Week 12: Advocacy

° I feel that as a counselor it is an integral part of my job to advocate for clients and challenge bias. Often, clients have not yet found their own voice within themselves and have not yet become able to advocate for themselves in their own best interest. I believe it is my function to help give clients the tools with which to represent and assert themselves in the various areas of their lives. Furthermore, there may be institutional forms of oppression and bias which clients are facing that may come into focus as part of the counseling process, and I also believe it is my task to address these issues, as well.

 

Being an advocate for my clients is a role I expected to take on for my clients and one I expect I will enjoy. My goal is to strive to keep my own values as separate as possible from the therapeutic relationship as I am able, but I know this is not possible. There are some groups I would find it more difficult to advocate for, for example, I would find it harder to be as enthusiastic about getting out there and focusing on the needs of pedophiles as I would, say, LGBT clients. However, I don’t see pedophiles as having the same pressing needs as LGBT clients. But, I can clearly see my values coming through even in my language just in discussing these two groups of people. I speak of a label in the former group and in the latter, they are referred to as the more human “clients.” This clearly reflects my beliefs.

 

 

°Blog references:

http://www.algbtic.org

The Association for LGBT Issues in Counseling is a website that provides information on competencies for therapists who are seeking to improve their skills in treating LGBT clients. The site features a therapist resource listing where individuals can locate mental health services for LGBT clients in their state, a discussion exchange listserv where counselors can talk online about LGBT issues that are on their mind, as well as a newsletter that includes submissions on LGBT issues from professional counselors, counseling students, counselor educators and counselors working in research settings. The site offers counselors who are interested in advocating for LGBT issues ways to promote equality toward the treatment of LGBT clients and communities.

 

http://www.hrc.org

Human Rights Campaign is a great website where counselors can direct LGBT clients to get information on such practical issues as coming out and parenting to more broad matters affecting the LGBT community including how to participate in state advocacy and marriage rights. HRC has a “Health & Aging” section section of its site where counselors and clients can go to find the site’s identified Leaders in LGBT Healthcare Equality, which selects healthcare facilities in states throughout the country chosen for excellence in providing an equal level of care to LGBT patients. HRC also offers LGBT clients who are struggling with addiction and potentially feeling lowered self-esteem ways to connect with and advocate for their community through a “local” section of the site that shows them how they can get involved and fight for equality in their area.

 

http://www.pride-institute.com

Pride Institute runs a treatment facility in Eden Prairie, MN, dedicated to helping LGBT individuals improve their sexual health and and mental health, as well as those seeking treatment for substance abuse problems tailored to LGBT needs. The facility’s website offers excellent resources to counselors who are looking for information on how to improve their skills in serving LGBT clients through webinars that can be downloaded on such topics as LGBT language awareness and understanding issues in substance abuse treatment. There is also a newsletter that has timely topics of interest to counselors, as well.

 

http://www.soulforce.org

Soulforce is an organization that seeks to promote nonviolent resistance to the oppression of LGBT Christians and the LGBT community. Soulforce’s website is a great resource for counselors and clients to to learn about Christian issues of religion and faith from an LGBT perspective from leading ministers in the field. The site is an excellent place to go for those dealing with substance abuse and struggling with the added guilt and shame of their LGBT orientation as Christians.

Week 11: Influences Shaping My Attitude Toward Substance Use

• What were your attitudes toward use of substances when you were a child and an adolescent?

My parents came of age during the ’60s and consequently both had rather liberal views regarding alcohol and drugs. As a result, I internalized these views and thought there was not a lot of danger in these substances as long as you did not abuse them. I did not realize how easily one could lose control over his or her use, however.

• What was your personal and peer group experience of substance use? How are your views the same or different now? What might it feel like to work with clients making different choices, or to encourage choices that you did not make?

