Final Post

 

• 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?

As a counselor working with a pregnant addict, I would be a lot more concerned about the safety of the baby and about the swiftness of recovery.  I would educate the mother on fetal alcohol syndrome and the possible complications that she could be causing for her pregnancy and for her child after it is born.  My treatment approach would focus on short-term approaches and avoid pharmacotherapy because of any possible issues that could arise from that.  I would also explore issues related to the pregnancy with the mother, which could be talking about effective parenting, determining logistical issues such as how to pay for the baby’s needs, and weighing the pros and cons of adoption, abortion, or keeping the baby.  I would have a lot of difficulty working with a client like this because I have an adopted cousin who suffers from fetal alcohol syndrome.  This has caused a lot of issues in her life, specifically cognitive and mental health issues.

• 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 think that advocacy is an important part of being a therapist.  If we want our clients to be empowered and to advocate for themselves, we should be willing to do the same for them.  By fighting for basic human rights, such as equal access to education or marriage equality, we are able to address possible future mental health issues that could arise.  Personally, the groups that I have the most passion to advocate for are sexual minorities and women.  I think this has to do with the fact that I am a proud ally and feminist and that I have grown up knowing many gay and lesbian individuals and seen the different ways that they are treated.  I do not think that I would have an issue advocating for other groups when I saw an opportunity to, but I would be less likely to seek out ways to advocate for them.

• 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.

PFLAG is an organization for parents, family, friends, and other allies to lend support and advocacy for the LGBT community.  This website is a great resource for those who have a loved one who identifies as a part of the LGBT community.  The website talks about different issues that LGBT members may face and offers suggestions for how to lend support as well as advocacy events.

The Human Rights Campaign is a large civil rights organization that is committed to advocating for the LGBT community.  This organization is responsible for a lot of lobbying and other efforts to put LGBT issues into the forefront.  This website has information about a variety of different issues regarding the LGBT community and information about political successes that have occurred in the battle for equality.

The Pride Institute helps LGBT individuals suffering from addictions.  Since many LGBT individuals may feel uncomfortable in normal treatment groups, this provides them a safe place to work through their addiction issues without the stigma of their sexual identity.  The website provides information about the staff and the different programs offered.  It also addresses questions that individuals may have before seeking treatment.

The ALGBTIC website is a useful resource for counselors working with LGBT individuals.  This website provides useful information on how best to work with this community and has links to articles about counseling issues and the LGBT community.  It also includes a list of competencies for working with the general LGB community as well as competencies for working with transgender individuals.

 

Childhood Perspective

 

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

I grew up in a fairly strict family, so when I was in elementary and middle school I thought I would never drink or at least that I would not drink until I was 21.  Once I entered high school and started knowing people who drank or did drugs, my opinions about substances began to change and I became accepting of others who decided to experiment.  I was always terrified of hard drugs like heroin or meth, but did not see anything wrong with friends trying pot or drinking.  I didn’t have a real opinion about drugs I thought were somewhere in the middle, like cocaine, however freshman year of college was the first time that I actually saw cocaine and I was uncomfortable about it and left the party.

• 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 didn’t drink until senior year of high school and my close high school friends didn’t drink or do anything when we were in high school.  Some of my less close friends had experimented with a variety of drugs and two of them actually entered NA when we were still in high school.  When I got to college I drank way too much freshman year and thought that that was the normal way that people socialized with each other.  Today I view drinking as something that should be done in moderation, although I see nothing wrong with someone my age letting loose every once in awhile.  I would feel fine working with clients making different choices than I made in high school since I’ve known many people in my life with very different experiences with substances as an adolescent.  For example, my ex-boyfriend had started drinking in middle school and realized he was an alcoholic when he was in college and my best friend has dated two former heroin addicts, so I have exposure to adults who had to deal with struggles with substances when they were younger.

