I have been in the field of addiction treatment for close to 15
years. During this time, we as a field have changed quite a bit, as have
many of our methods. I am among those in our field who went through
treatment the “old-fashioned” way. I attended a social detoxification
program without the benefit of any type of medication to curb the
symptoms of my disease. The program itself was primarily a social model
program that had very few of what I could call “clinicians.” The program
relied heavily upon 12-step programs to fuel its success, and the staff
members were well-meaning members of those programs with little to no
professional qualifications or experience.
I went through treatment during a time when confrontation was the
tool of choice and “tough love” was the preferred method. Obviously,
this influenced me early in my career. I often projected my own
treatment experience into the ideas I had about what would work and what
would not. Mind you, I was very young at the time and had virtually no
education, but I had a misperception in the beginning that psychiatric
medication should be avoided and that medical assistance during the
detox process was only to be used in the most extreme circumstances to
avoid death. Aside from those situations, I believed that “sweating it
out” was better because it would scare the addict from picking up again.
Today I believe it scares them out of getting help or causes them to
prematurely terminate treatment more often than not. These are some of
many ideas I have changed over the years.
As my career progressed, I learned about treatment approaches such as
motivational interviewing. Miller and Rollnick taught our field the
truth about confrontation and its dire consequences to addicts. I
watched tough love destroy families while addicts died anyway. While new
information and experience flowed toward me, I was mentored by
fantastic clinicians. They taught me how to be kind, patient and
effective at the same time. One of the things I find interesting about
this today is that at the time, I presumed I was more empathic and
compassionate to the addicts I worked with than they were because I had
personal experience with addiction. I was wrong. The truth was,
oftentimes they had taken a much kinder view of the symptoms of
addiction than I did. When I would blame the patient for my
ineffectiveness, they would help me to explore what was blocking me from
being helpful to my patients. Was it my own judgment? My own regrets?
Arrogance? At some point or another, all of these have been true.
I purposely wrote this article in the first person, rather than the
observational, reporting tone of most professional articles. I have
always benefited greatly from thoughtfully written articles that were
written this way, and I believe they have impacted my attitudes about
counseling greatly. Possibly this is because right, wrong or
indifferent, they were true, at least for the writer. Just as I teach my
clients to speak in the first person about their lives, sometimes it is
best to do the same when I speak to my professional peers. The fact for
me is that overwhelming fear of the codependency monster and the
medical practice of extreme detachment has never worked for me. I have
found that being effective for me includes loving my clients. I am not
stating this in a general, “I love my work” kind of way. This statement
is exactly as written. Part of the counseling process is loving my
Now before the codependency fear-mongers jump to any conclusions, I
want to clarify that this is not without boundaries. Boundaries are
incredibly important to treatment. I recall once telling a clinician I
was treating that I could not refer to them due to how they were dealing
with certain problems. This was a hard thing to say to this person whom
I loved, but my honesty and boundary later became a central tenet of
the therapy, because the modeling of integrity and boundaries was
powerful and inspiring for the client. Being kind, being patient and
using a non-confrontational approach to treatment does not mean cowering
away from issues. Loving them does not mean I have lost who I am in the
vortex of who they are.
In my experience, these attitudes and treatment ideals have fostered
closeness, bonding and ultimately healing for many, many addicts I have
worked with. They fostered a sense of respect for my clients, and the
honesty of the relationship gave weight to my words and suggestions that
might have never been there in the past. These clients did not change,
heal and grow because I was perfect at this model of counseling or that.
They changed, healed and grew because they felt safe, loved and
received honest feedback in a kind, compassionate way. As a counselor, I
was not interfering with their growth, but was facilitating it and
joining them in it. For any reader that sees this as a bunch of fluff, I
assure you my approach is anything but. There is no co-signing of
anything here. But there is no abuse either.
I urge other counselors, both new and experienced to constantly
re-evaluate and remain open to new ideas. Explore ethics and yourself.
Try writing your own ethical code in addition to the one that your
certifying or licensing board has recommended. Engage in your own
therapy process, whether you need it or not. Ask yourself, what in you
prevents you from loving a certain client or patient. What is at risk
for you? The answers may surprise you and they are certainly fantastic
fodder for your own growth in supervision, therapy and as a clinician.
In the end, you will not only benefit, but your clients will as well.