By Tricia Chandler, PhD, LPC, MAC
Kaplan University Faculty
Counseling in general has changed considerably in the 23 years since I began working in the field as a holistic professional counselor, addiction counselor, and art therapist. The traditional approaches of keeping addiction counseling and mental health counseling separate is one of the bigger changes that has been occurring since the turn of the century. While specialization was prized in the twentieth century and continues to some degree still, the realization that the issues of mental illness and addiction are interrelated has become more obvious with our increased understanding of neurobiology and neuropsychology (Pinel, 2011).
Between the advances in neurosciences, and the advent of Positive Psychology and its move toward wellness approaches rather then the psychopathology approaches to working with clients, there is a need to integrate treatment approaches to working with the whole person to empower positive change and healing (Seligman, Rashid, & Parks, 2006; Seligman, Steen, Park, & Peterson, 2005). This article will explore one professional's perspective of misconceptions about the profession, address truths and myths about our role in the field, explore the many aspects of being a counselor, and what has been the really rewarding aspects of this career.
Misconceptions about the Profession
The biggest misconception from this professional's perspective in the field is that the human body, emotions, mind, and spirit are somehow separate, and that the interpersonal, environmental, and physical, emotional, mental problems an individual has are not connected. Humans are complex beings and from the holistic perspective everything affects everything. When a client comes into a counselor's office and admits a need for help, he or she is demonstrating more courage than one can even imagine, as it is not easy to admit one's vulnerabilities to a trusted friend much less a stranger. Even if that client is mandated to be in the counselor's office and has not fully accepted the need for treatment, the client is reaching out beyond his or her own comfort level to tentatively hope that there may be help to the overwhelming issues the individual is facing.
In that first moment the counselor has the opportunity to develop therapeutic rapport with the client if she or he can demonstrate unconditional caring and empathy for the client. I want to hear each individual's story that comes to me for help, and to see the thread of causal issues that has lead that client to me for help, and I do this by asking the client to tell me what is going on for him or her while listening actively to what is being conveyed. That extra 20 minutes is huge in developing therapeutic rapport and provides copious amounts of information quickly that will help in the assessment, diagnostic, and treatment planning for the client.
Another misperception in the field is that people fall into addiction due to moral failings, and that this is a separate issue from all the other things going on in someone's life. Dr. Gabor Mate` (2010) who has worked with addicts in the Skid Row area of Vancouver, Canada, has noted the underlying issues that every man and woman he has interviewed in the 15 years he has worked as an addiction doctor in that area. He noted that childhood trauma, neglect, and abuse is a driving component of succumbing to addiction, and he supports a biopsychosocial and environmental approach to treating these individuals, which again suggests the need for integrative treatment, and gender specific treatment if there is to be any hope for recovery (Chandler, 2013). Thus it is important for the addiction counselor to recognize that if only the addiction is treated and not the underlying issues the client's success in recovery will be undermined.
Truths and Myths about the Counseling Role and the Hats We Wear
Having addressed the myth that addiction is a moral failing and that it is a separate issue from the rest of the person, there is also a myth that recovery treatment is a one-size-fits-all approach. A myth that has been promoted by pharmaceutical companies suggests that psychiatric medications are safe and the main form of treatment for any addiction and/or mental disorder, while being somehow less harmful then illicit substances (Breggin, 2008). It is quite clear from the literature that pharmaceutical medications lead to brain-disabling much like illicit substances do with long-term use, and the adverse side effects from these legal substances contribute to co-occurring disorders with clients self-medicating to feel more normal (Schatzberg & Nemeroff, 2013).
Treatment approaches are a mix of intuition and science and need to be individualized to the needs of the client. The main role of the counselor is to empower the client to seek congruence between core values, thoughts, and emotions to create positive changes in his or her life. Without that congruence being developed change will not be maintained when stressors become too overwhelming, which is the main reason for relapse and recidivism.