• 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 had the same PE teacher from kindergarten through 8th grade and during health she often acted like a school counselor for us as well, talking to us about a variety of issues from basic self-esteem or hygiene to serious issues like overdoses and sexual assault in age appropriate ways.  She was very open with us about her own child’s struggle with addiction and this had a lasting impact on my perception of drugs and alcohol.  I have never tried pot and I feel as though a lot of that can be attributed to the discussions she would have with our class every year.  On the other hand, I feel that the way that my parents were overprotective growing up mixed with the new freedom I had in college led to my drinking way too much as a freshman.  I hope to emulate the way my PE teacher talked to us by being open and understanding about substances but discard the strict, unforgiving perspective of my parents.  To be fair, a lot of that was them reacting to my mom having grown up in a family impacted by alcoholism.

Feeling Stressed

• If you have been under a lot of stress, resulting in overuse of self-control resources, this fatigue may have led to ineffective coping strategies. Has this ever happened to you? What were the circumstances?

Honestly, this semester has been very stressful for me.  I am currently working two different part-time jobs throughout the week, as well as another job answering phones at my church every other Sunday.  I took two weekend elective classes and am taking two semester-long classes, one of which is my practicum.  Unfortunately, while I really like my site for practicum, it is two hours away and one of my clients is extremely difficult.  My brother is also getting married in a few weeks. In addition to helping out with that, the other bridesmaids and I have been trying to plan a surprise bridal shower and a baccellorette party for my brother’s fiance through email, since we are all over the country and have never actually all met, which makes it a lot more difficult.

In the past month, I have been coping by staying up watching TV and eating out a lot more than normal to save time that I would spend preparing food for myself.  This has led to me sleeping less and spending a lot more on food.  This has led to me feeling exhausted during the day, making me rely even more on these coping mechanisms.

That being said, the bridal shower is this weekend and now completely planned, and I am getting a lot of help from my supervisor with my difficult client, so this past week I have begun to feel less stressed and am getting back into my regular pace of doing things.

 

12-Step Programs

 

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

12-step facilitation of treatment is very much in line with my personal theory of life because I feel like people mimic those that they surround themselves with.  By surrounding themselves with others working towards recovery and actively practicing sobriety, individuals will follow this behavior more easily.

In my own personal life, I like the idea of making amends.  I think that this is something that a lot of people don’t do out of embarrassment.  I try to apologize whenever I am at fault for something or recognize a way that I have negatively impacted someone else.

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

I think that using a 12-step program in conjunction with therapy is the best approach.  I do not think that it is best used entirely on its own, since there a lack of therapeutic support in 12-step programs.  However, used with cognitive behavioral therapy or another therapeutic approach to addiction treatment, the social support gained from being in a 12-step program could be extremely beneficial and something that I would recommend to clients.

The thing that makes me really wary of the 12-step approach is the reliance on God.  A lot of people, especially in this area, are not religious and do not want religion pushed onto them.  I think that everyone’s own personal beliefs should be respected, so I do not think that individuals working on addictions should be forced to surrender themselves to these religious ideas.

 

Pharmocotherapy

• Choose one of the following perspectives and explain your position: “Do you support the use of pharmacotherapy in the treatment of addictions? If so why? If not, why not?”

I do support the use of pharmocotherapy if it is what the client feels is going to be the most useful for him or her.  Suboxone, methadone, and other drug replacement approaches have been proven to be effective in treating addictions.  Therefore, I think that if a client wants to try pharmocotherapy, I should not stand in the way of an approach that works.  I do, however, think that this is something that needs to be heavily monitored.  By replacing one drug with another, there is a risk of adverse effects and a chance of replacing one addiction with another.  At my practicum, there is a group on suboxone and there have been instances of individuals in the group selling it to those addicted.  Ultimately, if a client is struggling with different approaches and want to try pharmocotherapy, I would definitely support this decision, but would monitor closely the impact that it is having.

 

Counteracting the “Us Vs. Them” Mentality

 

• A quote from your 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.” Do you see this tendency in yourself? How do you stay in contact with your inner client? What does that mean for you?

