am wrong (Step 10). I hope that this reflects a growing confidence. For the substance abuser, confidence is often intertwined with self-efficacy and ultimately, hopefully, recovery.

How does 12-Step facilitation of treatment relate to your preferred counseling orientation? What parts do you see that you could utilize for treatment?

When properly completed, I believe that the 12-Steps offer those who complete them a journey of insight and honesty. I think that it is not intended as a checklist towards recovery, but as an experience. I think this complements my insight-oriented strategy for counseling. The lessons that a client learns from his or her own reflection is much more powerful than anything a counselor “states” during a session. As a counselor, I hope to play a part in a client figuring out something that will ultimately help him or her function at a higher level. The victory comes from completing the race, not from crossing the finish line.

I think that Step 4 offers a client an opportunity for incredible insight if they fully engage in their recovery. This is often challenging in my current roles as my time with a client or patient is limited due to the shorter-term nature of my counseling roles. Prayer, meditation, and faith can be powerfully motivating for many clients. As appropriate, I may encourage clients to explore their faith if it offers comfort and support.

The Benefits of Pharmacology

Posted: July 20, 2014 in Uncategorized

Many of the opponents of pharmacology as a means to treat drug addiction question the wisdom of using one drug to help someone stop or decrease the use of another drug. I support using every safe and ethical means to help someone struggling with addiction to abstain from its use. I support the use of doctor prescribed medications as a means to help some clients discover or manage his or her recovery. It is my belief that prescribing doctors specializing in addiction medicine should more closely manage their patients and end pharmacological treatment for patients who abuse their prescribed medications.
During my counseling internship, I worked at a methadone clinic. I believe that methadone use is likely the most controversial pharmacological methods of treating addiction. After my four months working in that clinic, I understand why. Methadone is a powerful medication and frequently abused by some users. Many of these methadone abusers combine the drug with benzodiazepines and alcohol for a dangerous combination of CNS depressants. Nodding off is one the more common and less dangerous side effects of this awful cocktail. This combination may result in death.
The most inspiring client I worked with at the methadone clinic was one of its most tenured clients. He started off at the standard beginning dose of 40mg and worked his way up towards somewhere near 200mg. More importantly he ended his long history of IV heroin use. A few months into the program he began a GED program and began working. Before too long, he earned take home privileges and only had to come to the clinic once a week. He later earned his GED and acquired a higher paying job in an industry of his choosing. After over a year of negative drug screens and medication compliance, he was receiving one month of take homes and seeing his children again. This client eventually began to decrease his methadone dose each month. During my internship, this client graduated the program and stopped taking methadone. This is the type of client that methadone programs can really help.
I will spare you numerous examples of clients who taint the image of drug replacement programs. Some of these clients sell, abuse, and otherwise manipulate their way through the program. They can hurt other clients and their recovery. The outside of some methadone clinics can be scary places. Many clinics hire private security staff to keep people from loitering. I believe that these are the clients that prescribing doctors should refer to non-pharmacological programs.
Whether it is antabuse, naltrexone, methadone, or suboxone, pharmacology can be a great benefit to many clients suffering with addiction. At home and at work, I am a fan of using the right tool for the right job. Medications can be great for some and criminal or deadly for others. Addiction professionals have an obligation to help their clients utilize the tools that offer them the greatest opportunity for recovery.

My Inner Client

Posted: July 13, 2014 in Uncategorized

Staying Connected to My Inner Client

I can certainly see how a counselor can leave his or her graduate program and forget many of the stated motivations for pursuing the profession. Mental health consumers can often test the patience and good nature of even the most kind-hearted counselors. I have worked in roles where tenured professionals act in ways that I hope to never act. They might make disrespectful comments about or even to clients. However positive my intentions, I am aware of my initial reactions to abusive and sometimes entitled substance abuse clients. I admit to feelings of astonishment, hurt, and anger after being verbally abused by a client or patient. I accept my initial reactions, but choose not to let them influence my professional judgment and obligation for client service. While I may want to challenge or debate non-material topics as a response to irritating clients, I choose not to because it serves no clinical purpose. I have a mantra I say to myself when I feel as though I am beginning to become defensive or judgmental. I remind myself that he or she is here (my program or facility) for a reason. They are here to get help for an illness or a behavioral problem. I also think that we can avoid becoming self-righteous by finding appropriate peers for consultation and positive supervisors for support. Many counseling roles are stressful and demanding. Without validation from someone about the work we do, I think it is easier to slip into patterns of meanness and callousness.

