A few final thoughts!

Discuss the complexity of working with clients who are also pregnant. How would a pregnancy change your approach to treatment? What issues might come up for you as a counselor? How might you talk about these risks with your client? How would you respond if your client continued to heavily drink or use substances while pregnant?
Working with a pregnant women who is smoking, drinking alcohol or abusing other substances would be extremely difficult for me. I would really have to dig deep and remind myself that getting pregnant doesn’t make an addiction go away. Knowing how much harm that could be done to the unborn baby I would do everything in my power to educate her and get her the help she needs to get clean and remain sober. I would also educate her on the risks of not getting clean and the rewards of deciding to do so. I think pulling at a soon to be moms heart strings may work better than any other tactic. Letting her know that she won’t be able to keep her baby if the baby has any traces of illegal substances in its system may motivate her to become clean.
Helping this particular client would be very complex for multiple reasons. First, helping a pregnant women detox from harmful substances may be more complex than normal because a medical detox may put the baby in more jeopardy. Secondly, I as a counselor am supposed to have my client’s best interest at heart and honestly I may struggle to do that, depending on the client’s determination to get clean, because I would be worried about the baby.
If a client continued to use I would consult my supervisor. I would also consult laws in the area. I honestly don’t know if I could continue counseling a women who refused to get clean for the sake of her baby. I can understand not wanting to help yourself but when it involves a helpless baby I don’t think I could handle it. I personally would probably have to refer the client elsewhere if that situation where to happen.

What does it mean to you to advocate for clients and challenge bias? How do you feel about taking on that role? Is that a role you expected to take on as a counselor? Are there some groups for whom it would be harder or easier for you to advocate for? Does that reflect on your own beliefs and values? How so?
I would love to take on the role as an advocate in my community for clients who receive a lot of bias regarding their diagnosis or personal choices. It would be extremely easy for me to advocate for those with eating disorders, suicidal ideations, other mental health issues, those with special needs, those in the LGBT community and rape victims. I would not be able to advocate for rapists or other physical abusers. I know a lot of times people who commit those types of offences were once the victim but it would still be difficult to advocate for them. I think that does reflect my beliefs and values because in my opinion I don’t care if it happened to the abuser when they were a child because they still know it’s wrong to hurt someone else. When a fully competent person’s decisions negatively affect another person is when I struggle to remain understanding and empathetic.

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My early thoughts on Drugs and Alcohol

What were your attitudes toward use of substances when you were a child and an adolescent?
As a child and adolescent I hated when adults would drink or smoke. My mom told me that I would get really upset when people were over at the house drinking and having a good time. She said one time I even started throwing everyone’s drinks away and told them it was time to go. I don’t remember this event but it is totally something I would do. To this day I am still relatively uncomfortable around intoxicated people, probably because they are too unpredictable. Also, my dad smokes cigarettes and he developed cancer in the middle of his chest cavity. I was only eight when this diagnosis was made so I decided it was caused from the cigarettes. Whether that was the case or not it definitely affected the way I think about different substances.
What was your personal and peer group experience of substance use? How are your views the same or different now? What might it feel like to work with clients making different choices, or to encourage choices that you did not make?
As a high school student I was what one may call a “goody two shoes.” I was an over achiever who never broke any rules and neither did the group of people I hung out with. I didn’t drink alcohol for the first time until I was 18 and I had never even considered doing any sort of drug. My views are a little different now that I am older and understand more about alcohol and different drugs. I personally always like to be in control…I’m a little bit of a control freak. Because of this personality trait I never do anything that makes me lose complete control, like drink so much that I blackout, I know my limits. Many of my friends are heavy drinkers and have done drugs like molly or cocaine and I still think they’re great people. I just don’t necessarily agree with their choices. All I can do is be there to support them and try and help them make better decisions if needed. I feel like that is how I will be with clients. To each their own but maybe I can help guide them down a better less destructive path.
Who advised you about drugs and alcohol, and when? What was your response? What encouraged or discouraged use in the approaches you encountered? What do you hope to emulate or discard from your models?
I honestly don’t remember who taught me about drugs and alcohol, probably a mix of my parents and the school. I know my elementary school had the D.A.R.E program and I learned a lot from that in the 5th and 6th grade. I think the main reason I was encouraged to not use drugs or drink was because I have a huge fear of getting in trouble. That fear has always stopped me from doing anything against the “rules.” I was also an over achiever, like I said earlier, and grades were and still are extremely important to me so I would never do anything to jeopardize my “A.” I think I will always remember and tell others that drugs and alcohol may change a person’s goals and or priorities. So if someone is going to get mixed up in those things then I would want them think about what matters most to them.