Depending on the way I look at this quote, I both have this tendency and I do not have this tendency.  I am aware of the fact that I need help with certain issues in my own life and have been in therapy for myself in the past.  I think that this is very important for counselors, since if we do not work through our own issues, these are likely to spill over into the counseling session in the form of countertransference.  I also, however, am able to separate my own issues from my others’.  I feel that it is important not to over-identify with a client because this can also lead to countertransference and pushing our own perspectives of an issue onto a client or not fully understanding what the client is saying.  As I move forward in this career, I think that it is important to do a lot of introspection to identify what my own issues or biases might be and to address these and work on them so that they do not come into the counseling session with me.  For me, this means continually reflecting on my own responses and being willing to go to my own counseling if I think it is necessary.

• 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”?

I try to be as accepting as possible of others.  When people get on my nerves or bother me I try to think through their reasoning for doing whatever it is that bothered me and rationalizing it from their point of view.  For example, I have a coworker who always leaves the fitting room a mess for everyone else to clean up.  I am able to realize that she views interacting with customers as the most important aspect of the job and if at all possible will seek out customers to help and talk to in order to make their shopping experience as enjoyable as possible.  This allows me to not be as bothered by this, since I understand why the fitting rooms were neglected.  Going into counseling, it is important to try to understand the reasoning behind a client’s poor choices.  When it comes to addictions counseling, gaining this insight can also then help put in place alternative actions that the client can take in the future in similar situations.  It is also important to remember that we are human also and often do not make the most rational decisions either.

 

Cognitive Behavioral Therapy

 

• Which of the foundational philosophies of counseling are you most comfortable with and why?

Of all of the foundational philosophies of counseling used for the treatment of addictions, I am most comfortable with the idea of using cognitive  behavioral therapy with this population.  This approach is very commonly used with addicts and has been proven to be extremely effective.  Cognitive behavioral therapy with addicts works with a combination of different interventions: social, environmental, emotional, cognitive, and physical.  In my opinion, all of these play a crucial role in whether or not an individual will continue to use and are most effective when used in conjunction with each other.  For example, by reducing environmental exposure to triggers, such as the neighborhood where he or she used to buy drugs or watching movies with lots of heavy drug use, there is less temptation to use.  However, by pairing this with cognitive interventions aimed at stopping automatic thinking and modifying beliefs about use, when exposure to these triggers does eventually occur, the client will be able to be able to reduce the weight that these triggers have.  When all of these interventions are combined together, the client is well equipped to face the world with tools to avoid using again.  I feel as though this is a very lasting approach that will have more permanent results than some of the other approaches used.

• Are you a hopeful person? Are you motivating and encouraging? Do you have a judgmental attitude?

I tend to be a hopeful person.  I feel as though anyone is capable of change and I feel that things that happen in life, even the worst things, can be used to strengthen a person if looked at in the right context.  When it comes to substance abuse, the ability to look back on one’s life to evaluate what went wrong to lead to addiction and then being able to change this to get through the addiction is one of the most hopeful and strong things that a person can do.  I also think that I can be motivating and encouraging because I feel so strongly that everyone is capable of change.  I feel as though I am able to convey this to others.  Unfortunately, I can have a judgmental attitude at times when I feel that someone is unwilling to try to address the things that are causing them problems and are willing to just throw in the towel.  I don’t judge someone based on the problems or way that they are, but I do judge when someone is aware that a change needs to be made but is unwilling to take the steps to make that change happen.

 

 

Netflix

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

I definitely spend way too much time watching shows on Netflix.  It’s funny that the question asks how I view this substance as a “beloved ‘friend'” because I actually do start to feel like the characters in the shows are like friends that I go to at the end of the day.  I get to know their personalities and their traits and in watching them interact with each other on the screen, I feel as though I am in that world with them.  I empathize with them and I get angry at them and I care about them just like with real friends.

• How is it sensual (appeals to my senses)?

Netflix appeals to my senses because it can be visually and auditorily exciting.  My emotions get invested in what I am watching, so in addition to my senses being stimulated, I am able to experience a whole range of emotions while watching.

