Keeping it Green:
Maintaining a Positive Focus as a Professional Counselor

The issue—or some might say problem—of managing frustration and avoiding cynicism as a counseling professional is one that may be more pervasive than many in higher education imagine. Addressing the issues of high-risk student behaviors like underage and dangerous drinking, indiscriminate use of illicit substances, or unprotected sexual activity to mention but a few of the more frequently cited examples from the media, is enough to dampen the spirits of even the most stalwart counseling professional. Not only can media-reported national stats about percentages of high-risk drinkers and untoward incidents related to alcohol or other drug use on campus prove to be frustrating for counseling professionals, the potential threat to their optimism in and efficacy regarding the COUNSELING profession would appear to be an all too likely consequence of a steady diet of bad news from the media and personal stories of heartache resulting from high-risk student behavior on their individual campuses. At times it may seem that practitioners are like the knot in the middle of a rope in a huge tug-of-war with individual clients refusing to change their individual behaviors on one end and national trends regarding high-risk or "dangerous" drinking on the other. Yet not only do we not see COUNSELING professionals leaving the field in droves, unlike many religious orders, the number of vocations that attract young professionals to a calling to work in counseling in higher education are encouraging.

It would seem that regardless if individual counseling professionals weather the problems on their individual campuses or know something the media seems to be oblivious to that allows them to keep their collective heads above water, it would appear that as much—if not more—of the frustration and cynicism experienced by some counseling practitioners results from their personal perceptions on the issues that arise when working in this field. In other words, dealing with high-risk students and their behaviors may be an occupational hazard associated with being a counseling professional, but that does not mean that each professional in the field will experience the chronic frustration and institutional cynicism. As with so many things in life, one tends to find what is expected. The practitioner that expects to see new prevention strategies fail or individual students refuse to change, regardless of the evidence presented to them supporting such, will likely find evidence to support this belief.

If this sounds vaguely familiar, I suggest you dust off your old notebooks from undergraduate social psych and review "confirmation bias" and "illusory correlation." Because one thinks something is true, the relatively few cases experienced that support the belief held are touted as proof that the hypothesis IS true. The classic example of this in addiction counseling is the belief that effective addictions counseling necessitates breaking through a client's denial with directive confrontation (some call this "attack therapy") in order to enable clients to improve. True, some clients exposed to such counseling techniques respond and get sober, this being the illusion of support for the practice that has become the mainstay of the addictions treatment industry for 30 years. Unfortunately, most clients introduced to treatment via attack therapy drop out prematurely. Ironically, these clients are deemed "not ready" to get sober so the client is blamed for the failure to improve when it is more than likely that an inappropriate treatment choice was made by the counselor. This is also roughly similar to what we have seen over that past several years in the published research from the Harvard School of Public Health. This research reports on the steady if not increasing rates of "binge drinking" and then assigns "blame" to social norms and other proactive strategies as being ineffective and unsubstantiated. NOTE: Unsubstantiated does not mean "ineffective," it simply means the technique has yet to be substantiated, but this is another essay :)

So how does the counseling practitioner keep from burning out or becoming so cynical about addressing high-risk student behavior as to consider a career change to welding? There are numerous ways to accomplish this and here is a representative sample:

1. Like the bumper sticker on a liberal's hybrid gas-electric powered auto might suggest, "Think globally, but act locally." Counseling professionals know what they are doing on their individual campuses. They all know the prevention programs, therapy groups, policy reforms, and environmental changes they have been able to affect. We still confer virtually and in person regarding the field, including the "bad news" nationally, but we do so knowing that we make a difference. Just as people do not change by dwelling on mistakes and missed opportunities or by obsessing on the final goal, counseling professionals realize that change is a process rather than an event; they know that on their best days they can help others, but we cannot save them.

2. Many in the Counseling field have come to realize many think and believe as they do. This realization results in most of these professionals seeking out these "others" and conversing with them. The best antidote for the "six o'clock news syndrome" is to speak with others about what is really going on. Just like we all know that not" all 16 to 25 year old members of a particular racial group" are doing what the six o'clock news constantly suggests is the norm, so SA aware of the myriad opportunities to receive various points of view. To paraphrase Woody Guthrie, "Let them that have eyes see and them that have ears hear!" With online news services like JoinTogether.com, newsletters like NASPA’s AOD Knowledge Community and The Network's News From the Front; conventions, workshops, and seminars like the U.S. Department of Education’s National Meeting the field has access to "what's what." This is a powerful antidote to the media's constant barrage of, "We’ve got trouble, right here in River City, and that starts with "T" and that rhymes with "B" and that stands for BOOZE."

3. We are also becoming more sophisticated as a field. Many (most?) have become familiar with Prochaska's Transtheoretical model of counseling with its view of readiness to change occurring on a continuum (see http://robertchapman.net/treatingaddictions.htm for additional information). The appropriateness of meeting someone on this change continuum where he or she is and working to motivate movement to the next stage of readiness rather than instantly trying to move that person to the last stage is very empowering and a powerful inoculation against burnout. To read more, see my essay "IF It Walks Like a Duck and Looks Like a Duck, Why Should I Be Surprised When it Quacks?" - http://www.robertchapman.net/essays/essay.htm click on "Preventing burnout when working with substance abusers."

Counseling professionals are a resilient bunch. We know how important our work is. We know that academic success cannot occur until and unless addressing the issues of students outside the classroom. This does not mean that every student that enrolls in college or university will receive a degree after completing the requisite number of courses. Likewise, anticipating and addressing every high-risk student behavior before it results in a tragedy is unrealistic. That said, it does mean that counseling professionals need to be cognizant of where they seek information lest they inadvertently place themselves on an informational junk food diet. Just as too much fast food can result in hardening of the arteries, too much fast information can result in hardening of the attitudes, a condition just as prone to shortening careers.

