some final thoughts

Working with clients who are pregnant requires the same attention, care, and empathy as any other client.  It is important to recognize that a pregnant client may have different issues and concerns than what I may be generally used to.  Some of what she is dealing with in her life may be temporary, especially because of physiological changes in her body that may even be causing her to feel certain ways.  Since I have never been pregnant before, I would want to ensure that the client was comfortable talking to me and I may even broach this consideration if I thought it to be an issue during sessions.  I would encourage her to bring up anything she wants to related to her pregnancy or happenings in her personal life that revolve around it.  I would be careful not to stereotypes or make assumptions about relationships in her life unless I am aware of them, such as with the baby’s father.  As a counselor, issues would definitely come up for me if the client was using substances while pregnant.  This is a serious issue because it could cause major damage to the child and potentially destroy aspects of his or her life.  In some cases, it would even be unethical not to report because of the harm it could cause, and this would be something I would explain to the client.  With confidentiality, it is always my responsibility to explain what I would be required to report, and one of those circumstances would be when the client could cause harm to another person.  In this case, it would be my role to protect the life of the victim, which would be the baby.  I would attempt to educate the client on the impacts substance usage could have on the baby and why it is so risky to continue with using.  I would help her devise and implement a plan for her life that will allow her to make steps to taking care of herself and the baby, and to protect both of them as well.  However, if she was drinking heavily or using substances and continued to do so, I would indeed report it and most likely make her aware of this need.

Advocating for clients and challenging biases means that counselors make it their role and responsibilities to stand up for the needs of the client and provide support and resources when appropriate and necessary.  Many times this involves counselors going out of their way to do what is best for the client, and therefore often involves extra effort.  Counselors are agents of social change and must not forget this in their work because they are often times the only people who can listen and understand enough of what the client needs to ensure that those needs are met.  Advocacy can occur within systems and organizations, or within individuals and families.  For me, taking on this role is a lot of responsibility and it can be scary but it is also something I know I want to do, because often times it is one of the only things we can do to help other people.  Change is not only about the individual but often times involves much more than that, and requires reaching out to others in order to be made efficient.  This is a role I expected to take as a counselor because I have seen it done for me personally.  When I was in a stressful and potentially harmful situation that was out of my control, the counselor I went to called in the people involved that had more control over the situation and stood up for my rights, expressing that circumstances needed to change and why this was important.  This brought the issue to the attention of the people involved, who had previously thought it was just something that I had kind of been complaining about and did not realize the seriousness of it.  It took the counselor I was seeing to advocate for me and show others in an additional and stronger voice that what was going on was not okay.  Since then, I have been willing to take on the same role, because I saw first hand the importance of it and how much can be accomplished with an advocate who is standing up for someone else’s needs.  That does not mean that advocating for others will always be easy, or will always be along terms that I necessarily agree with.  There will be people who will not listen to me as a counselor, people who do not want to hear what I have to say, people who do not agree, and people who just do not care.  I expect to work in difficult cases, particularly with people who are a lot different from me and have very different backgrounds.  For example, I have been in situations where people do not want to hear what I have to say, simply because I am a white, female, young student, who also happens to be Jewish.  These traits together, especially on the surface, do not make my voice seem powerful.  However, it is important for me to play my part and try anyway, even if I do not receive the intended outcome, and then move forward and take other actions from there.  I must use the efforts I have to speak my mind and stand up for my clients, even with the possibility that other people might not accept what I have to say.  Everyone has basic human rights to be who they are and live in the ways they want to live, as long as they are not harming others.  I believe it is my job as a professional counselor to help out in every way that I can when it is appropriate.  This goes along with my personal values.  I feel the need to help unless I am unable to help any further.