I remember in the 8^th grade a friend bringing alcohol to a party I had at my house. I didn’t have any because I wasn’t ready to drink yet. I soon distanced myself from this girl at school. The same thing happened a few months later, only with a group of friends who were smoking pot. Again, I distanced myself socially. Looking back, I guess I had some strength in being able to resist at that point. But by the age of 18, I did start drinking, even though it was not legal.

I do not support kids using alcohol underage or using marijuana. It is illegal. I also believe using certain illegal substances can be very destructive to a person. In terms of working with clients who might make different choices, this is something I can expect to encounter. However, I am assuming the reason people are coming into counseling is typically because they want to make changes in their lives. I will support clients in helping them try to make those changes and transition to a healthier lifestyle — physically, emotionally and spiritually.

• Who advised you about drugs and alcohol, and when? What was your response? What encouraged or discouraged use in the approaches you encountered? What do you hope to emulate or discard from your models?

I believe I was mostly influenced by what my parents told me about drugs and alcohol, as well as what I saw in the popular media in the ’70s and ’80s during my youth. Despite the overall negative message I got from my parents about drugs and alcohol (my father was more vocal about drugs since he became somewhat of a drinker by the time I was in high school), it was communicated that binge drinking and drugging was fine and fun as long as you were careful. This is actually what I thought at the time. The reality was neither one of my parents were actually sitting down and really talking to me about drugs and alcohol. I guess the biggest thing I hope to discard in the message that was transmitted to me within my own family is that certain substances can be very addictive, particularly for certain individuals. Addiction runs in my family. This is something that I talk openly with my son about and I would encourage this style of communication with individuals and families I counsel, as well.

Week 9: Maintenance and Relapse Prevention

I remember when I was at home with my son and working limited part-time hours as a copy editor when he was a toddler. It was around then that I started to gain a lot of weight. Things had become strained in my marriage (my husband and I wound up getting divorced when my son was 10 years old after 21 years of marriage). I started eating more out of stress and it was not the healthy kind of eating. I had been trying to use my self-control to be a good mother and organize the days at home for my son and me, but it did not come naturally. We had moved to a new area where I felt uprooted and so my resources had already felt drained. Not having the support of a strong marriage also had made me feel depleted so I turned to chocolate and simple carbohydrates to comfort myself. One day I was just tired of the weight I had gained — 67 pounds in all — and I decided I had to do something. I had been reading about Overeaters Anonymous every week as a copy editor at my job and decided to give it a try out of desperation. There I got the support I finally needed, in conjunction with counseling that I also sought at the time, to lose the weight, which I did over the next eight months. That was eight years ago and I have kept most of the weight off in the years since. I can still see that at times in my life when there is a lot of overuse of my self-control in many areas of my life, there can be adverse effects on my eating. That is why it is vital to my physical, emotional, and spiritual health that I get to as many OA meetings as possible and practice the 12-step philosophy in my life.

Week 8: 12-Step Facilitation of Treatment

I wholeheartedly endorse the 12-step philosophy and believe it not only facilitates and supports treatment, but it has personally facilitated and supported my own treatment through the years, most importantly through my membership primarily of Overeaters Anonymous, but to a lesser extent Alcoholics Anonymous, as well. I have tried to fully integrate the 12 steps into my life over the years and have found the results to have been far more gratifying than I could have ever expected or desired. However, one’s work is never complete and is measured as the saying goes, “One day at a time.” The addict must continue to work at recovery to stay recovered.

The aspect of the 12-steps that I struggle with the most Step 3, which requires turning my will and my life over to the care of God as I understand him. As a spiritual person who is non-religious this has been a stumbling block at times, more because I have been unsure how to define my Higher Power. Definitions for Higher Power I am aware of include the 12-step group, itself, along with nature and existential freedom. But overall, despite my struggles with the concept of a Higher Power, I believe the tenets of the 12-step philosophy make a lot of sense and have helped make it easier for me to live with myself.

Furthermore, I think the 12-step philosophy is compatible with my counseling orientation, which is a combination of cognitive-behavioral, humanistic and existential therapies. I have also read many books about the 12 steps, and when boiled down to their essential principles, I believe they are founded on tenets that many people live by and are, therefore, readily embraced by most people with addictions. I think 12-step groups are an excellent way for individuals struggling with addiction to come together for self-help, education and social support.

