Addiction is a very harsh and gruelling experience for the addicted individual. Not only is the person tested for courage, patience, and discipline, but faith above all others. He will have to have faith in himself that he will be able to surpass this situation in time and faith in the people around him. It is very important for family members to support and love their estranged loved one, because more often than not, it is the estrangement from the family that have caused the addiction.
However, in cases that the addicted individual is not in good terms with his family, it is up to the counsellor to convince the addicted individual to be at peace with his family and to be with him every step of the way. Addiction and the reasons that cause it are varied and subjective. Each case usually presents itself with different variables and circumstances. However, most of the trends are the same and only their periods are the ones that vary. Some recover faster than others, some take more than a five years, some do not recover at all.
Due to the various factors that can affect the addiction and the actual recovery phase, most treatment plans made by counsellors are individually based, and mostly dependent on the individual’s case history. A case history of a client determines the course of the treatment plan. An assessment will most likely determine the case history of the addicted client and is very useful in the determination of the steps to be taken in the treatment plan. In one case study, a seventeen-year-old girl is reported to have gone missing after three days of not showing up at their household.
Her parents did not alarm the authorities at first because their daughter had already formed the habit of not coming home for a couple of days and will show up sober at their doorstep later. Growing up in a fairly normal household, the girl, Pauline’s (not her real name) parents are both white and working. Albeit her father was, absent from most of her life, because he were caught and was sent to prison with a sentence of five years, his presence now made a big difference. Having to grow up with no male figure of authority inside the house, Pauline grasped to his brother like there was no one else there for her.
Her mother, on the other hand, is busy working double shifts because of having to raise two children on her own for sometime. However, apart from all of these, Pauline grew up pretty well in a safe environment. Nevertheless, little did she know that the threat to her well-being was going to come from someone in her family and not from strangers. When Pauline was thirteen years old, her brother taught her how to drink and smoke pot. In the process, 13-year-old Pauline was always taking shots with her brother and her brother’s friends.
It did not take long until her brother’s friends sexually abused her, repeatedly whenever she would near passing out. The events that have happened in Pauline’s life made her depressed and aloof, not wanting to tell anybody about what happened. Mostly because she thinks that she is at fault, and she has caused herself all the miserable and humiliating things that has happened to her for the past five years of her life, the years of growing up without a father. The depression took its toll on her, and it made her run away from home a couple of times a month.
She would come back when she had experienced her usual fix. Pauline does not have any money, so she would exchange sexual favours in return for her drugs. Her father returned from prison jobless, but never wanting to let her daughter go astray. The family, not together again, persuaded Pauline to come back to them. However, she refused at first, but her father was persistent and he asked for the help of the authorities in bringing her daughter back. Pauline was found on the streets, dirty and hungry. However, when she saw her father hurry to her with a blanket, she rushed back to home.
The family got the strength from each other, supporting her in all her endeavours and in seeking counselling help; the whole family did to support her. One might think that Pauline’s case is common and is easy to surpass. However, since the family is the root of her problem and depression, it will be hard to seek support from the people that have misled you at first. Trying to come around situations like this will need an individualized treatment plan. Getting the child to talk about what happened to her is not an easy task as she will always be doubtful of the people around her because of what happened.
However, the first step in achieving the right kind of treatment plan for her is to gain her trust and to establish rapport with her. During the first meeting, it is important to tell her that everything she says to you is confidential and that nobody else will have to know unless she, herself, allows it. It is also important to tell her why she is there and that her cooperation is very much needed. She has the choice to go to counselling and also to avert if she does not feel like attending. At this point, the client should be aware of his or her problems.
If he or she is not aware, he or she is still in the pre-contemplation stage. Being in this stage will prove to be difficult for the counsellor because the client will most likely use denial, as a defence and it would be useless to ask him or her to talk. The contemplation stage is where the client gets to accept his or her problem and will now try to seek help or treatment. The preparation stage follows, and this is where the client will learn of the appropriate treatment for him or her. Thereafter, a proper assessment can be done.
Assessment is very crucial, as aforementioned; it will determine the whole course of the treatment. Evaluating the presenting issues is the first step in assessment. Being able to identify the client’s current crisis or dilemma will establish expectations from both the counsellor and the client in crisis. The counsellor’s responsiveness will get the client to engage in their conversation, so it is imperative that the counsellor show the client that he or she understands the client and that he listens attentively.
Determining the client’s strengths is an opportunity to help the client use these strengths to work for them. Sometimes, if the client is feeling helpless and powerless, his or her strength can help him or her overcome this. The usual demographic data, contact person for emergencies, will also have to be assessed. This basic information, albeit not always necessary to obtain, may be useful in the future so it is also essential to take these. Guardians, support services, and other statutory issues will also be addressed in this step. Exploration of the client’s current relationships is the next step.