Some websites I found that can be used for information regarding gender and LGBT issues in addictions counseling:

http://pride-institute.com/about/why-lgbt-treatment/

Pride Institute recognizes that members of the LGBT community are more likely to use drugs and alcohol than members of the general population.  It provides explanations in various areas for why this is and what this organization is about, and even a self-assessment for individuals to determine their own needs.  Additionally, it includes abundant information on available programs, supports, health professionals, and employers.  The site itself includes helpful links and photos to give users a sense of what they can experience.  This is an excellent service for those seeking help with their addictions in the LGBT community.  It is a reminder that no one has to be alone and resources are available to those who are struggling.

http://www.lionrockrecovery.com/online-intensive-outpatient/lgbt-friendly-addiction-treatment/

This is also a similar website that provides information about Lionrock’s recovery program for those struggling with addictions in the LGBT community.  A great feature of this website is real quotes from recovering patients at Lionrock who talk about how the program has helped them.  The site includes explanations on individualized treatment, convenient schedules, cultural competence, and how to be resourceful online with their program, specifically through live video counseling.  This provides a great opportunity for people to get better, often times without even having to leave their computer, but also encourages them to discover what will be helpful to them.

http://www.colorsyouth.org/who-we-are

Colors LGBTQ Youth Counseling Services provides free psychotherapeutic services to young individuals.  Counselors are trained in various areas, one of which includes Affirmative Addictions Treatment.  However, they become competent in various dimensions, all revolving around working with LGBTQ youth.  This gives young people who are a part of this community the opportunity to be understood on all kinds of levels, as they surely have many different needs, concerns, and issues they are dealing with throughout their lives.  With the chance to be understood on various levels, they will be more likely to combat issues such as addiction that affect their lives.  They have counselors who become competent in working with them overall rather than just in one area, so they can get to know them as young and developing people and not just as addicts within a specific population.

http://www.apa.org/pi/lgbt/resources/guidelines.aspx

This is a basic guideline by the American Psychological Association that psychologists as well as counselors should refer to when working with members of the LGBT community.  It addresses attitudes towards members of this community and about homosexuality and bisexuality, relationships and families, issues of diversity, economic and workplace issues, education and training, research, and references.  While clients definitely need resources that they can turn to when seeking help, it is also very important for counselors to have sources like this one to refer to in order to provide them assistance with understanding various issues within counseling, and to be able to look back on the guidelines when they need to throughout their work.  Although a document of guidelines cannot provide as much information as an understanding from first hand experience and getting to know individuals and stories on a personal level, this is a start and helpful in counselor competence for working with LGBT people in addictions counseling.

 

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Attitudes of substance abuse while growing up

As a child, I was convinced of everything we were taught in school: drugs are bad, and say no to them.  When someone mentioned that my much older cousin might be using drugs and drinking alcohol, I was absolutely appalled and thought she was crazy.  However, as I got older and drugs became more “cool” to kids my age, I realized that I never really knew what it meant to say no to drugs, because I never really knew what drugs were.  When my adolescent peers developed interests in marijuana and how much fun it was, I could not wrap my head around how this substance could have been the same thing I was taught to stay away from since elementary school, or why my friends liked it.  It was confusing for me to stick to what I knew was right, but also be able to have fun with my friends at the same time, and I could not understand if or why this had to be controversial.

My friend group experimented with various substances, and looking back, I think it was kind of helpful for me to know first hand of some of the effects that drugs and alcohol can have on my body.  Although I would not partake in using them now, I feel that I have a sense of not only what it is like to use certain substances but also what it is like to belong to a friend group that uses, and how people are affected by various influences.  Additionally, it is beneficial to know how all of this affects other aspects of life, including family, career, and other things that are truly important, and that often can be destroyed by drugs and alcohol.  I feel like I will be able to understand various clients because of experiences that I have had or that I have watched friends have, including people who do and do not want to continue their substance usage.  It is important for clients to actually want to change their ways, because that is not something that a counselor or anyone else can implement for them.  This has to come from their own desires and motivations, so it may be my job as a counselor to help them find that.

