I have been thinking a lot about work lately. Because I want to go back.
I want to pay rent and bills, and have money left over to save for things like a car, a passport, and travel – particularly back to my beloved Belfast (which I still can’t see pics of without crying).
I want to be able to go shopping for food and not have to constantly add up prices, and reluctantly put things back. I cannot even recall what that’s like, for the brief times I wasn’t poor. I do recall it felt good, though.
I am not one of those people who, even when they make a decent living, pinches every penny and eats crappy food to save money. I find them really annoying, those “cheap bastards”.
Anyway, I got to thinking, as I was reading websites yesterday. Since I subscribe to a lot of healthcare blogs, news sites, and so on, I read a lot of stories about people who either are in therapy, or conduct therapy as trained and educated professionals, or “conduct therapy” as laypeople who think “I can do that, I don’t need education”.
I have softened my stance a bit on this last group. It used to annoy me to no end when people would ask, rhetorically, “Why do I have to jump through a bunch of hoops to get a degree and get licensed, when doing therapy is so easy? All my friends come to me for help, and they tell me I’m better than any counselor they’ve ever paid to see.”
I used to think, “You arrogant so-and-so! Therapy isn’t just letting people state their problem, and then you tell them what to do, ala Ann Landers! It’s nothing like that!”
But, oh, it is, to a certain extent. It’s not supposed to be, but it is.
I have worked in quite a few places, mostly hospitals but some outpatient places, and with the rare exception, that’s exactly what the average person will find when he/she goes to a therapist.
Aside #1: Yes, my master’s degree is in experimental psychology, with a minor in special education. But, most of the core requirements are the same as clinical – until you get to the “practicum” part and the graduate level in counseling etc.
However…when you have access to academic journals and read a lot of research on therapeutic techniques, plus get a lot of continuing education mini-courses/training seminars/conferences through the workplace, you tend to get a lot of clinical knowledge and can use that to drive your therapeutic techniques. That’s what I did.
Example: The last place I worked at was a methadone clinic. In my opinion, methadone maintenance is a good idea – in theory. The theory being, of course, that you switch people from heroin to methadone, then get them off that completely via therapy and tapering.
What a stone pity it doesn’t work that way in practice.
At this particular outpatient facility, the clients had to have failed rehab a lot of times to even get in (not sure why that was a supposedly clinical requirement – but it sure makes for a profitable business).
Some clients came via court order, in lieu of jail.
Some came because they were pregnant (and Pennsylvania, unlike Tennessee and other places, does not automatically charge a woman with child abuse if she becomes pregnant while addicted). They were worried about their babies.
Some came because they wanted a free alternative to heroin.
Only a few ever came because they wanted, really wanted, to get clean.
The program goes like this: You come in for your dose, and on days when you are required to go to either group or individual therapy, you do that first AND THEN dose.
Let me tell you, there’s nothing like leading group therapy at 5:30 AM with a group of people who are in various stages of withdrawal. It’s not fair to them, and the fact that usually that was the ONLY way the company could get them into therapy speaks volumes about how ineffective the program is.
And how ineffective the screening process is.
Aside #2: When you admit patients to a program who pretty clearly do not want to deal with their addiction and get off heroin, you can be assured that those patients are going to be quite profitable for your business – because they’ll never get better, and they’ll consistently resist tapering off.
Cha-ching! Client for life – or until the insurance runs out.
I sat in on a couple of these “group therapy” sessions when I first started working there. The first one involved the “therapist” (I cannot and will not call these people therapists, degree or not) playing Hangman with the group.
Hangman! You know, the game where you guess the word by guessing letters.
Hangman! Not “Hangman-and-then-we-discuss-these-terms-you-just-guessed-and-apply-them-to-your-addiction” That might have actually counted as “psychoeducational”.
But just the game? No, that doesn’t count as anything but “time-filler-for-someone-who-doesn’t-know-how-to-conduct-group-therapy”. And, “easy-thing-to-do-with-clients-so-they-won’t-hate-me-because-I-won’t-let-them-dose-until-we’re-finished”.
This was typical stuff. The other things the “therapists” did for group were:
~ Picked a topic and let clients ramble.
~ Brought a Bible and conducted Bible study under the guise of, not in addition to, therapy. I am all in favor of using the Bible – or any other religious/spirtitual text – if the client’s beliefs are important to them, and if it is an adjunct to therapy. But in place of therapy? No, that’s completely unprofessional.
~ Went around the room and asked each client, “So, how are you doing?” That usually ate up the entire time, and the “therapist” didn’t even have to talk.
Group therapy interventions like showing videos had to be approved by the director (who had no degree in anything, nor had any experience with addiction). I wanted to show part of a video from PBS explaining where heroin comes from, and how it contributes to terrorism.
My idea was that maybe some clients who couldn’t be reached other ways would possibly be reached by this little nugget of knowledge. Especially if they were Gulf War veterans.
I wasn’t allowed to do it. Why? “Showing how heroin is made might trigger them to use.”
Trigger them to use?? When 80-99% of them are testing positive not only for methadone, but for illegal opiates, alcohol, and benzodiazepines?
Aside #3: “Benzodiazepines” are drugs like Xanax and Valium. If you take them with any kind of opiate or alcohol, you get higher than a kite. Or stop breathing and die. Or both.
This decision of hers just illustrated how little she knows about addiction, therapy, or…well, or about people in general, and addicts in particular, really.