I have been in the field of addiction treatment for close to 15 years. During this time, we as a field have changed quite a bit, as have many of our methods. I am among those in our field who went through treatment the “old-fashioned” way. I attended a social detoxification program without the benefit of any type of medication to curb the symptoms of my disease. The program itself was primarily a social model program that had very few of what I could call “clinicians.” The program relied heavily upon 12-step programs to fuel its success, and the staff members were well-meaning members of those programs with little to no professional qualifications or experience.
I went through treatment during a time when confrontation was the tool of choice and “tough love” was the preferred method. Obviously, this influenced me early in my career. I often projected my own treatment experience into the ideas I had about what would work and what would not. Mind you, I was very young at the time and had virtually no education, but I had a misperception in the beginning that psychiatric medication should be avoided and that medical assistance during the detox process was only to be used in the most extreme circumstances to avoid death. Aside from those situations, I believed that “sweating it out” was better because it would scare the addict from picking up again. Today I believe it scares them out of getting help or causes them to prematurely terminate treatment more often than not. These are some of many ideas I have changed over the years.
As my career progressed, I learned about treatment approaches such as motivational interviewing. Miller and Rollnick taught our field the truth about confrontation and its dire consequences to addicts. I watched tough love destroy families while addicts died anyway. While new information and experience flowed toward me, I was mentored by fantastic clinicians. They taught me how to be kind, patient and effective at the same time. One of the things I find interesting about this today is that at the time, I presumed I was more empathic and compassionate to the addicts I worked with than they were because I had personal experience with addiction. I was wrong. The truth was, oftentimes they had taken a much kinder view of the symptoms of addiction than I did. When I would blame the patient for my ineffectiveness, they would help me to explore what was blocking me from being helpful to my patients. Was it my own judgment? My own regrets? Arrogance? At some point or another, all of these have been true.
I purposely wrote this article in the first person, rather than the observational, reporting tone of most professional articles. I have always benefited greatly from thoughtfully written articles that were written this way, and I believe they have impacted my attitudes about counseling greatly. Possibly this is because right, wrong or indifferent, they were true, at least for the writer. Just as I teach my clients to speak in the first person about their lives, sometimes it is best to do the same when I speak to my professional peers. The fact for me is that overwhelming fear of the codependency monster and the medical practice of extreme detachment has never worked for me. I have found that being effective for me includes loving my clients. I am not stating this in a general, “I love my work” kind of way. This statement is exactly as written. Part of the counseling process is loving my clients.
Now before the codependency fear-mongers jump to any conclusions, I want to clarify that this is not without boundaries. Boundaries are incredibly important to treatment. I recall once telling a clinician I was treating that I could not refer to them due to how they were dealing with certain problems. This was a hard thing to say to this person whom I loved, but my honesty and boundary later became a central tenet of the therapy, because the modeling of integrity and boundaries was powerful and inspiring for the client. Being kind, being patient and using a non-confrontational approach to treatment does not mean cowering away from issues. Loving them does not mean I have lost who I am in the vortex of who they are.
In my experience, these attitudes and treatment ideals have fostered closeness, bonding and ultimately healing for many, many addicts I have worked with. They fostered a sense of respect for my clients, and the honesty of the relationship gave weight to my words and suggestions that might have never been there in the past. These clients did not change, heal and grow because I was perfect at this model of counseling or that. They changed, healed and grew because they felt safe, loved and received honest feedback in a kind, compassionate way. As a counselor, I was not interfering with their growth, but was facilitating it and joining them in it. For any reader that sees this as a bunch of fluff, I assure you my approach is anything but. There is no co-signing of anything here. But there is no abuse either.
I urge other counselors, both new and experienced to constantly re-evaluate and remain open to new ideas. Explore ethics and yourself. Try writing your own ethical code in addition to the one that your certifying or licensing board has recommended. Engage in your own therapy process, whether you need it or not. Ask yourself, what in you prevents you from loving a certain client or patient. What is at risk for you? The answers may surprise you and they are certainly fantastic fodder for your own growth in supervision, therapy and as a clinician. In the end, you will not only benefit, but your clients will as well.
Kansas Cafferty, LAADC, MCA, MFTI
Director, True North Recovery Services