Tag Archives: addiction treatment

How do I…?

How do I…?

  A question that emerges after the story has been told, the problem outlined. A man doesn’t trust himself: he has a plan to stop doing what he’s been doing for a long time, perhaps his entire life. He’s determined; the stakes are higher than they have ever been before, which usually means that others will be affected. Guilt will be key. The guilt stems from the prospect of failure, a background of it, and the implicit knowledge that there is something inside that demands expression.

 How do I…?

 As a therapist, I attend to the question on its own terms, responding with an outline’s semblance. First I mimic the crowd, who also knows the story, the history of the problem, and the stakes. Those stakes are reiterated. Regular reminders about the consequences of problem behavior: the impacts upon self and especially others; the damage to health, career, family. To hear some, you’d think that nothing more than such interventions are called for in the prevention of self destruction. I think that therapy supplies the subtext: people care; the man, despite himself, and despite the observations of some, cares also Further, reality can be cruel. Fate is indifferent.

 Implicit is the call for fellowship. The man in question has been isolating, not talking to others, getting lost in himself. Where is the accountability? I ask. I’m quick to explain: I don’t mean he should answer to me, or that he owes anything to anyone. At an early stage of therapy, I avoid stepping into dynamic roles wherein lines of authority are unconsciously laid. I mean something subtler; having something like structure, containment—that there is someone to speak to, to be honest to, when mania has run its course.

 How do I…?

 Continuity. How do you keep it up, your motivation? A woman changes her mind, doesn’t want what she wanted last month, has forgotten what drove her in another mood; what seemed different. The next twisting, turning switch must be explained while the past is denied. A therapist is memory—an aspect of containment. Something changed. Why? The question doesn’t compel answers as much as it does thinking, the protraction of curiosity, and slowing down. Very little has to happen “right now”.

 How do 1…?

Needs. A subset of the why question: why do people do what they do, especially if what they do generates guilt? Why doesn’t guilt itself motivate change? Why doesn’t remorse always do what courtrooms think it should? People do what they do in spite of guilt, in spite of shame, guilt’s less confident twin. Truth—that something within—hurts; it hurts self and others, and it always will. It needs out. It needs to be released, titrated in the spirit of compromise, for if it can be discharged without anyone knowing, then no one gets hurt.

 How do I…?

 Hope. When continuity has broken down; when the relapse once cast as a mere change of mind has returned the individual back to square one, a knowledge of pain lingers. The day after is another appointment. The fellowship, in all likelihood, is still there. People still care. The questions are still worthwhile. Curiosity is resilient. The therapist is in his office, waiting.

Graeme Daniels, MFT

 

 

 

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Working Through Rehab: opening salvo

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So, you’re thinking of placing your kid in rehab? Or, maybe you’re thinking of getting a job in such a place, as a counselor, social worker, therapist, or whatever they’re being called these days. Do you know what it’s like being in rehab, or working in one? Have you visited a drug treatment facility, or heard stories from your neighbor who sent their kid to an out-of-state boarding school the previous summer, and later discharged just in time to begin senior year in high school. Are boarding schools the same thing as rehab? You wonder. A doctor outlines options: suggests therapy for a troubled teen, or an assessment at a nearby hospital, which boasts detox facilities and an intensive outpatient program, committing kids and their families to eight weeks of group and family therapy, ten hours a week, not counting the 12-step meetings that counselors will ask participants to attend on the weekends. A residential admission is the next level of care. It is the last resort as far as professional intervention is concerned—the last stop on the treatment ladder.

            Do you want this? Need this? Does a kid getting referred to rehab even have a choice: Meaning, is a court presenting rehab as an alternative to incarceration? Or are the parents the mandating authority? Perhaps your kid’s best friend has called you up, or texted you anonymously, warning that he or she is drinking or smoking much more than you realize, or “experimenting” with some other, supposedly more hardcore drug—one that will really scare you. You notice the kid’s grades are going down, and that more time is being spent with sedentary, seemingly anti-social activities: marathon spells of video-gaming; the vague notion of “hanging out”. What happened to that kid that seemed vibrant a year or so before: polite, energetic, and gregarious. Is this normal adolescence? You worry. How long do you wait to see what happens?

Maybe this isn’t your story. Maybe you’re a parent who has struggled with your own substance use. Maybe you’re an addict, and it seems like your kid is following suit. You don’t know what to do, or even if, given your own history, you have the aptitude or even the right to speak your concerns. After all, did you listen to adults when you were a teen? So, your kid is staying out all hours, has joined a gang, become a dealer as well as a user. Involvement in the juvenile justice system seems imminent, if it hasn’t happened already. You’ve already had several phone calls from Child Protective Services; one or two home visits. You and a couple of county social workers are on a first name basis.

Maybe you’re a fledgling member of the mental health profession, and working with troubled kids seems like a good idea: a stepping stone to a career as a social worker, a teacher, or, if you’re really stupid, a psychotherapist.  You’re a tweenie that’s looking for a job while in school. Or you’re a journeyman counselor that’s just completed requirements for certification as a drug and alcohol abuse counselor. An adolescent drug treatment program, attached, say, to a larger hospital, will offer steady employment, some modest benefits, if not a particularly competitive wage. You’re okay with that, maybe…for the time being. You want to reach young minds, work with those who may be more flexible in their ways, feel more hope than the adult addicts you’ve known. It will be less depressing, you think, working with kids.

Now that you’ve read the brochures and the websites of various programs, or taken tours of their sterile, hospital corridors and dorm-like accommodations, settle in for a first hand look at what happens in adolescent drug rehab programs, from the ground up, because that’s where I started. To do this properly, I have to go back in time to give some history, some context for what is happening today, especially in residential programs, for while some things have changed, others have not. Along the way, there are markers of change, nodal moments in my working life that in my opinion reflect trends in the business as a whole. If by the end of this text, the reader still wants to enter this field, or admit his or her child to a rehab like the ones I worked at, I’ll have no complaints. Just consider this the longest informed consent form in rehab history.

** opening of Working Through Rehab: An Inside Look at Adolescent Drug Treatment

 

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