I was first advised against drugs and alcohol in the school system, as a basic elementary school curriculum.  As I stated before, the idea of dugs never became very real until I became an adolescent and my friends became interested in drug use.  Before then, we were taught to say no if someone offered us drugs.  To me, it always sounded like a stranger would come out of nowhere and offer me something that I should practice refusing.  This seemed so simple, because of course I could reject something from someone I did not know; the world of drugs and alcohol did not become real to me until it became an actual topic between my preteen friend group.  Even then, I could not understand what people meant by the thrill of getting high or drunk without having actually experienced it for myself.  I feel like my positive support system, especially my family at a time when my friend group was unhelpful, was what ultimately encouraged me to make good choices with my life that included staying away from harmful substances.  My parents were very clear about my role, which was to do well in school so that I could get into a good college.  They rewarded me appropriately to encourage me and help me become motivated.  For example, when I entered a phase in my adolescence where all I cared about was clothes, I would be rewarded with a new shirt from my favorite store if I earned an “A” on a test.  I was also punished, such as not being allowed to go out with my friends if I did something unacceptable.  However, in terms of drugs and alcohol, my parents rarely punished me; instead, when they found out about harmful behaviors I may have been experimenting with, they successfully made me feel extremely guilty instead of simply getting angry and taking away privileges.  Whenever I got caught, I knew how disappointed I had made them, and I never wanted to feel the shame that they made me feel; I think this worked with me because I have always had a close relationship with my parents and I actually care about the way they think of me.  As I got older and got into the college of my choice, I realized that drugs and alcohol were simply did not have a huge role in my life.  To this day, I am constantly around plenty of people who do not share that view, but drugs and alcohol do not have an important role in my individual life.

I know that not everyone does or can have a similar upbringing that I had, and people find out what they care about in very different ways.  However, I believe that all individuals can find themselves through what they care about and what positive influences are motivating to them.  For me, those were always my long term goals such as getting into college or getting a job, important relationships in my life, and passions such as music and writing.  I believe that I can help others emulate my attitude that substances do not have to have a major role in their lives by discovering positive influences and aspects of their lives that are important to them.

When my self-regulation “muscle” gets tired…

There have been plenty of times that I have been under a lot of stress, resulting in overuse of self-control resources, in which my state of fatigue leads to ineffective coping strategies. I can think of many regular examples, but one in particular occurs frequently. As a graduate student and having just gotten my degree in school counseling this past May, I have constantly been switching from job to job for the past two years, reconstructing my schedule every few months. For example, when I first entered the program, I had the consistency of working every day and going to school at night, but that quickly changed with intercession and readjusting my schedule for those classes, and then once again for practicum, and internship; now that I have graduated, I am still trying to figure everything out with my jobs and school schedule to make things work. This constant adjustment and readjustment affects important aspects of my life such as my sleeping schedule, eating habits, exercise routines, and my social life. I constantly have to figure out how much time I actually have to get homework done, when I need to go to sleep, and what I am going to do at lunch for work tomorrow. When all of this piles up, on top of typical and often stressful life events and environmental factors, my body is affected; mainly, I lose a great deal of sleep because I want to stay awake and do other things, such as hang out with my friends or even just catch up on a TV show. The lack of sleep causes me to also lose control with eating healthily, and I always notice that the more stressed I am with my schedule, the worse my eating habits become. Sometimes, this loss of self-control causes my work habits to begin to suffer, and this is usually my breaking point where I know I need to do something about my state of fatigue. To pick myself back up and get everything back together, I always need to take some time to relax, get back to the gym, and get a good amount of sleep, but as all my fellow grad students know, it can be so difficult to ever actually find this time. This is why it is so important to be constantly taking care of ourselves, because often times life gets in the way and we forget to do so.

Twelve Steps

The 12-Step facilitation of treatment relates to my personal theory of life because it encompasses both emotional and practical ideals that I believe people should incorporate despite whether or not they are addicted to a substance. Aspects such as admitting that something has had power over us, admitting our wrongs, making amends, and improving ourselves overall are all very important to me in terms of overcoming various issues in life that do not have to relate to alcohol. If desired, these are the particular parts I would integrate, especially when life issues involve another person. I believe it is important to take steps to fix things in relationships as well as looking within ourselves. Many people say time heals all wound, but I believe this often must be combined with effort. It is impossible to reach any desired goals or outcomes without putting in the effort and working on the steps we need to work on. Being able to focus on 12 specific steps allows people the opportunity to work on a piece of the bigger picture without being overwhelmed by the ultimate goal. When they finally reach that twelfth step, it is all the more rewarding.