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

Watching can be healing because it takes me away emotionally from what is happening in my own life.  It is able to provide an escape from any stressors that I might be experiencing.  It can also provide advice or life lessons by seeing how characters handle situations that I might be also experiencing.

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

I am a bit of a procrastinator, so I often find myself watching Netflix instead of doing things I need to be doing.  On the other hand, if it weren’t Netflix, I would probably find something else to procrastinate with.  Also, when I have had a bad day, I often turn to watching Netflix instead of interacting with anyone, so I suppose it has cost me times when I could have been out making friends or fostering friendships that I already had.

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

If I truly wanted to change my behavior, the best treatment would be to cancel my subscription so that I would be forced to stop watching.

 

Process Addictions

• What biases do you find in yourself about process addictions?

When I think about process addictions, I typically think about video games, internet, and TV/Netflix.  This might be due to the age group that I am in or the fact that these are things that I spend a good amount of my time doing.  In fact, my efforts to make my way through the new season of “House of Cards” is why I didn’t get this post done earlier (only halfway through, but I’m not sure if that’s good or bad given that it only became available on Friday).  I was surprised to find that the textbook did not address any of these addictions, other than a brief box lumping the internet and MMORPGs together.  It seems to me that when I look around these are the addictions that seem to be ubiquitous.  College Humor even made fun of today’s extreme internet usage with a post about the 7 stages of Reddit addiction, and binge-watching shows is quickly becoming the way most TV is watched.  Upon further reflection after this chapter, perhaps what I’ve considered “addiction” is just a consistent way of spending free time.  Yes, all of these can become addictions if taken to excess, as was hyperbolically demonstrated in “The Guild” clip, but for many people binge watching a TV show or playing a video game every night do not constitute addiction.  Middle schoolers who reblog on Tumblr everyday are normally still able to get their homework done, just as parents marathoning “Downton Abbey” still get their children where they need to be, make dinner, and complete other household duties.  Likewise, most gamers don’t go through withdrawal when their family goes on a vacation.  There is a difference between frequent or even excessive use and actual addiction.  I am quick to jokingly label someone as addicted to video games, an internet site or the internet in general, or TV, but in reality most of these “addicts” that I’ve labeled do not meet the criteria of true addiction.

As far as other addictions go, I am somewhat quick to judge someone with a shopping addiction or a sex addiction as not having an actual addiction.  I have considered these addictions to be excuses for behavior that could get one in trouble.  Addiction seems to make for an easy scapegoat when someone is trying to explain to a spouse why all the credit cards have been maxed out or why he or she has had yet another affair.  I also viewed these behaviors as easily controllable if one wanted.  I did find the Nightline clip below helpful in getting insight into what it is like to be addicted to shopping.

After watching this I’ve realized that it is unfortunate that, as an employee at a retail store, we have incentive programs to keep big spenders coming back into the store.  I have personally cold called customers who have spent extravagant amounts in our store to let them know of upcoming sales, and we have specialty discounts and send reminder emails to our “Elite” customers who have spent over $1,000 on clothes from our company alone in the last year.  I have always considered this good business practice, but I am now wondering how this could be damaging to these quick spending customers.

• Are there some behaviors your more readily accept or reject as being problematic or addicting?

I definitely view gambling addiction and shopping addiction as the most problematic process addictions.  These can quickly deplete an individual’s finances and can cause him or her to be forced into declaring bankruptcy or losing assets.

Like many people, I have never considered workaholism an issue.  While I am by no means a workaholic, I would consider my dad to be one as he spends longer than normal hours at work and then brings office work home at the end of the day which he works on well into the night.  Even on days off, if he is unable to occupy himself sufficiently with office work, he’ll vigorously go about cleaning the house or doing yardwork.  From my perspective, this is no way to live life, but I do not see it as being harmful.  After reading this chapter in the textbook, I can see the ways that this type of addiction can lead to relationship problems and physical problems brought on by stress.