A significant truth about the role of the counselor is that we are the ones in the trenches with the clients, and spend more time getting to know the client than anyone else in the team. Depending upon the agency setting, the roles of the counselor may be quite complex. The counselor has a caseload that requires regular individual sessions, most likely leads multiple group counseling sessions per week, could include case management for the client, and participates in team sessions. Therefore it is extremely important to advocate for the client with the prescribing psychiatrist, psychologist, primary care physician, family, and legal system if needed. Other responsibilities may include:
- Developing the skills to be investigative about the history of the client
- Helping him or her with finding housing, accessing social security disability and other government assistance
- Speaking for treatment over incarceration in judge's chambers
- Providing family/couples counseling
- Even sometimes going with the client to celebrate getting that GED after years can all be part of the role of the counselor.
These things may not seem like part of the job to some counselors, yet the client in one's care is in need of someone who can create and hold an "envelope of safety" for that client while he or she is doing extremely hard work to improve the circumstances of life. So there are many hats that might need to be worn by the counselor to help that client.
Another part of the job is documenting well and consistently. The mental health and addiction fields are a business, so there is a need to be able to access both the healing approaches related to being an effective counselor, while understanding the need to assess, diagnose, and document every aspect of treatment with the client. There is a quote in the field: "If it is not in the chart it did not happen." This unfortunately is not something that every counselor understands, and I have known very empathetic counselors that were negligent in documenting along with counselors that dotted every "i" but did not show true empathy and concern for the person before them.
If documentation is missing or sloppy, the agency could be at risk for losing accreditation to operate, and insurance companies can deny payment for services rendered. One thing I would say to any future counselor is that assessing fully, diagnosing correctly, and making sure that what is done for the client is documented is of paramount importance to be professional, along with to Do No Harm. Continuing to learn, critically thinking about the issues people are experiencing, and being open-minded to continue to grow our selves is the biggest challenge in this field.
Gratifying Experiences That are Part of the Job
Being a holistic professional counselor I have worked in co-occurring disorders with youth and adults, along with trauma issues with children, youth, and adults throughout my career. In that capacity I have advocated for clients in whatever way has been needed. Gratifying experiences occur when:
- The "light goes on" for a client with understanding how childhood experiences are contributing to the mental disorders and addiction issues, and the client is able to forgive him or herself for what was out of the client's control.
- A client tells the counselor that this was the first time he or she felt heard by a counselor.
- Clients begin to integrate their experiences and are able to turn their lives around is the best thing that can happen in the field.
- A client heals enough to say "I want to give back and become an addiction counselor" really makes our hard work worth it, and another Wounded Healer evolves.
The counseling field has morphed and changed considerably in the past 23 years that I have been a counselor and psychologist. The holistic approach of treating the whole person and integrating treatment is a departure from the twentieth century approach of treating issues separately and is continuing to develop more effective treatment modalities to counseling the addiction and mental health issues people are experiencing, and co-occurring disorders are more the norm then the exception these days.
As counselors we have a mandate to empower our clients and advocate for them, as we are the professionals that spend the most time with them and our opinions are both needed and respected by the other professionals involved with our clients. We are rewarded when our clients succeed with their heartfelt appreciation and their going forth to pay that forward toward others who need care, empathy, and treatment. As such, this industry is a business so counselors need to be artful, organized, and continue to grow themselves to be as effective and helpful as possible.
Breggin, P. R. (2008). Brain-disabling treatments in psychiatry: Drugs, electroshock, and psychopharmaceutical complex.(2nd ed.). New York, NY: Springer Publishing company.
Chandler, T. (2013). Integrative treatment pilot study: An extended care holistic treatment facility for women with co-occurring disorders. Annals of Psychotherapy & Integrative Health, 16(3), 62-73.
Mate`, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Press.
Pinel, J. P. J. (2011). Biopsychology, (8th ed.). Boston, MA: Allyn & Bacon.
Schatzberg, A. F. & Nemeroff, C. B. (Eds.). (2013). Essentials in clinical psychopharmacology, (3rd ed.). Arlington, VA: American Psychiatric Publishing.
Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006, November). Positive psychotherapy. American Psychologist, 774-788.
Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 6(5), 410- 421.