I am fortunate in that I have some work experience with people coping with addiction. I have been privileged to learn from more experienced clinicians, as a co-facilitator of an intensive outpatient treatment program (IOP). The IOP focuses on early recovery skills including identifying internal/external triggers for use, exercising environmental control to reduce contact/influence of triggers, dealing with cravings, the relapse process, post-acute withdrawal syndrome (what the brain and body go through as they recover), dealing with feelings, building new social networks, replacing using activities, and structuring time. Our approach draws heavily from CBT— replacing unhelpful behaviors with those that are more adaptive and identifying the belief systems that underlie these behaviors. One of my strengths for assisting Sahira is my knowledge of this evidenced-based practice for addressing substance use.
I also tend to be compassionate and empathic over judging. A non-judgmental stance would be important for developing a rapport with Sahira, and for helping her to overcome shame and guilt for the choices she has made during active addiction. Without trying to be too personal, I’ll disclose that I am adopted. I share this because I think this experience has helped me to realize that genetics are only a small part of the equation that determines who we are. Our environments and experiences are huge determinants of who we will become. I believe that different environment and different experiences could have made me someone else (anyone else). I do not judge individuals with addiction because I know that I could have found myself in the same place if circumstances had been different. There are always opportunities to recognize our humanness, and how our needs as people make us more alike than different.
As part of our program, we look at the losses and gains for use (decisional balance) and we discuss readiness to change (stages of change). These are Motivational Interviewing approaches, yet I am less familiar with practicing all the components of this technique: expressing empathy, rolling with resistance, developing discrepancies and supporting self-efficacy. I feel comfortable with my ability to empathize with clients and to affirm positive behaviors. However, I do want to build on skills for eliciting change talk and for reflecting on what I see and hear from clients. Specifically, I often find myself asking closed-ended questions, when I would generate more meaningful conversation with open-ended questions. I could also improve on skills relevant to self-efficacy— assisting clients with generating small, realistic goals that can be tackled between sessions, and on helping them to generate possible solutions to problems.
My clients often utilize 12-step programs, yet I have only been to several meetings. I do not know the ins and outs of stepwork or the culture well. I would like to become more familiar with AA, NA and other derivatives. The principles of 12-step programs sometimes differ from my training as a clinician, but there is no question that they are programs that my clients value. They assist individuals in building new sober support networks that help them to remain abstinent, reducing their exposure to triggers and reducing isolation. Clients undergo self-exploration through the 12 steps. They learn from the behaviors modeled by others who are more established in recovery. They feel empowered and comforted to when they learn that this illness affects many people. Further, it seems valuable that individuals enter the rooms of AA/NA as equals. Addiction does not discriminate on the basis of sex, race, religion, education or wealth.
In a nutshell, I feel comfortable with my skill in delivering Rogers’ Three Conditions for growth— genuineness, unconditional positive regard and empathy. However, I would be a better clinician if I developed more specific knowledge of interventions including Motivational Interviewing, support groups, and perhaps mindfulness-based cognitive therapies, like Dialectical Behavior Therapy and Acceptance and Commitment Therapy. I would like to develop greater skills in working with depression, anxiety and trauma too, as they are so often co-occuring in clients with substance use problems.