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.
Victoria's Viewpoint 
It seems these days that it’s all about the money. Nothing else matters. Honesty, quality, people’s lives… All that is trumped by profit ( unintentional pun there).
They ( politicians, corporations, etc.) seem to be obsessed with saving money. Ok, so where do these savings go? You and I never see it. Who’s taking all of these “savings”, and why do knock ourselves out to keep shoveling into someone else’s pocket?
I could go on, but we have this discussion frequently, so there’s no point rehashing it. I’ll just get myself worked up.
Well, as usual, I enjoy reading your posts tremendously.
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Interesting. I worked doing a follow up program for people doing the methadone program. I would go to their homes and fill out a questionaire and without exageration 90% were using again. The other ten percent were dead or in jail. I was wondering if you were going to start a private counseling clinic that would actually try to get these people to quit. It seems like you have some sound ideas of using a different approach which would include redirecting the addicts thinking process which I believe is the only sound method to get someone to quit. An addictive personality will always be addicted. Counseling should try to find a substitute addiction that is less harmful to society and the individual. Boredom is the greatest demon that addicts must overcome because it allows the mind to manifest whatever demon causes them to trigger using. Finding a volunteer job such as helping at the local animal shelter or hospice work are substitutes that I think would help addicts. Now first thing one would say is you don’t want an addict in a hospital environment where opioids are common usage but seeing how they are used to end the life of a person is very powerful for an addict to see. Many addicts have od’d or had someone od and then were brought back and it adds a good deal of reality to their drug use. It depicts the end because when you use that is where you are headed. Unless you have the genetics of Keith Richards. I’ve rambled long enough but I think you may be onto something. Good luck. Peace, Love, and Understanding
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@Charlie:
Yeah, you’re right – we’ve had this discussion many many times – and both of us get worked up about it on a regular basis lol.
The best job I ever had was working in a place that did not involve life-changing decisions. It didn’t pay well, and it involved some physical labor, but I loved the people I worked with/for and it was in a place where I would have literally scrubbed toilets (and I did that, too, in that job) in order to stay living there.
You probably know to what I am referring but suffice to say, barring a miracle, it’s not likely I will have that opportunity again (though they did promise to rehire me if I came back…no, I didn’t get fired from that job, quite the opposite).
The temptation to just slip back into academic research is strong, but that holds other pressures (publish or perish, which you wouldn’t think I would have a problem with…) and has other kinds of politics, and I’m not sure how I would do in that environment (past successes notwithstanding). There also is very little, if any, age discrimination in that kind of work.
But I’m fairly sure my major professor has retired by now, along with a few others I know. It might not be easy to find a professor who would take me on as a student.
@”Gray”:
I completely agree with you that it is a way of thinking that needs to be addressed, and the focus off the substance. This is what upsets me so much about lawmakers and medical professionals who continue to harp on the drugs themselves, totally ignoring the twisted thought processes that drive an addict’s behavior – their solution is to just make opiates ridiculously hard or impossible to obtain for anything, even end-of-life pain.
You saw the problem first-hand (well, all 3 of us, living in FC, saw it first-hand) when you did the follow-up with methadone patients. The success rates for any program are very low, even I suspect for AA (which claims anonymity prevents it from disclosing success rates lol oh sure it does), the supposed “gold standard” for treatment.
In my opinion, cognitive-behavioral therapy is the only thing that works. Like you mentioned, it’s how they think, it’s boredom, and it’s their peers, too.
I know a couple of people who are “successfully in recovery” who are A&D counselors, who have either just switched addictions (to psychotropic drugs that get them high like Seroquel, to muscle relaxants for minor injuries, to benzos “for the stress of being a counselor”, and to “social drinking”), or who are what we used to call “dry drunks” – not on any substance, but still wreaking havoc in their own lives and others’. They have little to no insight as to how they themselves think/behave, and are fairly easily derailed and relapse back to their drug of choice if they think they won’t get caught.
Many A&D counselors who are “former addicts” merely work in places where they don’t drug test employees, have supervisors who are also using, or have the people involved in the drug-testing in their pocket or easily fooled. Addicts are very clever that way, and if they spent even half as much time and brainpower doing something decent instead of constantly obsessing over getting high, the world would be a much more productive and positive place.
I don’t know if my success rate would be any better, but I think at least by focusing on the real problem, it might be. Now I just need the credentials and funding to do it. Somehow. Most days, a lottery win seems like the only way I could do it. 😦 I have no idea how to do any of this, practically-speaking.
My dream is to do that and to also start up and run a domestic violence shelter, not necessarily connecting the two (that discussion is for another time – oh look! I’ve just now written another blog entry in my own comments section lol).
Thanks, guys, for your comments!!!
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Gray,
You make a really good point as well, as far as addicts finding volunteer jobs. It’s similar to the programs here, and in other states pairing prisoners and dogs to train. It gives them something to focus on besides themselves. It might or might not extrapolate to addicts, but it’s certainly worth trying. Hanging fire just doesn’t work.
My own experience with addiction is strictly observation. I am a layman and absolutely not an expert and certainly don’t have the background and boots-on-the-ground that you and Victoria have. So I am not an expert (in anything other than being a smartass, I suppose). Like everyone else our age, I’ve seen it in friends and family, coworkers and acquaintances. I saw a lot of it in the AF when I was stationed with a bunch of guys just back from SE Asia. I can’t say it was rampant, but there was a much higher incidence than in the general population. And during the 80s, there was a lot of cocaine and alcohol addiction at the place I was working, from the VP on down. (Don’t even mention tobacco, which is just as bad and deadly.) And, on a personal note, all of this was a huge factor in me straightening myself out.
Again, like everyone else, I’ve seen the end result when their addictions finally catch up to them for the last time. It’s really heartbreaking when you have to say to yourself they didn’t have to die like that.
But from that decidedly non-expert standpoint, in my opinion, the current system is certainly not working to anyone’s advantage other than the corporations who have a vested interest in keeping things as they are.
If all the interested parties (Rehab corporations, Big Pharma, etc.) were truly interested in fixing people, they would listen to people like you two and your suggestions. They may or may not work, but they have to be more effective than some what comes from some suit in a cube, who’s main interest is the bottom line. If it’s done right, they could still make money, if that’s their main concern.
At the risk of beating the dead elephant in the room (Would you like some mixed metaphors with that, sir?), I think when the profit motive is the primary driving force. everyone suffers except the stockholders. People like you get frustrated and discouraged, the addicts remain addicts, family issues become worse, and society itself suffers. For those of you genuinely interested in helping, then you must feel like you’re on that hamster wheel going nowhere fast.
I certainly understand that people need to eat and make a living, and have bills to pay, etc. I am not arguing against that, at all.
This is just my opinion and unlike apparently most people today, I DON’T have all the answers.
But if you are only in it for the money, then maybe you’re better off selling used cars.
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Nailed it again!!
I think A&D counseling is one of the few professions where you really do not need to actually be a professional – and you, Charlie, are a very good example of that. All it takes is intelligence, a willingness to observe and listen, and a desire to help. When one intervention doesn’t work, you try another. It’s a lot of trial and error, and meeting people “where they are”. Oh and the addict HAS to make material changes in his/her life, or all the counseling in the world won’t make any difference.
What you DON’T do is throw lots of people into an institution, focus on triggers triggers triggers, shove religion down their throats, and tell them they are helpless to overcome their thoughts and behaviors. How is that, in any way, empowering?
I think Gray and I need to start our own treatment program heh. Charlie, you can do the PSAs and ads for it, since you are now on your way to becoming a famous actor!
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