This treatment relates to my preferred counseling orientation because of its separation into different stages, which relates to meeting the client where he or she is. A client has a presenting problem upon entering therapy, and a counselor cannot just jump to the end goal; they have to work through it together, and work through it slowly, in order for it to be effective. In terms of addictions treatment, I definitely support clients attending meetings or groups for their various needs, which often can occur in addition to individual counseling. It is important for people to be able to connect to others and powerful to have that connection in a place where others truly understand at least a major part of what they are going through. This is made possible in groups such as AA, which I would surely encourage for my clients in addictions counseling. There are various treatment goals that 12-step groups have established that I would utilize in my own work with clients, including abstinence from alcohol and other drugs, steady employment, stable social relationships, positive physical and emotional health, improved spiritual strength, and adherence to legal mandates or other requirements as applicable. In my work which I often combine CBT with other theories, I would help clients work towards these goals in addition to the work they would be doing outside of therapy. I would help them establish plans and specific interventions to attain these goals.

Pharmacotherapy for Treating Addictions

I do support the use of pharmacotherapy for treating addictions.  It is important to remember that not every client is the same and therefore not every treatment should be the same, and therefore many some clients will benefit more from pharmacotherapy than others.  Still, I believe it is important for therapists to be familiar with pharmacotherapy as an option to utilize for treatment.

Certain medications have been proven to have various benefits for clients who have substance abuse disorders.  Some of these, according to http://www.dpt.samhsa.gov/medications/medsindex.aspx, include improved survival, increase retention in treatment, decrease in illicit opiate use, decrease hepatits and HIV seroconversion, decrease in criminal activities, increase in employment, and improved birth outcomes with perinatal addicts.  Even though I do believe that medications should not be used to solve problems, and often it is necessary to combine medication with personal hard work and effort in overcoming challenges, they do have benefits that can assist in treatment.  In other words, pharmacotherapy can be part of treatment but should not solely be relied on for changing people.

Both chemical and behavioral addictions need to be taken into consideration when working with clients with substance abuse disorders.  Various perspectives must be considered, and nothing is going to be a quick fix when it comes to addictions.  If medications can be used for support, and will cause more benefits then harm to the client, then I am supportive of their use.  However, I believe that much more work is necessary than pharmacotherapy alone.

My Inner Client

A quote from the text states, “…we get so involved in the role of counselor that we sometimes forget the client inside 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.”

I do not so much see this as a tendency for myself, but rather, I sometimes think of it as a necessity.  I have to remind myself that I am in the setting as the therapist and not the client, and that there is indeed a need to separate myself from my own issues in order to focus on the person who is sitting in front of me and what he or she is telling me.  I feel like this quote may pertain to people who have been working as therapists for a long time, and who are so used to being in the role of the therapist.  However, as a recent graduate and current student enrolled in this program, and also as someone who has taken advantage of the free counseling services offered to me over the years, I am used to being the client; often I have to remind myself that I am not, instead of vice versa.

I believe that empathy is the key to remembering our role in general, and to also remembering that we are humans just like are clients.  We have emotions too and it is okay to feel.  What matters is the ways we do or do not express those feelings, and how we bring them into the therapeutic settings in which we are working.  By utilizing empathy throughout therapy, we are able to feel with the client and even self-disclose if and when it is appropriate to do so.  We must have the ability to stay with the client and keep our focus, but by doing so, we do not have to forget how we are feeling.  If these feelings are inappropriate to share during the session, we can do so after with supervisors or seek or own counseling.  This is often even recommended, because counselors have a lot to carry on their shoulders.

I often do feel like I can connect to my clients, and if I cannot, I can usually think about someone in my life who can on some level.  Clients are never the first people to experience the problems they are having, and they will not be the last.  In my current work setting, I am a middle school counselor.  The only “us” versus “them” that I really see, besides the obvious age and maturity differences, are the fact that students have certain rules that they must follow throughout the day; for example, they cannot walk around in the halls without a pass during class times, and they cannot make phone calls throughout the day.  Other than that, I generally feel able to experience what they are telling me along with them in order to help them explore their issues and feelings.  Reading this quote in the chapter was almost a warning to me that this could potentially happen if I get too used to my position.  In order to prevent too much separation from my clients and to my inner client as well, I hope to continue to care for my own issues by making sure I have people to talk to when I need to, both professionally and personally, and partaking in self-care.  Doing so can continue to help remind me of how important it is to be empathic and present with my clients.