Coping Skills

If you have been under a lot of stress, resulting in overuse of self-control resources, this fatigue may have led to ineffective coping strategies. Has this ever happened to you? What were the circumstances?
Everyone gets stressed for a multitude of reasons and they have to figure out the best way to deal with all the pressure they are feeling. “Coping skills refer to strategies that help individuals to effectively manage their behavior, especially in high risk situations (Capuzzi & Stauffer, 2012, p.263).” Currently I think I handle stress pretty well but it took me a long time to figure out what’s most helpful for me. For me talking about what’s going on with others, taking deep breaths, making lists and accomplishing things step by step really help me cope when I am experiencing a lot of stress. Before I figured out what worked for me I used to get really anxious and become really frantic because I felt like there just wasn’t enough hours in the day to accomplish everything. Although I would become anxious I never handled the anxiety caused by stress in an ineffective way. I honestly think the reason for that is because I have A TON of support from friends and family. Their support has always helped calm me down and bring things into perspective.

12 step programs

How does 12-Step facilitation of treatment relate to your personal theory of life? What parts could you integrate if desired?
Out of the twelve steps I really like steps 8 and 9. Both of these steps have to do with making amends with people who you have harmed. I personally think these steps have a lot to do with personal forgiveness. I feel like many people have a difficult time forgiving themselves for the mistakes they have made and over time those mistakes take their toll on the individual. For addicted individuals maybe the heaviness of carrying around all the hurt drove them to use a substance. Maybe once a person makes amends with those they have wronged the hurt will be lifted and they will no longer have to abuse a substance to cope. In the future when working with addicted individuals or others dealing with guilt, shame and forgiveness I could use these steps as a possible homework assignment that we could discuss during the next sessions.
How does 12-Step facilitation of treatment relate to your preferred counseling orientation? What parts do you see that you could utilize for treatment?
Currently, I don’t have a preferred counseling orientation, nor do I think I will be using only one orientation with my clients. Much of the research shows how beneficial self-help groups are in addition to individual counseling. I feel like I could utilize self-help groups like NA or AA with many of my clients regardless of what orientation I decide to counsel from. Although many orientations like cognitive behavior therapy are very goal oriented and so are self-help groups that utilize the 12 steps and 12 traditions. So if I were counseling clients using the CBT approach I wouldn’t hesitate to send them to a self-help group because that type of client may be more open to setting goals to help change behavior.

Using Drugs to treat drug addiction

Choose one of the following perspectives and explain your position: “Do you support the use of pharmacotherapy in the treatment of addictions? If so why? If not, why not?”
This is a difficult question for me to answer and I’ll explain why later but I do agree with the use of Pharmacotherapy in the treatment of addictions. I have witnessed the benefit to a medical detox. I used to work at a drug detox facility so I have watched the process of someone being medically detoxed. Not only was this a painful process for the patient but it was scary for me to watch. I can only imagine how terrible and scary it would be to detox off of drugs like meth or heroin without the use of medication.
The main reason I question the use of pharmacotherapy for the treatment of addictions is because I think it’s strange to treat a drug problem with another drug but like I said I have seen the benefits so, I’ll let that point go. The next reason is because medical detoxes are no joke and I don’t think staff are trained well enough to handle everything that could happen. The only reason I say that is because I had a very scary personal experience while working at this particular facility.
Here’s my story…
Prior to working at this medical detox facility I worked with girls who had eating disorders and I was thoroughly trained on administering medication. I then got a job as a CNA at this detox facility. I was trained in about 2 hours to do a job I have never done and I was going to be the only staff at the facility overnight. During my first shift all I kept thinking was, “thank god Remuda taught me about these medications and how to administer them properly.” Anyway it was my job to monitor the patient’s vitals and then give them their next dose of medication. This was a much more difficult job than it should have been. In the past I have administered medication on a set time schedule but I learned when dealing with medical detox it’s much more difficult. These patients had a series of meds to be taken at certain time intervals and sometimes the time interval would overlap. That’s when things got scary for me. I would never typically give a patient a muscle relaxer, Vicodin, oxycodone and a blood pressure pill all at once but when intervals overlap what do you do? When my training doesn’t go far enough to give me the answer and the on call person is not answering the phone what do I do? To make the decision harder I have someone in an extreme amount of pain screaming for their meds (Don’t forget these are addicts so they know exactly when the can have their next dose of each medication and they want it right then). One part of me thinks I shouldn’t give any of the meds (but I don’t want to ruin the detox) and another part says give them all the meds (but what if it’s dangerous). I ended up giving her all the meds because I was following the doctor’s interval schedule. That was the wrong decision because all those meds combined relaxed the patient so much that her heart rate was extremely low and she stated, “I felt higher than I have been in a long time.” Not only did I endanger the patient but that comment broke my heart because I just got a detoxing addict higher than ever all because of the prescribed medication.
So the goal of a medical detox is to help the patient detox safely, quickly and to keep them as comfortable as possible. Not to get them higher than normal. So that’s what worries me about using medication when treating addictions. So overall, I think anyone treating addictions needs to have a higher level of education to deal with the scenarios that can come up during detox or further treatment for client safety purposes.