Unlike many people, I do not see sex addiction as being very problematic.  If an individual is not in a relationship, where another individual could be hurt, or if the individual is in an open relationship, and if the individual uses proper protection, gets regular check ups, and agrees on any necessary “safe words” ahead of time, I do not see frequent or extreme sex to be an issue worthy of concern by a therapist.  When it would become an issue is when protection is not being used or if the type of sex or sexual behavior crosses legal boundary lines.

• What shapes your views of these processes?

As I said earlier, my own personal experience and exposure is what makes me quick to think about and label people with technology based addictions than other addictions.  Also, the normalization of workaholism in today’s culture as well as watching my dad work hard and push us to work hard makes it difficult to see this as an issue.  Like with technology, I will jokingly call someone a workaholic, but I do not view this as a behavior that needs to be changed (I’m realizing through this chapter that in some people it is counterproductive and can have other negative effects).

• Are you more likely to call something an addiction if you are uncomfortable with the behavior or view it as undesirable or unhealthy?

I am actually less likely to refer to something as an addiction if I am uncomfortable with it.  Like I’ve said before, the things I jokingly call people addicts for are things that I am very familiar with.  From a clinical standpoint, I would try to be conservative with labeling people addicts when it comes to process addictions.  I would really want to explore to what extent it is interfering with their everyday life.

• How might your own beliefs, morality, or spiritual beliefs shape your views of your client’s problems?

I do not think that my Catholic upbringing has much of an impact on my view of process addictions.  I do think the fact that both my parents have degrees in economics and the importance they’ve put on saving money and being financially responsible makes me more wary of financially damaging issues like shopping and gambling, although in reality any process addiction can ultimately cause financial troubles.

Working With Substance Addictions

• After reviewing the web references for this week, discuss what types of approaches are you more comfortable with?

I feel as though the most important aspect of recovery is social support.  Just like continuing to go to the gym is easier if you have a workout buddy, having someone who can both relate to what you are going through and push you to continue while holding you accountable is going to have far better results than trying to do it all on your own.  Because of this, when working with addicts, even those well into recovery, I would recommend groups like Alcoholics Anonymous or Narcotics Anonymous.

I also really liked the idea of the Motivational Interview.  I lean most towards a person-centered approach to counseling, and this is exactly that.  It provides the client with autonomy in deciding his or her future.  By having this self-driven and self-chosen goal, the client is more likely to continue working towards it even when it gets difficult.  This is true in many areas of life.  For example, a young athlete who wants to be the best and win will work much harder for it than one being pushed into it by a parent or friends.  Through the motivational interview, the client sets their own path to recovery through the support of the therapist.

• What strengths do you have as an individual to assist someone similar to Sahira?

My biggest strength is my ability to show empathy and to truly care about someone’s story.  I have always been able to put myself in other people’s shoes and think about how things are affecting them.  I am also a good listener and am open to many opinions and viewpoints.  These will help me not just with clients like Sahira, but with all clients.

• What are areas that you might feel you need to work on?

My biggest weakness when working with those suffering from substance addictions is my lack of personal experience.  I have no experience with drugs and I rarely drink.  Outside of myself, my exposure has been more to those who are suffering due to a loved one’s substance abuse than their own.  This has caused me in the past to align myself with those who end up being victimized by addicts and to view addiction through the eyes of those hurt from outside of the addiction.  Since I tend to be empathic and nonjudgmental, hopefully once I start working with addicts this will not be an issue.

Another weakness I have is getting overly invested in helping people.  I know that many addicts relapse and that this is something that will eventually happen to one of my clients.  The best thing for the client would be if I were to view it as what it is, something that happens that he or she needs to work through.  I am fearful that I will view it as a failure of my counseling.  Hopefully, I will be able to think through it logically and come to the next session in a way that will help the client feel ready to get back on track.  Along with this, some clients might decide that this isn’t worth it to them and leave therapy and go back completely, if not more so.  This, again, I see myself as having difficulty dealing with.