Knowing which relationships mean the most to the adolescent may help the counsellor in determining the client’s social support system. On the contrary, knowing which relationships are superficial and are of less importance to the adolescent can also help the counsellor determine the relationships that need no special attention because of the little influence it has on the client’s life. However, caution is needed when asking the adolescent about these relationships as he or she might get emotional and can experience a variety of feelings all at once.
This exploration of relationships should be done gradually and if only the adolescent is willing to talk about it. Next step is to determine if the adolescent wants to include his or her family during the counselling sessions, or to prepare for a separate counselling session for the whole family. At the same time, familial relationships can also be assessed. How close is the client to who in the family, and who have been giving her a hard time can be assessed through this. Problems within the family are determined next.
He or she maybe reluctant to speak at first and extreme caution should be utilized during this, but the counsellor can ask about it in the latter sessions. Peer relationships of the client are assessed next. At this age, peer relationships play a big role for the adolescent, and the absence or presence of these relationships can say a lot about the client already. The client’s health, both physical and emotional, is assessed too. This can help determine the client’s ability to take care of him or herself, and if they are mental illness issues that may be a hindrance to the client’s recovery.
Other assessment questions that can prove to be helpful in determining the client’ condition is knowing what was happening in the client’s life when the substance abuse first started, and what might have prompted him or her to continue using these substances. Once the assessment is complete, the actual treatment stage can begin, and it is called the action stage. In the case of the client, Pauline, the lack of time her parents spent with her made her turn away from them and cling to his brother, who introduced substance abuse to her.
She might have the idea that since her brother is doing it, and since her brother is her figure of authority, she might have concluded herself that what her brother is doing is all right. It is important in counselling that a contract is agreed upon by the counsellor and his client. This can be a way to avoid other expectations that can become a hindrance to the recovery of the client. The counsellor and the client agree on certain things like the client showing up twice or thrice a week, for how many hours, among many others. A cognitive behavioural therapeutic approach can be used in a situation like this.
It seems apparent that Pauline wants to become a normal adolescent again, and she is cooperating with the treatment plan and she answers all of the counsel’s questions. In fact, she was even able to admit to the counsellor all of the spiteful actions she has done and has been done to her, including the sexual abuse of her brother’s friends. Cognitive behaviour therapy is based on the idea that emotions and behaviours are brought about by the person’s own thoughts. Furthermore, these thoughts are the person’s own and caused by outside stimuli and situations.
The pivotal point for the therapy is when the patient realizes that he or she cannot change whatever it is that is happening around him or her, or the circumstances in which he or she might find himself in. However, how he or she reacts to these circumstances can be learned to react the same way whatever happens. This is what cognitive behaviour therapy is offering. The role of the counsellor in effectively delivering this treatment plan is to help the client recognize the situations that can bring about the substance addiction.
If the counsellor has been able to identify this via the assessment earlier and is continuing to know more about it, then he or she can assist the client with this. Avoiding the situations that can prompt substance abuse use is the main goal; however, if there are unavoidable circumstances, then coping with the situation is what the counsellor will ask the client to do. There are two important skills that should be used in doing this therapy, and they are functional analysis skills and skills training.
In utilizing the functional analysis skills, the counsellor and the client will work together to be able to identify the thoughts, random feelings and certain circumstances of the patient at the period of substance abuse. In determining these, relapses can be avoided. Better coping skills are needed to be able to avoid relapsing once sober already. In skills training, the counsellor helps the client to overcome the old habits that tend to bring him or her back to substance abuse, and instead will teach newer coping skills and adaptive methods to avoid these.
In Pauline’s case, when she thinks about the absence of her parents in her growing years and the sexual abuse of her brother’s friends, she tends to want to not feel those and will hence run to substance abuse. Talking to her parents about what she is feeling or writing them, down in a journal, may be helpful in situations like this. It is very important for the family to know that they are needed by their addicted family member and that they should make time for this until the family member is able to cope by herself.
Occupying one’s time with extra activities or hobbies can also alleviate anxiety and can make the person preoccupied. Activities like this are best done with a friend or a family member, so as to keep the client focused and to make sure that client is able to finish her tasks. A go-to person or a confidante is also needed by the patient. Her parents can be these people, or a peer can stand as this person. Sometimes medications are needed for the withdrawals to help the client cope up with it. Continuous counselling is needed even after a client has been sober for long.
This will help monitor the progress that the client is making in the real world. Support systems are also important even if the client is sober already. Pauline might only need one parent to look out for her and might have a hard time talking to her brother for some time, so it is important that her parents understand where the situation is coming from even though they do not know why. What is important in this situation is that she has accepted what has happened to her and will want to make amends. Counselling is always a two-way process, and the participation of the client is needed in order to make the therapy work.