Week 7: Benefits of Pharmacotherapy

I support the use of pharmacotherapy in the treatment of addictions for several reasons. First, for many clients who become addicted to substances, their neurotransmitters and hormones are behaving differently, often due to a predisposition to addiction or co-occurring conditions. Secondly, once certain addicted clients are placed on the appropriate medications they are better able to function in their lives. In addition, research has indicated that mental health interventions targeting pharmacotherapy adherence enhance the outcomes of addiction treatment (Reid, Teesson, Sannibale, Matsuda, & Haber, 2005, as cited in Capuzzi & Stauffer, 2012, p. 219). I have mentioned in previous posts that I work in a Methadone and Suboxone clinic and see everyday firsthand the difference these drugs make for the patients who do not have to experience the severe heroin cravings that forced them on the streets every day to steal and prostitute themselves to get their fix. I agree with our text when it says, “As a professional counselor, you are under an ethical obligation to provide your clients treatment based not upon bias but upon scientific evidence of effectiveness”  (Capuzzi & Stauffer, 2012, p. 211).

In addition, our text states that in encouraging our clients to get the support they need from others like themselves out in the community they may encounter a bias against using medication to deal with their addiction at 12-step meetings. While this may be the true at some meetings, I have not found this to be the case with people I have typically encountered at the 12-step meetings I have attended as a member, which have included both AA and Overeaters Anonymous. For the most part, I believe our society, including the counseling profession, as well the individuals who make up the array of 12-step programs that exist, are becoming more enlightened about the needs and treatment of those who are addicted. There is new scientific evidence and information revealed about the brain every day. To ignore the benefits of pharmacotherapy would be equivalent to leaving people suffering in the psychological Dark Ages.

References:
Capuzzi, D. & Stauffer, M. D. (2012). Foundations of addictions counseling. (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Reid, S., Teesson, M. Sannibale, C. Matsuda, M., & Haber, P. S. (2005). The efficacy of compliance therapy for alcohol dependence: A randomized controlled trial. Journal of Studies on Alcohol, 66, 833-841.

Week 6: Relating to the Client

— A quote from your text states: “… we get so involved in the role of counselor that we sometimes forget the counselor inside of us. It can become habit to separate ourselves from our clients with a sense of self-righteousness that we do not have the problems they do.” Do you see this tendency in yourself? How do you stay in contact with your inner client? What does that mean for you?

I do not see this tendency in myself because I personally struggle with addiction. I definitely do not feel self-righteous about myself because I have gone through similar defeats in trying to control my unhealthy attachments. I currently work at a methadone clinic for my practicum and it is common for counselors to draw upon their own addiction experiences in relating to their clients. The challenge for me at this point in my career is to not self-disclose too much about my own issues with addiction, particularly to alcohol and food. I believe it is valuable to reveal to my clients information regarding my “experience, strength and hope,” in the tradition of the 12-step philosophy, as a means of educating clients and building therapeutic rapport; however, I need to make sure I do not cross over the line and disclose for the sake of trying to meet my own needs. I also stay in contact with my inner client by dealing with my addictions on a continuing basis by regularly attending 12-step meetings.

— What beliefs about yourself do you have that will allow you to find commonalities with your clients so that you do not see it as “us” versus “them”?

Even though I struggle with addiction myself, there are times that I find myself comparing severities of addictions. I suppose this could amount to an us-versus-them mentality when dealing with clients with addictions to intravenous drugs, which are considered society’s biggest taboo. But I haven’t really found that to be the case in my experience so far in my practicum because I catch myself when this happens and tell myself that we all struggle with some behavior(s) and/or substances we wish we had better control over. That attitude really keeps any inclinations of superiority in check.