Robert

Intervening with Individuals with Addictions Always Works...100% of the Time

I believe that every intervention with addicted individuals always works, 100% of the time…never fails. I cannot prove this, I just know it.

I learned this in the 1970s when I would call at the Olean (NY) City Jail each morning and interview anyone intoxicated when arrested the night before. The entire interview might last 5-minutes, which was just enough time to introduce myself and convey the message, “You do not have to feel this way anymore…there is something you can do.” I would like to say that most interviewees had a “Paul on the road to Damascus” epiphany and immediately asked for help; that was the rare exception rather than the rule. There was, however, one gentleman who showed up in my office the better part of a year later, with a crumpled up copy of my business card in his hand, asking if I remembered speaking with him in the jail many months before. Of course I did not, but this was one of those occasions when God lets us tell a lie and still leaves open the gate to Heaven…"yes," I respond, “I remember.” He proceeded to share about what those in AA refer to as having become, “sick and tired of being sick and tired”; he went into treatment.

It was at this point that I realized that any and every effort made to proffer assistance works because although it may take 50 crises, interventions, and “trips to the bottom,” there could not be the 50th event that resulted in change had there not been the 25th…the 10th…the first! We never know…and whether we mount intervention #1 and never see the person again or intervention #50 and shepherd the individual to recovery, there could be no "final intervention" if there was no "initial intervention."

A related experience involved a student I saw when working in a university counseling center. I had conducted an assessment, shared my concerns — rather bluntly I might add — and proffered assistance. The student politely declined and left. A number of years went by before this student returned…quite a number of years. He asked to see me and told me that he left my office that day and went back out and “did his thing” until he hit that final brick wall; he turned to AA; he got sober. He then reached in his pocket and took out his 5-year brass medallion celebrating his 5-years of sobriety in AA and gave it to me saying that his process of change started the day we had our last session when I shared that, “what causes a problem is a problem when it causes problems” and he wanted me to have it as his way of saying thank you. You just never know…

By way of closing — and to not extend this post too much — I include two web links to further experiences I have had that serve to ground my belief that interventions always work. I share them as I know you will appreciate them:

• http://bit.ly/Hvq1h
• http://bit.ly/8IpGJ4 - scroll down to “Rain in My Heart” (this is an earlier post recorded on this blog)

Robert

How do you spell “addiction”?
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"Addiction" may not be what most people think it is at first glance. Most of us "know" what addiction is "when we see it," but too often this recognition is of the disorder in its latter stages.

Can someone be addicted when not using a drug? Can someone be physically dependent on a substance, but not be addicted to it? Is there one all encompassing definition that would address the beliefs of all who wish to describe an addiction or more importantly, diagnose an addicted individual? These are questions that have not been answered with anything approaching a consensus in the “helping professions” so I do not expect that we will reach a consensus this semester where the fields of medicine, psychology, biology, sociology, and numerous other disciplines have failed to accomplish such to date.

This post attempts to expand on what you have hopefully begun to recognize as the foundation for your approach to “understanding addiction,” namely, a personal consideration of the etiology or “origins” of an addictive disorder. This is of the utmost importance for the counselor providing counseling services to the addicted client and her/his family.

If a counselor is unable to explain the diagnosis to the diagnosed individual’s satisfaction (understanding), it will be difficult if not impossible to engage that individual in the recommended course of treatment. If you tell me, assuming I’m your client, that after having conducted an assessment, it is your opinion that my presenting problem involves the abuse of or dependence on substance “X,” but you are unable to help me understand what that means other than the judgmental meaning ascribed by "the public," I am not very likely to embrace the treatment suggestions that you might make. And if you can explain an addictive disorder, but that explanation is steeped in hearsay rather than documented fact, then your efforts to “get the horse to drink” once you have led it to the water is rather slim.

In this post you are invited to consider some of the major models that have been used to explain the etiology or “origins” of an addictive disorder. Reviewing these models and determining which has the greatest utility in effectively treating an individual's addiction, is a crucial piece in engaging that person in treatment. If your he or she hears you calling him a bum or her a tramp when you suggest that s/he is an “alcoholic” or an “addict,” then that client will resist your treatment efforts if not refuse to work with you altogether. Remember: just as you and I have formulated an opinion of what an addiction is and what an addicted person is like from our “observations on life,” so have our clients. Many “hear” addict/alcoholic/etc and think “failure,” "loser," "degenerate," etc.

As you read the assigned material this week (http://wings.buffalo.edu/aru/ARUreport04.html), I would like you to identify which outlined model most closely captures your understanding of the etiology of an addictive disorder. Consider posting your comments on this topic/reading, be prepared to explain: 1) what is attractive about the model you most strongly related to; and/or 2) what argument might you mount if you were to use this model in order to explain it to a client you have diagnosed as having an addiction. NOTE: In responding to your positions, I may pretend to be your client, listening to your explanation of my addiction in the context of your model. I will then “give you feedback” as I would anticipate a resistant client might do in response to your explanation :)

Later in this series of posts we will talk about “premature” treatment, that is, suggesting action oriented treatment before the client has made a commitment to change. For now, however, we will assume that the client is at least willing to consider changing in order to improve—although that does not mean this change will automatically include a willingness to abstain from “X” simply because you have suggested it.

If you have the time, you may enjoy this review of various models that are used to explain addictive disorders - http://www.indiana.edu/~engs/cbook/chap1.html