Week 12- Advocacy

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?

Working as a job coach, everyday I am advocating for my clients and challenging the biases that clients hold about themselves as well as potential employers. Sometimes my clients don’t believe that they are capable of working and finding a job. Empowering clients first to try and then to believe in themselves enough to persevere through challenges at work with supports. This part of my job is the most rewarding, but it is only possible when I am able to make positive partnerships with potential employers who are understanding and willing to go through the process of working with an employee with a job coach. A part of that role requires educating employers about government incentives to hiring individuals with disabilities along with government regulations regarding reasonable accommodations. This is a role that I take on with this job but I do not separate it from the role I will take as a counselor. Employment is an important part of clients recovery because it provides them with a source of pride along with a sense of belonging and contributing to the community. This is a difficult group to advocate for because of the bottom line driven focus of business that can sometimes overlook the needs and talents of individuals with disabilities. Specifically advocating for individuals with mental health issues can be particularly difficult because of the negative stigma that still lingers and is gaining increased traction in our society about mental health.  Education and sharing success stories has been helpful in getting employers to understand the rewarding experience that is possible when working with an employee who is affiliated with a mental health agency and has a job coach.

Session 11

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

I would say that I really didn’t start to form my own attitudes about the use of substances until around the end of middle school. As a younger child I believed that drugs were bad and ruined people’s lives. I still believed that as a teen, but my attitude began to accept and understand the shades of gray. I began to understand that not everyone who used drugs was an addict or drank was an alcoholic. It all came down to the who, what, when, and where that can complicate understandings. This was a good complication however, because I began to learn more about adults in my life who used substances but were not in need of treatment and were fully functional and successful in their lives. Looking back I can say that they were definitely addicted to their substances of choice (mostly marijuana and alcohol) without the damaging consequences of addiction as we know it.

 

• 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 personally knew people who smoked marijuana and drank underage. I knew of people who used hard drugs like cocaine that I thought were scary. I think that created the distinction that I hold today when it comes to substance use. I believe there are some drugs that are destructive by design that I stay away from at all costs and would encourage the same to others. When working with clients who are making different choices I will feel compelled and even obligated to help them through the process of identifying problems and working towards change if they believe and can acknowledge that their substance use is damaging to themselves or others.

 

• 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?

My first teachers about drugs and alcohol was probably D.A.R.E in elementary school. We didn’t have the presentation by trained police officers. All we had was a banner with the logo D.A.R.E to resist drugs and violence. What discouraged use most strongly were the great role models at my school who encouraged excellence in their students. We were all told the basics about drugs being bad and destructive but was most lasting for me was all the encouragement and support I received to reach for my goals. Education about drugs and their effects is important and can be boosted with encouragement of achievement.

 

Session 8- 12-step Facilitation

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

My personal life theory is built upon how I have gone through my own life so far. I have always had a plan for life and a clear view (most times) of the steps I needed to take to get me to my goals. With each step I get closer to where I want to be in life and though sometimes I may return to a previous step or stay on one step for a long while, I am always making progress. I would love to integrate the group aspect of the 12-step facilitation of treatment because I mostly go through my steps on my own. Being able to share my experiences with others along the journey and get their feedback is empowering and encouraging.

• 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 have a straightforward approach to counseling where I prefer to be clear about what is being worked on, the goals for the future, and how we will work together to get there. I want to empower my clients to move towards their own change and I think that by utilizing the 12 step model can allow for treatment that engages and guides those who may be lost or don’t know where to begin their journey to recovery.

Session 7- Pharmacotherapy

Do you support the use of pharmacotherapy in the treatment of addictions? If so why? If not, why not?

 

I support the use of pharmacotherapy in the treatment of addiction because it can be beneficial to a client’s recovery and compliance to treatment when abstinence is just not enough. The podcast that we listened to earlier in the course where we heard Sahira tell her story of addiction and her road to recovery, she highlighted the importance of gradually using less medication to her success as opposed to going cold turkey. She could not handle the withdrawal symptoms and it led to failed recovery attempts in the past. Sahira benefited most strongly from a program that did not force total abstinence upon her. The client’s needs and beliefs should be at the heart of the decision to use pharmacotherapy. Our text points to Weiden and Rao (2005) who suggest that considering pharmacotherapy clinicians should “(1) ask for—and listen to—the client’s beliefs and attitudes about the prescribed medication, (2) work to understand the client’s perspective rather than trying to contradict or correct this perspective, (3) understand that it is the client’s subjective beliefs, rather than objective medical, reality that influences client compliance, (4) withhold responding until the client has discussed all major arguments for and against a medication, and (5) ground any discussion of compliance concerns within the client’s point of view” (p.220). This view is spot on when it comes to the approach we should take assisting clients in general because at the center of the decision is the client and although they may suffer from addiction they should have a strong voice when it comes to treatment. This charges each clinician with the task of not only listening to and understanding the client’s perspective, but also of providing unbiased information and education so clients can make informed decisions.

 

Session 6-Connecting with My Inner Client

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?