Reference:

Capuzzi, D. & Stauffer,  M. D. (2012). Foundations of Addictions Counseling (2nd ed.). Pearson, NJ: Upper Saddle River.

Week 5 Treatment of Addictions

I am most comfortable with the foundational counseling philosophies of cognitive behavioral and humanistic therapies in the treatment of addictions, along with solution-focused counseling. According to W. R. Miller’s et al.’s (2003) review of alcoholism treatment approaches, “CB interventions are well represented among the most effective treatments” (as cited in Capuzzi & Stauffer, 2012, p. 144). Furthermore, I currently work at a methodone treatment center for my practicum, which identifies itself as the oldest in the country, as well as a DUI referral practice, and both programs primarily utilize cognitive behavioral therapy with their clients. In addition, I believe humanistic theory is the cornerstone of good counseling and helps establish a strong therapeutic alliance.

I am attracted to solution-focused counseling because it centers on clients strengths as opposed to continually looking at what is wrong with clients, which can fuel the cycle of addiction. It is easy for counselors and clients, alike, to get caught in the negativity of the client’s life. Solution-focused therapy does just what it sounds like — it keeps the focus on solutions. By keeping the language centered on change and how things can be different, clients can, hopefully, make transformations both small and large. The law of attraction says that what you focus on gets larger in your life. Solution-focused therapy is based on that premise. As a counselor, I believe I am there to help my client find new language and discover the solutions to their concerns and issues by working with them to discover their strengths and resources.

As far as my tolerance for addicted individuals, I believe I have a great deal of compassion. I have heroin and alcohol addiction in my family and am a recovering alcoholic and food addict myself. I currently attend 12-step meetings and believe I am open-minded about other people’s addiction. At the risk of too much self-disclosure, I think one of my deficits, at times, is that I struggle with a lack of confidence that stems from my struggles with depression. Because of this, I believe I also sometimes suffer from a lack of hope, which could negatively impact my clients. I do everything I can to take care of myself, get counseling and treatment for the depression, seek supervision when I need it, attend 12-step meetings and enlist social support. I also look at the other side of the situation, which is I have tremendous empathy for those clients struggling with addiction and coexisting conditions, as well. I understand what they are going through because I have walked their path myself.

 

 

 

Reference

Capuzzi, D. & Stauffer, M. D. (2012). Foundations of addictions counseling. (2^nd ed.). Upper Saddle River, NJ: Pearson.

Unhealthy Attachment to Overeating

I am responding to this week’s questions regarding my own unhealthy attachment to overeating.

How do I consider this substance/behavior pattern a beloved “friend”?

I began overeating when I was a child at around the age of 10 when there were times I was alone after school and feeling lonely. I would use food as a way to calm my anxiety or relieve boredom. When I was younger I noticed that when actual friends were around I was not quite as distracted by the food and I would tend not to overeat as much because I was busy with life, but by the time I was in my teen years, the addictive pattern was fully engaged and I would overeat whether I was around other people or not.

How is it sensual?

Because overeating involves food and the sense of taste it is naturally sensual. This was and continues to be overeating’s addictive appeal for me and why I need to be mindful of my eating.

How does this substance/behavior pattern provide “healing” or is it a “balm” to my emotional wounds?

The substance/behavior is absolutely balm to my emotional wounds in that I have a long history, as I said, in using overeating to deal with loneliness and anxiety. When I was 10 and I was alone after school that came at a time when my parents divorced and I was going through some difficult psychological issues. Over the years there continued to be times I used food as way to avoid uncomfortable feelings and situations. The overeating was definitely soothing and an escape from the distress I was feeling.

How my addictive substance/behavior pattern is “hated” — what has it cost me?

I have gained and lost many pounds over the years and had to deal with the embarrassment that goes along with large weight gains. My cholesterol has been very high, as well as my triglycerides. I have also paid a high cost in the self-absorption that comes with an addiction.

What might be a good resource or treatment method for a behavior change?

