Exploring Beneath Addiction

In the last several years it has become more and more clear in the media as well as within the mental health profession that addiction has become an out-of-control epidemic, especially addictions to meth, opioids, and heroin.

I supervise post-grad interns who work with this population (addicts of all substances), many of whom are homeless and/or ex-incarcerated. Most of these clients have years, if not decades, of addictive patterns of behavior well established, such as lying, cheating, and portraying some level of aggression or passive-aggressive behavior. Many are dually diagnosed with other mental illnesses and have suffered various traumas during the course of their lives.

These entrenched behaviors often become like masks or shields for the people living inside of them, seemingly impenetrable to those working with them. So many layers of harm from others, self harm, and harm done to others are woven into the horrific disease of addiction, that it seems extremely difficult to unravel and find the human being strangling inside.

Exploring beneath this quagmire of addiction requires the willingness to suspend judgment and presumptions about the limitations of hope placed on or by this person. Societal norms and personal records of misconduct have put boxes of low expectations on addicts. To find the real people hiding in these boxes is the primary challenge of therapy, as I see it. As we go about the careful process of doing so, we need to help that person exposed learn to not be afraid of who he or she really is, but to have the courage to heal and embrace the broken goodness within.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Believing in our common good

In a recent blog, John Sommers-Flanagan, quoted Adler:

“An incalculable amount of tension and useless effort would be spared in this world if we realized that cooperation and love can never be won by force.” (Adler, 1931, p. 132).

It seems to be obvious on first glance that “force” can never win over the spirit of love or cooperation. Yet, the evidence that entangles our world and everyday lives demonstrates how intensely we as human beings try to hold on to the erroneous belief that we can “make” people love and respect us.

This tends to get us in a lot of trouble. We see this all the time, particularly in the lives of our clients. Couples who have to engage in an argument to its last breath in order to be proven right, adolescents who engage in risky behaviors such as using drugs or running away in order to get parental attention, or the parents who demand respect from their children through intimidation, if not abuse.

The core issue here, as I see it, is that we tend to treat respect as an asymmetrical phenomenon. That is, there is often an  assumption that one person deserves or receives more respect than the other. Therefore, the relationship remains static in its inequality (i.e. a male dominates a sexual relationship or a power struggle is ongoing because there is always competition for who should be the winner for the most respect).

When one steps back to consider this dilemma, the obvious conclusion is that the premise of necessary inequality is false. Parents, teachers, employers, law enforcers, and even therapists can easily fall into the trap of assuming that authority means demanding more respect than one in that position must give to those under such authority.

This way of thinking is toxic, particularly as the concept extends beyond clear lines of established authority or power. The common good of all evaporates when others are belittled, marginalized, or discriminated against.

As therapists, I believe that we have a critical responsibility to demonstrate and advocate for genuine and equitable conveyed expressions of respect in the therapy room and beyond. To do so requires our diligent exercise in practicing for the good of all.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Multicultural Counseling: Working with People of Color

It is well-documented that working with minority populations can be challenging for therapists, especially for white therapists, largely because of trust and specific cultural issues. Because the current, if not ongoing, issues of racism and bigotry have been brought into the spotlight so starkly once again, I find it to be important and timely to look at these challenges more deeply, so that we, as therapists, can more effectively be part of the solution rather than contribute to the problem.

Williams and Levitt (2007)¹ studied the differences between the values of therapists and clients as they relate to multiculturalism. They found substantial evidence supporting the fact that real value differences exist between therapists and clients and, “therapists cannot be value-neutral and that they routinely convey their values with clients.” (p. 256) Therefore, they say, “the potential exists for therapists to consciously or unconsciously influence clients to become more like themselves.” They point out that most therapists are unaware of the potential negative effects of sharing such values with the client, because they do so intending to benefit the client. Within a multicultural context, there is a higher probability of alienation, shame and/or indoctrination for the client in ways that either shut down the treatment or is counter-indicated for real progress to be gained.

According to the research, among the most prominent ethnic minority groups in this country (African-Americans², Latinos³, Native-Americans⁴, Asian-Americans⁵ and Middle Eastern Americans), common themes exist in their overall experiences with therapy. Additionally, there is vast underutilization of mental health services, primarily for the following reasons: a sense of alienation and shame, stereotyping and lack of trust in the therapist (particularly a white therapist).

Because this phenomenon is so embedded in horrific histories as well as ongoing cultural disparities, it often seems insurmountable to rectify. But it is my strong conviction that we in this field can, and must, put every effort into positively intervening in this issue by fully recognizing it and, coming from a place of authenticity, fully focus respectfully on the unique cultural backgrounds and qualities of each human being we encounter.

¹Williams, D., & Levitt, H. M. (2008). Clients’ experiences of difference with therapists: Sustaining faith in psychotherapy. Psychotherapy Research, 18(3), 256-270.

²Thompson, V. L. S., Bazile, A., & Akbar, M. (2004). African Americans’ perceptions of psychotherapy and psychotherapists. Professional psychology: Research and practice, 35(1), 19.

³Comas-Diaz, L. (2006). Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 43(4), 436.

⁴Heinrich, R. K., Corbine, J. L., & Thomas, K. R. (1990). Counseling Native Americans. Journal of Counseling & Development, 69(2), 128-133 and Trujillo, A. (2000). Psychotherapy with Native Americans: A view into the role of religion and spirituality.

⁵Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental health services research, 3(4), 201-214.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

 

 

Preparing for Difficult Clients

Working with clients productively isn’t always an easy road. Clinicians frequently run into clients who are challenging, frustrating, maddening or otherwise pushing our emotional buttons in some fashion.

For example, there are clients who have their own anger issues and come in ready to pick a fight. They simply want to argue with us, and question our knowledge or expertise. There are clients who are passive-aggressive, are in denial of their addictions or simply don’t engage in therapy the way we would like in order to make the progress we wish for them. Then there are clients we just don’t like for some reason; they don’t share our values and don’t respect our time or our boundaries.

Often, the rule of wisdom is to refer such clients out so that they can find a better fit and get better care. But before you do that, I have a few suggestions for preparing yourself for your next session.

To begin with, check yourself. How are you feeling? Tired? Anxious? Hungry? Already dreading this appointment or preoccupied with something you’d rather be doing? What buttons are being pushed inside of you by this client? Spend some time slowing down and acknowledging your feelings. Breathe and try divesting yourself from feeling graded (even pass-fail) on the outcome of this session. This is your client’s session, not yours.

Then spend some time thinking about where your client is emotionally and cognitively. As I frequently say to interns, try going behind the curtain of the stage your client occupies to see the stagehands at work. What’s going on behind the behavior or attitudes you’re seeing and experiencing? Behind the anger is there fear or doubt? Behind the bluster is there insecurity or sadness? Is there a traumatized child puppeteer behind the puppet you see?

As you go into your session, attempt to drop all negative pre-conceptions, judgments and expectations into the trash can. Work with the person in front of you who is scared, sad, lonely or vulnerable from a place of authentic respect.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.