AA, Spirituality, Religion, and Professional Counseling: Part II
As mentioned in my last post, AA (and other 12-step fellowships) neither advocate for nor against any issues, including whether those with symptoms of substance use disorders should become involved with AA. The issue of primacy in this discussion is how do we, practitioners of counseling, interact with AA and, more to the point, the role it plays in the care plans we negotiate with individuals involved with us in counseling.
As with many issues that surface in counseling, counselors are taught to explore all options with clients and eschew pushing a personal agenda. This does not mean that we do not have professional opinions about what works best or better than other things, but it does mean that we need to assess the client’s wishes and attempt to find a course of treatment that is appropriate in our professional opinion while at the same time consistent with the individuals wishes.
True, AA is not for everyone. That said, it seems to work well for many--and whether this means initially finding sobriety or pursuing recovery once "dry"--this is an issue that the practitioner should consider when determining: (1) If a referral should be discussed and, more to the point, (2) when that discussion should take place in the counseling relationship. Because of the success so many recovering people attribute to 12-step programs, contemporary counselors cannot not consider such programs as a potential adjunct to professional counseling. This does not mean that “all” clients should be referred, but neither does it mean that none should be referred. It is part of what professional counselors do to determine: (1) What will work best, (2) for this individual, (3) at this particular time, (4) to best address this or her needs.
If counseling practice has changed at all over the years it is to have moved away from treating the diagnosis a client has and focus on providing service to the individual who presents seeking care for his or her needs. True, one’s diagnosis will inform the course of this treatment, but as I mentioned in my earlier post on this topic, “there are many paths to the same destination.”
So, it seems to me that the issue is not “if” AA is appropriate, i.e., is it evidence-based treatment? Is it too religious/not religious enough, etc.? Rather the issue is how and when do I, as a professional counselor, address this issue with individuals for whom a diagnosis of a substance use disorder is appropriate. For John Jones the decision may be to not discuss this now, but perhaps later. For Mary Brown it may be to refer her immediately, and for little Johnny Middleschool, it may be to not discuss this option at all unless Johnny bring it up.
The second issue of importance in this discussion seems to be mandating individuals to attend meetings. I have to agree that mandating treatment of any sort is questionable in its effectiveness. Like the old saying goes, “Never teach a pig to sing; it annoys the pig and frustrates the teacher.” That said, there is something to be said for mandating attending “X” meetings. This is not mandated treatment as much as mandated window shopping. Any first-year psych major exposed to Bandura’s Social Learning Theory quickly can appreciate the significance of vicarious learning, which is exactly what happens when individuals attend meetings, even when mandated. For counselors to rail against the criminal justice system for its infringement on the civil rights of individuals mandated by the court to attend “X” meetings may be missing the point.
AA and other 12-step fellowships are not treatment. First of all AA will never even discuss this as it is a violation of its tradition to remain silent on issues of politics, religion, etc. So mandating attendance to a specific number of meetings may be a hassle for the individual referred, may be perceived as having been made to “go to church,” or may simply be viewed as a waste of time, but we forget Bandura’s findings resulting from all that research in the 70s...you know what you learn and learn what you are taught...and life is a most effective teacher. And as with so many things, something new is only learned when something new is presented in such a way as to allow the observer to recognize that “the new” costs less and has fewer hassles than what was previously believed.
In my counseling career, I have told individuals, both those who voluntarily attend and those mandated to do so, to: (1) Go to a larger, open meeting, (2) arrive as the meeting is about to start, (3) sit in the back and do not say anything unless you want to, (4) leave when the meeting is over, and (5) do not just listen to the speaker but watch the other people at the meeting...what are they doing? Are they complaining or simply talking? Are they laughing or sitting sullen with their arms folded on their chest? Are they smiling or frowning? I suggest that we discuss what was seen and heard, but not just what the speaker or chair had to say, but what were the dynamics of the whole meeting they attended.
In summary, our issue as professional counselors is to determine what is best for the individuals with whom we work, but to do so in concert with their input. This means that what some may consider as controversial options, such as attending mutual aid groups as an adjunct to professional counseling, need to be considered and evaluated for appropriateness not based on their merits—they all have merits in their own right and these are clear for those who are actively involved—but based on what the individual with whom we are working wants to accomplish.
As with many issues that surface in counseling, counselors are taught to explore all options with clients and eschew pushing a personal agenda. This does not mean that we do not have professional opinions about what works best or better than other things, but it does mean that we need to assess the client’s wishes and attempt to find a course of treatment that is appropriate in our professional opinion while at the same time consistent with the individuals wishes.
True, AA is not for everyone. That said, it seems to work well for many--and whether this means initially finding sobriety or pursuing recovery once "dry"--this is an issue that the practitioner should consider when determining: (1) If a referral should be discussed and, more to the point, (2) when that discussion should take place in the counseling relationship. Because of the success so many recovering people attribute to 12-step programs, contemporary counselors cannot not consider such programs as a potential adjunct to professional counseling. This does not mean that “all” clients should be referred, but neither does it mean that none should be referred. It is part of what professional counselors do to determine: (1) What will work best, (2) for this individual, (3) at this particular time, (4) to best address this or her needs.
If counseling practice has changed at all over the years it is to have moved away from treating the diagnosis a client has and focus on providing service to the individual who presents seeking care for his or her needs. True, one’s diagnosis will inform the course of this treatment, but as I mentioned in my earlier post on this topic, “there are many paths to the same destination.”
So, it seems to me that the issue is not “if” AA is appropriate, i.e., is it evidence-based treatment? Is it too religious/not religious enough, etc.? Rather the issue is how and when do I, as a professional counselor, address this issue with individuals for whom a diagnosis of a substance use disorder is appropriate. For John Jones the decision may be to not discuss this now, but perhaps later. For Mary Brown it may be to refer her immediately, and for little Johnny Middleschool, it may be to not discuss this option at all unless Johnny bring it up.
AA and other 12-step fellowships are not treatment. First of all AA will never even discuss this as it is a violation of its tradition to remain silent on issues of politics, religion, etc. So mandating attendance to a specific number of meetings may be a hassle for the individual referred, may be perceived as having been made to “go to church,” or may simply be viewed as a waste of time, but we forget Bandura’s findings resulting from all that research in the 70s...you know what you learn and learn what you are taught...and life is a most effective teacher. And as with so many things, something new is only learned when something new is presented in such a way as to allow the observer to recognize that “the new” costs less and has fewer hassles than what was previously believed.
In my counseling career, I have told individuals, both those who voluntarily attend and those mandated to do so, to: (1) Go to a larger, open meeting, (2) arrive as the meeting is about to start, (3) sit in the back and do not say anything unless you want to, (4) leave when the meeting is over, and (5) do not just listen to the speaker but watch the other people at the meeting...what are they doing? Are they complaining or simply talking? Are they laughing or sitting sullen with their arms folded on their chest? Are they smiling or frowning? I suggest that we discuss what was seen and heard, but not just what the speaker or chair had to say, but what were the dynamics of the whole meeting they attended.
In summary, our issue as professional counselors is to determine what is best for the individuals with whom we work, but to do so in concert with their input. This means that what some may consider as controversial options, such as attending mutual aid groups as an adjunct to professional counseling, need to be considered and evaluated for appropriateness not based on their merits—they all have merits in their own right and these are clear for those who are actively involved—but based on what the individual with whom we are working wants to accomplish.
What do you think?
Dr. Robert
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