 

Week 5

Of the foundational philosophies of counseling, I am probably most comfortable with motivation. I strongly believe in the drive to change and to do something differently. Helping a client discover the reasons that they want to be different and the forces that they have, both internally and externally, to actually do something, can be vital to improving lives. People face obstacles and boundaries to reaching their goals every day, so it is necessary to seek out ways that they can overcome the pressures in their own lives; in order to do this, they must find what will encourage them to do so, and then what will encourage them to stay with it. It takes the initial motivation to develop habit. I am eager to help others find this initial motivation. I have found it in myself for various goals of my own, including exercise as I discussed in my previous post, which contributes to my comfort level of helping other people seek their own motivation.

I do believe that I am a hopeful, motivating, and encouraging person. My positive energy and beliefs are also contributing factors in the ways that I can help others. I definitely think that it is important to focus on positive outcomes and beliefs in order to defeat the negativity in someone’s life, including addictive behavior. I do not think it would be fair to say that I do not have a judgmental attitude, because everyone does to some degree. Still, I make a continuous effort to strive to listen and be empathic with those I encounter. I think that this is all we can ask of others: to try. This does not just involve effort, but patience as well. People are not always going to change overnight, and it is part of my job to instill the hope and encouragement that I have to the best of my abilities, even through frustrations and difficulties.

a personal “addiction”

Although it is not necessarily a negative addition to my life, I am obsessed with exercising. I generally need to exercise during my day in order to have a good day, the same way I might need a “friend” in some cases. I tend to rely on exercise to calm my nerves and help get me through difficult experiences. This behavior initially began a few months after I had recovered from brain surgery and had gained a lot of weight from the steroids I was on to reduce the swelling in my brain. I have never been one to eat super healthy, so going to the gym all the time became somewhat therapeutic for me, initially to help take off the weight I had gained. Once I started getting into the habit of exercising for a few hours a day, I never really stopped. In a sensual context, I look forward to the experience I get upon entering the gym; even the smells of gross and sweaty people can be somewhat comforting, because it presents a place where I do not have to look my best or fit in but can simply relax and engage in my own workout routine.

Working out has definitely become a healing process for my emotional wounds in a variety of ways. It gives me the opportunity to take a break from reality and even run away from it, especially with cardio routines. I can be away from my responsibilities while I am at the gym. In contrast, I can even get some of my work done, because I can usually read a textbook or respond to emails on my phone when I’m on a machine. Still, my mind feels occupied by the constant movement, and I always feel refreshed when my workout is over.

Sometimes exercise is “hated” because it does seem to take over my life a little, as I can spend hours a day working out and often feel the need to do so. Sometimes this causes me to neglect other responsibilities or even overwork myself. If I do not get this time, and I often cannot find it, my anxiety increases and my mood decreases. Additionally, the exercises that I do are not always necessarily beneficial to my body; sometimes I will work out through injuries that I should not bother, or stay on the elliptical for two or more hours, which is probably not very helpful to anything, but I generally do not care about that in the moment.

For behavior change, I should probably be able to approach my anxiety in ways other than just exercise and getting to the gym every day. There are aspects of my life that I attempt to avoid and can do so when I work out. Maybe if I can try other methods, I would not rely so much on one way of dealing with emotional difficulties. For example, bibliotherapy might be a good alternative technique. It will be good for me to have options other than pushing my body on a daily basis when it is not always healthy for me. This is also important because I have had various surgeries since my brain surgery that have kept me from the gym, and I need to be able to not fall into a depression because I cannot work out or be active. I can also try to attempt other exercises that may actually provide me with various challenges and make my workout more worthwhile.