Recognition of the need for self-care and a sense of mindfulness help me to stay connected to my inner client. Most times, I am aware when I am reacting to stress or negative emotions. I have never expected myself to be perfect at all times and in all situations. I admit that I make mistakes and can still learn to improve my functioning. By remaining humble, I am more able to relate to many of the challenges of my clients. Humbleness and my desire to grow as a person keep me from feeling superior to anyone.

Keeping it from becoming “Us” and “Them”

Life is often difficult and will challenge all of us at some time. Empathy often serves me well as a means to keep my views of self and client from turning into an “us” and “them” scenario. I recently worked with an adolescent who had a mood disorder and a substance abuse disorder. He was frequently in fights and smoked at least four blunts every day. Without empathy and a consideration for life’s difficulties, one may not get beyond his charges. Interest and empathy allow us to explore history and consider how we may respond if we were “in his shoes”. How might I feel if as a teenager I was at home celebrating a holiday with my family when armed intruders broke down my door? How would I respond to being tied up as I watched my father shot and killed? Given some of the trauma and neglect many of our clients have endured, it is a wonder that they function as well as they do.

When considering the foundational philosophies of counseling, all seven of these philosophies are especially important for substance abuse clients.  I think that many of these foundational philosophies support non-directive counseling techniques like person-centered therapy. When he developed person-centered therapy, Carl Rogers incorporated a positive view of people into this counseling theory. Rogers felt that people have a great ability to understand and heal themselves as a whole and congruent person. The role of the counselor was not to direct or tell the client how to remedy their issues, but rather to support and aid in the client’s personal growth and actualization.   I believe that almost all individuals have a natural tendency to strive to do well.

I am most comfortable leveraging hope, identifying assets and strengths, and having a collaborative relationship between client and counselor.  To be blunt, why bother counseling if you do not have hope.  Hope brings motivation for change.  Clients without hope are much less likely to “work” in counseling and rarely show up after the initial intake.  Counselors without hope do their clients and the profession a great disservice.

I believe that identifying assets and strengths can service clients as a means to build self-efficacy.  Recognizing prior successes over earlier challenges can be a powerful tool towards recovery.  Many clients beat themselves up for every perceived mistake and disappointment.  I believe that even the most challenged client can find something to build upon.

The relationship between the client and the counselor is always important.  I think that substance abuse counseling can bring a unique type of shame, guilt, and remorse into session.  The most effective substance abuse counselors leave judgement behind and demonstrate unconditional positive regard for their clients.  It is also important to remember that this counseling relationship is collaborative.  Clients are accountable.  My internship supervisor at the methadone clinic always said, “you should never work harder than your client is willing to work”

I consider myself a hopeful and positive person. I believe that we are all capable of much more than what we give ourselves credit for. I gravitate towards person-centered techniques as a means to encourage clients to strive towards their goals. As I gain experience as a counselor, I do realize that I sometimes seem to lose some hope with clients who fail to engage in their treatment plans or show no interest in bettering their situations. I admit to redirecting efforts towards those who “show up”. While I still cringe as I admit this, it is my reality. However, I always remain professional and ready to help “no show” clients if they “show up”.

As a human being, I admit to having a judgmental attitude at times. As a counseling professional, I work to leave judgment behind and focus on helping the individual. I frequently work with substance abusing, pregnant women. My heart breaks for the unborn child subjected to heroin, Xanax overdoses, and neglect. As a professional, I understand that judgment and criticism will only drive the patient further away. This would place both her and the child in even greater danger.