BE REAL!

A quote from your text states: “… we get so involved in the role of counselor that we sometimes forget the client inside us. It can become habit to separate ourselves from our clients with a sense of self-righteousness that we do not have the problems they do.” Do you see this tendency in yourself? How do you stay in contact with your inner client? What does that mean for you?
Over the past three years I have worked in many different mental health settings and I have never thought of my clients or patients having a problem and me being perfect or better than them because I don’t struggle with the same issues they do. The thing is every single one of us has our own problems and I think it’s important to remember that and maybe even disclose that to our patients. Not necessarily the problem it’s self but the fact that we struggle too, in different areas. A lot of patients have the idea that we as helpers are perfect and don’t have our own struggles so it can be hard for them to see us as real people. I think it is extremely important for my clients to see my realness. In fact, I strive for being real with my patients because I have heard comments that clients make about other staff members who are extremely closed off and act superior. Clients don’t go to those staff members for help when they need it. They go to the staff member that acts like a real person, not their superior. To me a “real” therapist show their personality without being unprofessional and responds in a way that makes the client feel heard but not belittled for talking about it.
What beliefs about yourself do you have that will allow you to find commonalities with your clients so that you do not see it as “us” versus “them”?
First of all I don’t know how any good clinician can see the therapeutic process as “us” vs “Them.” That idea baffles me. We are all human and we all have our own baggage so I don’t understand how someone could think that way. But I have this weird belief that I can connect with anyone I talk to because I am an outgoing, well rounded and open minded individual. Whenever I meet new clients I like to create an atmosphere that we are on a team. I think I easily do that because I search for common ground. Even if that common ground is a simple as we both love a certain TV show or like pancakes. I think little things like that build connections and at the same time show the client a tiny bit of who you are without being unprofessional and self-disclosing too much.

Theories

Which of the foundational philosophies of counseling are you most comfortable with and why?
In the brief time that I have been in this master’s program I have learned a lot about different counseling theories. None of the theories have stood out to me as being the “perfect” approach to counseling rather, bits and pieces of multiple theories used together seem to be the most effective.
At this point in time I am most attracted to and comfortable with Adlerian therapy. I personally feel that childhood experiences play a big role into who a person is as an adult so that’s why I am really drawn towards the Adlerian approach. In this approach counselors focus on interpretations of the clients past that may be influencing their present behavior (Corey, G. 2013). I also thoroughly believe that in order for a person to make positive changes in their life they need to be self-aware, take responsibility for their actions and understand that they always have a choice. The Adlerian approach states “responsibility and choice, meaning in life, striving for success, completion and perfection (Corey, G. 2013. p.103)” are a focus of therapy.

Would you use any assessments?
An Adlerian counselor uses a lifestyle assessment and early childhood memories to gain insight into the client’s goals, motivations and why they may behave the way they do. I think in the future I’ll give a lifestyle assessment to all my clients. I think having your client’s background before venturing into therapy would be helpful.

How will you know when you are competent in this theoretical foundation and its techniques?
Last semester in my theories class we did a lab practicing Adlerian therapy and I did a group project that included an Adlerian therapy role play. These two experiences have made me feel really knowledgeable when it comes to this theoretical foundation. Even though I have learned a lot on this approach I wouldn’t necessarily say I was competent. I think I would feel competent and ready to try this approach in a real life situation when I can easily recall the major beliefs and techniques associated with Adlerian therapy. I feel like I should know everything there is to know about a theoretical foundation and easily be able to explain it to someone else before I could feel competent enough to use it.