Process Addictions

I believe that process addictions are serious concerns that require effective treatment to overcome.  However, I definitely have some biases towards them, because I believe that human beings are addictive people, and it is so easy to fall into the trap of any kind of addiction.  When it is an especially harmful one, such as the process addictions that we have been reading about, it definitely involves potential dangerous situations and often this will include more than one person.  Still, many times I think these addictions develop out of either weakness or a lack of seeking help in appropriate ways and at appropriate times.  For example, in the case study we read for this week, Mike’s addiction began because of his frustration in his marriage and not being able to voice his wants and needs to his partner.  If Mike had sought out counseling or received help initially, he could have prevented his addictive behaviors.  Instead, he let himself sink into something that he ultimately knew was wrong, or he would not have kept it a secret from his wife.

 

In terms of process addictions, I do believe some behaviors are more problematic than others, only because of the fact that certain behaviors and addictions can put people at risk to more harm to themselves and to others than other behaviors.  For example, a gambling addiction can put a family in debt, and a sex addiction can destroy a relationship and also have devastating results for a family.  An Internet addiction, on the other hand, may definitely have harmful effects on people, but the impacts that it has on other people besides the addict may be less severe.  That is not to say that it is not an issue and should not be addressed.  However, there is something slightly safer about using the Internet, and gaming in particular, as an outlet, rather than gambling large amounts of money.  It is important to recognize that every individual is different and every case of addiction has differences as well; my personal views of these processes and of process addictions come from what I have read about in case studies and what I have seen personally throughout my life.

 

I do not believe that something is an addiction if it is uncomfortable, undesirable, or unhealthy.  I believe it is an addiction if it becomes persistent, repeated, uncontrollable, and intrusive on a person’s life.  In the case study example, if Mike had only utilized the website inappropriately one time, it would have been an undesirable and possibly unhealthy behavior.  However, once he became addicted to it, it took over his life, which became “unlivable” if he had not been online the night before.  My own beliefs and moralities might shape my views of my clients’ problems because I believe that people need to be surrounded by positive resources and support in their lives in order to behave appropriately and function properly.  This might influence me to encourage clients to seek out other people in their lives who influence them and who can help them work through their problems, even if that means involving people who are already involved in the problems.  It is important for me to not act condescendingly towards clients or make them feel ashamed for admitting that they have a problem and attempting to work through it.

 

Week 2

         After reviewing the web references for this week, one approach I feel especially comfortable with is motivational interviewing. I am used to utilizing this in my current work setting as a school counselor. I am comfortable working with younger people in general, as well as referring clients to experts when I know they are seeking help in an area where I lack sufficiency. As a school counselor, my knowledge resides in how I can help students in the school; this includes helping with problems at home, but in a situation like addiction, I would want to ensure that students can seek out resources when they are not in school, and are able to get the help they need from trained professionals.

            The strengths I have as an individual to assist someone similar to Sahira are empathy, patience, listening skills, and adaptability to individual needs. I recognize that it is up to my clients to tell me where they are in terms of thinking, feelings, and actions, and how it is necessary to follow their leads. I have worked with children my whole life, who often times will take their time when learning and discovering their own desires and needs. It can be an effort to slow down to get on their level in order to help them in the best way possible. This can be similar to working with Sahira because she will need to go at her own pace in order to get help and hopefully to ultimately implement change in her life. Another characteristic I have that will be important is honesty. I currently work as a school counselor in a middle school, and, through imitating my internship supervisor, I make an effort to not lie to students and to let them know that. For example, if I need to call their parents, I will let them know everything I will share before I share it, and often times I will allow them to sit in the room with me while I do so. This is important for building trust and it will be important for Sahira.

            One area I still could use practice in is confidence. Sometimes I feel like my voice is not strong or certain enough when I speak to clients, especially when I am not used to a topic or situation. This has improved with practice and will continue to do so with time. I believe that I need to work with a larger variety of populations that I am not as used to in order to build this confidence. Right now, I am not the kind of person or counselor who can go into a new setting and feel like I can work in it effectively, though I know it is important to not get too comfortable either, as anything could occur. I do not feel that sitting in a classroom and learning about a topic makes me competent enough to go straight into a real counseling setting, and so I would like to continue to gain practice in various areas.