I have felt disconnected from a client in my current job that struggles with depression. It is challenging for this client to maintain her part-time job while taking a class at MC and managing her mental health. I have found myself becoming frustrated with her because when I compare all of the responsibilities I have with work, school, family, and maintaining my health as well, I’ve felt like my client has it pretty easy. I found myself minimizing the impact her mental health has on her ability to maintain and applying the doctrine I grew up with that “If I can do it, you can do it.” Looking back on it now, I definitely see that I was centering my experience and in the process separating myself from my client because I felt like I didn’t have the problems that she did.  However, the reality is that everyone has his or her own struggles and their own ways of coping. I stay in contact with my inner client by reminding myself of times when a little understanding from someone would have gone a long way in helping me deal with an issue. As my client works with her treatment team to get and stay on track it’s important that I am encouraging and always believe that she is capable of making the changes she desires. Staying connected with my inner client means curbing my own frustrations and judgments about what I think my clients should do and remain understanding and encouraging as they go through their own process.

 

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 see mental health as an important part of everyone’s lives, not just those who have a diagnosis. We all fall on a spectrum of health when it comes to physical health and I believe the same principle applies to mental health. As an aspiring mental health practitioner I know I need to do a better job with having my mental check-ups by engaging in therapy. Like for most people, I neglect my health and put it off because I’m too busy. This can become very problematic once I begin practicing because of the negative impact neglecting self-care has on helping professionals. I believe in practicing what you preach therefore, I know that I will need to be more proactive with my mental health. Knowing this about myself helps me to identify with people struggling with managing their mental health.

Foundational Philosophies of Counseling

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

I am most comfortable with the multidisciplinary approach to counseling because working as a job coach and as a part of a treatment team has taught me the importance of integrated supports to fostering change. In reference to this concept the text pointed to Saitz, et al. (2005) findings that showed that linking patients to primary medical care services during detoxification improved levels of addiction severity. (83) The multidisciplinary team collaborates regularly to help the client improve in multiple areas of their lives. I have seen how patients/consumers benefit from this approach to counseling and wellness and have learned how to be a helpful part of a treatment team.

How will you know when you are competent in this theoretical foundation and its techniques?

I will know that I am competent in this as well as the other theoretical foundations after being able to note the improvement of those I’ve worked with. These theoretical foundations and their techniques are aimed at helping clients bring about positive changes in their lives therefore I believe that competent counselors should be able to point to client’s progress as an indicator of how effective their efforts have been.

Ch. 3- Process Addictions

What biases do you find in yourself about process addictions?

I find that because the physical dependency piece is not a part of process addictions, I may be less understanding and potentially less patient when it comes to the treatment process because I think I expect since the physiological blocks are less

 

Are there some behaviors your more readily accept or reject as being problematic or addicting? What shapes your views of these processes?

I honestly believe that any behavior can be problematic once it becomes impairing to a person’s life. When I think about the work addiction and how depending upon a person’s background working long hours or even multiple jobs is an accepted part of life and maybe even a societal expectation. It isn’t the action or behavior of working a lot that is problematic, it is the toll that it takes upon an individual, their family and their ability to function.

 

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 more likely to call something an addiction if it has become disruptive to a person’s life and functioning. A key aspect in my view on the nature of addiction is the impairment. Everything from relationships to one’s livelihood is jeopardized by the behavior. Just because I am uncomfortable with the behavior or it is unhealthy in my view does not mean that an individual is addicted.

 

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

I may find it difficult to not minimize someone’s problems especially if I feel like the need to change is so much greater than the satisfaction they receive from their addiction. For example, if I am working with a client who is a compulsive buyer I may focus more on the process of self-regulation instead of processing their thoughts and feelings. I may want to jump right into changing the behavior instead of taking the time to build rapport because of my view of the importance of getting active to make change.

Ch. 2- MI and Sahira

Just to remind everyone here are the questions we’re thinking about this week.

• After reviewing the web references for this week, discuss what types of approaches are you more comfortable with?
• What strengths do you have as an individual to assist someone similar to Sahira?
• What are areas that you might feel you need to work on?

I first learned about motivational interviewing during a training at my job and I was most drawn to this approach because of its focus on maintaining a person-centered approach and honoring the autonomy of the client. Sahira’s case reinforced to me the importance of honoring autonomy in particular because her journey to recovery was not the cold turkey/full detox approach that some professionals and facilities may mandate. For me, Sahira’s case represents the need for professionals to meet clients where they are in a nonjudgmental way to best help them make the changes they want for their lives. I think that motivational interviewing allows for Sahira to set the steps to reach her goal of sobriety that are based upon her own motivations. I have worked with clients similar to Sahira for whom finding their own way and motivations for change was stronger and more effective than any plan I could make for them. My strengths as an individual when assisting someone like Sahira stem from my belief that even when in crisis or lost in addiction,  everyone is capable (with help and encouragement of course) of finding their motivation for change and making a commitment that is meaningful for themselves. I believe in people’s ability to recover in their own way, at their own pace, and at their own time. Nevertheless, balance is key in most things in life and I can acknowledge that an area that I need to work on is the flip side of my understanding and patient approach. It’s difficult for me to give people that little push/kick-in-the-pants/reality check when needed. Once a person has figured out that they want to change and has thought about and agreed to the steps, I need to be able to also help them stay accountable to themselves and responsible for their recovery efforts. Addiction is serious and so is recovery therefore I believe that helping a person stay accountable is just as important as taking a person-centered approach to counseling.