Why don’t they change?! – Evaluating the therapeutic environment vs. blaming the addict

12/02/15 6:12 PM

Wealthy, famous, powerful, and addicted

This phrase – “Why don’t they change?!” – expresses the frustrations many counselors and family members experience when we enter treatment, complete our stay, and then struggle with relapse.

 

  • They tell us we don’t understand the first step, meaning we are unable to talk about or accept our powerlessness over drugs or alcohol or we believe we can control our use of alcohol or drugs by saying, “I’ll do a better job next time.”
  • We also are described as “running our own recovery program” and “unwilling to ask for help or take direction.”

Counselors will say in their treatment meetings that we have not suffered enough or need to go back out and use again so there will be more consequences. Their thinking is that with more consequences, we will admit to powerlessness over use and listen our counselor.

 

In my view, the answer to “Why don’t they change?” lies as much with counselors and the protocols used to treat us as within us. After all, we are the ones who need help, and to reject us out of hand is anti-therapeutic, to say the least – especially given the amount of money charged upfront for treatment. If we seem stuck, resistant, and likely to relapse, a far better approach is to evaluate the treatment setting and see if the right conditions exist to promote change.

Safety and trust

People – even those of us with wealth, fame, status, or power (WFSP) – generally do not change unless they feel safe and trust in their surroundings and counselors enough to risk new behaviors and shed old attitudes.

 

In my experience, there is far too much labeling of us by treatment center staff as uncooperative and far too little self-examination and acceptance of responsibility on the part of counselors and staff for how they can help promote change.

 

This means assessing why change is not happening and how the situation can be modified to help us take the risks and make the emotional shifts necessary to begin recovery.

Accessing emotions

Another impediment stems from the current treatment model, which emphasizes education and information. This is based on the idea that by reading and thinking about addiction, we will be inspired to stop using. To the contrary, we need an approach that builds trust and accesses our emotions – one that is based on relationships with empathetic counselors. While we may be motivated to enter treatment, once there, we need a supportive environment to create the conditions necessary to encourage us to adopt new behaviors.

 

To aid our discussion of these conditions, I developed the accompanying chart (below) with the client in the middle (that’s us), the counselor on the outside, and the interactions between the counselor and client that promote change (in yellow). For the client, there are four factors that set the stage for the change process (in blue) and four counselor attributes needed to encourage us to change. This chart helps in assessing where the blocks are to the change process.

Screen Shot 2015-02-12 at 12.02.45 PM

Conditions for Change for the Client 

  • Safety
  • Time
  • Space
  • Commitment 

Interactions Promoting Change 

  • Content
  • Personal Reflection
  • Dialogue
  • Coaching 

Counselor Attributes Supporting Change 

  • Conviction
  • Real
  • Compassion
  • Integrity

Conditions for Change

The client; the client’s family, social, and business relationships outside of treatment; and the counselor determine these four factors. For example, time can be influenced by how long the client is expected to remain in treatment or spend in recovery activities after treatment. Space is both a function of whether the client is expected to do business or communicate with family and friends while in treatment, as well as whether the client intends to do so or focus on treatment. In contrast, safety is very much influenced by the environment and counseling staff.

 

Safety

Treatment should foster an open environment in which it is safe to speak up without fear of reprisal, retaliation, or personal rejection. This includes:

  • No sharing of information with outsiders.
  • No reactions of resentment, envy, or awe.
  • No asking for money, favors, or a personal relationship.
  • Hearing what is said, not making it “off limits” because it doesn’t fit preconceived ideas about what is supposed to be said in recovery (i.e., talking about how money and privilege has impacted our life and addiction).
  • Setting boundaries.

Safety allows trust to develop. With trust comes the opportunity for honesty.

 

Time

We must allow time for the process of recovery. Getting over the physical affects of drugs and alcohol has little to do with recovery. Living a sober life means:

  • Recognizing the mental, emotional, and spiritual impacts of the disease.
  • Working on changing behavioral patterns from using to “normal.”
  • Learning to have personal relationships based on intimacy.
  • Establishing boundaries with non-WFSP.

These tasks rarely are accomplished in an in-patient program. The usual 28 days in treatment merely provide a foundation for continuing the process in the community.

 

Space

Treatment is supposed to create the space to reflect on core issues where we transition from our heads and into our hearts – where it is OK to feel confused. Having the space to recover means:

  • Getting away from it all.
  • Limited business transactions.
  • Minimal relationship calls.
  • Not using money or prominence in a way that separates us from others.

Allowing space is part of our recovery journey as we begin, over time, to gain insight and feeling into the layers of our experiences.

 

Commitment

Are we willing to do what is necessary for recovery? Committing to the process includes:

  • Recognizing we don’t have the answers.
  • Staying the course without knowing the outcome.
  • Asking for help.
  • Allowing counselors to “encourage” our efforts.