Overeaters Anonymous has been an excellent resource for helping me lose weight and achieve some semblance of physical, emotional and spiritual recovery. It is a 12-step program that is not easy to work but if I put in the effort, I do see results. I joined OA seven years ago and lost 67 pounds to get back down to a normal, healthy weight. I would definitely recommend it to those struggling with overeating. For those who have deeper emotional problems and need further support, individual counseling is also helpful as a supplement.

I would definitely consider myself in the camp that views process addictions as full-blown addictions. I believe this view results, in part, from my personal biases, which stem from my own struggles with overeating. I do not, however, feel that process addictions always hold the same power as substance addictions in terms of both the highs and withdrawal an individual experiences.

I would readily accept all of the process addictions our text identifies as the five most prominent to date: sex, gambling, working, compulsive buying, and food (Capuzzi & Stauffer, 2012, p. 42); although, I think I would more easily accept sex and eating as more powerful addictions because they are more deeply rooted as basic human drives and I also believe they would more potently affect the limbic system.

They are many influences that shape my views of these processes, including family, religion, mainstream society, and ultimately my own values. However, I feel I am rather open-minded when it comes to addiction — I see both substances and processes as having the potential to become habit-forming in individuals to the point that they lose their freedom.

If I am honest with myself, I may be a little more likely to call something an addiction if I am uncomfortable with the behavior or view it as undesirable or unhealthy, but I would hope not by by such a degree that would feel repelled by a client for exhibiting such a behavior. I would also hope that I would remain objective in my clients’ cases and focus on how their behavior is interfering with their “ability to truly know themselves, their spirituality and the world around them” (Schaef, 1990, as cited in Capuzzi & Stauffer, 2012, p. 42).

A quote by May (1988), a psychiatrist and spiritual counselor who studied addictions, sums up my own attitude when it comes to the way I hope my own sense of morality will shape how I approach my clients’ issues. May states: “Finally, I realized that for myself and other people, addictions are not limited to substances. I was also addicted to work, performance, responsibility, intimacy, being liked, helping others, and an almost endless list of other behaviors … I also learned that all people are addicts, and that addictions to alcohol and other drugs are simply more obvious and tragic addictions than others have. To be alive is to be addicted, and to be alive and addicted is to stand in need of grace” (p. 9-11).

References:

Capuzzi, D. & Stauffer, M. D. (2012). Foundations of addictions counseling. (2^nd ed.). Upper Saddle River, NJ: Pearson Education.

May, G. (1988). Addiction & grace: Love and spirituality in the healing of addictions. New York, NY: HarperCollins Publishing.

2/10/14

Prior to this week, I would have said I was more inclined use a humanistic approach combined with cognitive behavioral therapy and after viewing the web references I would say this is still true; however, the degree to which I relied on each will probably be in different measure. Behavioral therapy will now play a larger role due to information I have learned from the National Institute on Drug Abuse, which indicates that such approaches are the “most commonly used form of drug treatment” (NIDA, 2012). Additionally, behavioral therapies often involve dealing with an individual’s motivation to make changes, and as such, I think motivational interviewing, is another excellent way to help clients with addiction no matter where they are in terms of readiness for change.

I feel my strengths in working with clients such as Sahira include my own struggling with addiction, both to alcohol and overeating. I have attended both Alcoholics Anonymous and Overeaters Anonymous so I know what it’s like to deal with addiction; although, no two clients’ paths are ever the same and I would never presume to know what my client is experiencing. I am sure I would, however, feel a great deal of empathy for my client and want to help him or her as best I can. If anything I may overidentify with my clients and feel I need to rescue them, so I need to be aware of these kinds of feelings when they arise.

The areas I think I most need to work on will be staying abreast of new brain research, and incorporating that information into my work as a counselor. That field is generating new research all the time and because I have ADD, myself (which has resulted in a less than optimally functioning frontal lobe!), keeping up with the new data out there and using it to my clients’ advantage will be a challenge.

 

Reference:

National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide. (3^rd ed.) http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment. Retrieved Feb. 10, 2014.