Part of commitment is the courage to try new ways of interacting with others – to engage in trial and error.

Interactions Promoting Change

The counselor’s role is to engage in interactions leading to a change of perspective and, subsequently, behavior. The perspective change may occur during therapeutic encounters or later when we have an opportunity to process our experience. Thus, desired counselor attributes include the ability to communicate and interact with us in ways that support internal change.

 

Content (Information)

This includes what counselors know about the clinical needs and childhood experiences of the affluent, wealthy, and prominent (and how it is different for men and women). By knowing actual content, counselors build trust with patients. Examples:

  • Secrets
  • Lack of consequences
  • Being special
  • How money affects relationships
  • The connection between money, prominence, position, and addiction
  • The resentments and misconceptions of others

And most importantly: how this has impacted our lives.

 

Personal Reflection (Feelings)

Pain and emotional turbulence leads to change. There are countless ways we experience confusion regarding our addiction:

  • This is not how I planned my life.
  • What has happened to me?
  • How did I get here?
  • Why can’t I stop using?
  • Will I ever feel better about myself?

Counselors should be mindful of childhood issues (i.e., where is the pain?) and, for the newly successful, the fear of failure and feeling like a fraud.

 

Dialogue (Intimacy and Honesty)

Through honest discussion, counselors should be able to identify some of the challenges and dilemmas we face in the treatment setting in terms of relating to other patients, staff, and AA attendees. These obstacles can include:

  • Isolation vs. connection
  • Living in images vs. being real
  • Comparing differences vs. seeing similarities
  • Money and fame vs. recovery and humility
  • Remaining static vs. starting the process of insight

Coaching (Model Interactions)

Counselors are tasked with understanding where we are in terms of time, safety, space, and commitment to being in treatment and recovery. The counselor can help suggest words to use and ways to communicate with other patients, staff, and in meetings, such as:

  • Describing life experiences in ways that reduce distractions over details but still convey the meaning.
  • Owning one’s own bottom.
  • Setting boundaries (e.g, saying “no, I am here for treatment, not loans, tickets, or autographs.”).

Counselor Attributes

We often have very low trust levels in helping professionals, as well as the general public. This low trust level results from exploited relationships by counselors and apparent friends. Most of us have developed a “radar” to distinguish between people who are being genuine and those who are presenting a false front (exception: when we are using or with skilled manipulators). Counselors must be absolutely comfortable with their feelings about money and status, and if they cannot treat us without resentments, disrespect, or genuine empathy, they should not take us on as patients.

 

Conviction

Counselors must have confidence in what they are telling their patients and have faith that the information will promote recovery. If they think we do not really have specialized clinical needs, we will pick up on this attitude. Here’s what’s necessary for a counselor to be effective and convincing:

  • They need to walk the walk (and not speak negatively of us when we’re not present).
  • Focus on recovery.
  • Believe what they say.

Real

Putting on a false front to impress a patient or hide insecurities about having a patient who is very wealthy or famous is all too common. We easily see through the façade. Keeping it real includes:

  • No images
  • Humility
  • No hidden agendas

Compassion

An effective counselor needs to understand that money and prominence are barriers to recovery and that every person’s “story” is valid, despite the circumstances. Showing compassion means:

  • Hearing what is being said – not thinking “I wish I had that problem!”
  • Listening without judging.
  • Understanding the difficulties of recovery unique to the patient’s situation.

Integrity

Counselors are here for the patients, not the other way around. Too many times we become a source of vicarious pleasure for the staff. This becomes self-evident and destructive to the counselor-patient relationship. Integrity depends on the following:

  • Boundaries
  • Privacy
  • Focusing on the problems and issues that brought the patient to treatment

Trust comes from integrity, when we can see that the counselor is not focusing on who we are, what we have, and what we’ve done.

The professional’s therapeutic task

Recovery requires effort and commitment on the part of the patient and the counselor – neither can be held solely responsible for the success or nonsuccess of treatment. It’s true that many of us with WFSP show up to treatment with self-imposed limitations and expectations, but it’s a therapeutic task on the part of the professional to convince us to stay, encourage us to let go of our old habits, and to trust the process. But as we all know, trust is hard won, and we need the appropriate conditions. It’s on us to remain open to treatment, and it’s on the professionals to be worthy of our trust.

 

Not many treatment centers are up to the challenge of creating the conditions for change discussed here. But once a safe and trusting treatment environment is established, it’s up to us to choose to venture into the uncharted territory of recovery and say goodbye to our using lifestyle, friends, and ways of thinking.

 

Upcoming blogs will delve into dilemmas that inhibit our ability or willingness to commit to recovery.

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