Removing Barriers to Engaging the Client Support System

Transcription

1 Removing Barriers to Engaging the Client Support System BIRGITTE EPPEL MA LADC LAMFT Assessing client needs Barriers-provider and client Methods of engaging the client s support system Psychoeducational components Ethical Considerations What do your clients need? Survey distributed to clients: Would you be interested in attending a group where you could be there with your family, significant other, or a friend? What would be beneficial for your loved ones to learn about addiction and recovery? What prevents your loved ones from coming to a group at Park Avenue Center What prevents you from inviting them? *surveyed 65 men from Park Avenue Center s MICD/CD lectures in February of

2 22 clients said they had no interest in attending a group with family/loved ones Results: 4 unsure/maybe/whatever Clients gave these barriers or reasons why they don t want the involvement: Family lives far away scheduling/busy shame not ready family won t care fear want to work on self first then family later family already has been to a parenting program childcare client does not want family around school health concerns transportation **and my favorite: if they know more, they might not enable me anymore hahah More encouraging results: 39 clients said they did have interest in attending a group with family/loved ones They identified some of the same barriers, but said they would still be interested. Topics they would like to have families know about: How meetings are helpful, honesty, trust, addictive thinking, basics of 12 Step programs, relapse process, how family can help, triggers, defining addiction, communication, how to handle someone with an addiction, warning signs of relapse/how to identify old behaviors, mental illness, behavior that contributed to chemical use, setting boundaries, how to stop enabling, recovery environment, how recovery works Client barriers to participation: Logistical barriers: Transportation Distance No family/loved ones (this isn t always really true most clients have someone) Childcare Cost of program Time off of work Attitude/Belief barriers: Already did the family week at another treatment center not my problem Fear of being put on the spot Anger toward client Shame Not worth the time 2

3 Provider barriers to engaging the client s system: Logistical Not enough staff Lack of time Lack of training/competence No dedicated resources Space Billable? Attitudes and beliefs: Belief that Alanon is sufficient and that client s loved ones will follow recommendation of going to Alanon A client s recovery is separate from their loved one s recovery Clients need to disconnect from their system because it is unhealthy and create a new family with AA/NA. *This is a good idea, however, most clients have a difficult time following this recommendation and it ignores their relationships If we tell a client to disconnect and they don t, it creates a dynamic where they will lie and not discuss it in session. What to do with this information? Created a Psychoeducational/Support Group for clients and their loved one(s). Included psychoeducational and support within the group Increased promotion of couples/family therapy Worked on changing the culture within the company about needing to implement systems work Getting them to show up Incentives? Food, coffee, etc. are not necessary to get them to come. It is better to change the norm about the group. Having incentives implies that it is not in the norm for people to show up. Calls, letters, etc. Have client call/invite as well as the counselor. Keep trying! Most Sales aren t made on the first attempt so continue to make efforts to engage the family/partner/etc. Reminder calls on the day before or the day of group. When speaking to them assuming that they will be there. Do you think you ll be making it to family group while client is here? vs. When you come to family group on as a part of client s treatment, this is what to expect. 3

4 Getting them to show upcontinued I already did the family week at program. This is different and your loved one is in a different place now This is a lower commitment than, just come one time and see how it goes. You can always decide to stop coming. I don t really need any help, this isn t my problem. Yes, it is your problem, your life has been affected You re right, but client could use your help and support Many family members aren t ready to buy into the idea that loved ones also have their own recovery process. Saying that this group is for you! isn t always helpful because many family members are so used to caretaking, they would not be interested in something to help themselves. Preparing client for the loved one(s) involvement: Client may/will likely have resentments and their own anger toward their loved one(s). Discuss how client will handle it if their loved one(s) express anger, resentment, etc. toward them. Client has been working on reducing their shame and working through their own self-resentments but their family has not been participating in a program for hours per week and those feelings are still likely very fresh. Clients should not expect loved one to be as excited as they may be. Client may regress and be triggered when family comes. GOOD! Better to have this happen while a client is in treatment and has support rather than once they complete and have fewer supports. Include this in ongoing relapse prevention planning and treatment planning Preparing family/loved one(s) for involvement: What to expect from their loved one and what not to expect. What to expect from the group, meeting, etc. Reduces anxiety about coming. 4

5 Providing couples/family therapy Essential for clients in their treatment process. Better to do along side the treatment process rather than wait until after. If it needs to be done outside of treatment, have referrals and accommodate appointments as needed. Being in a relationship with a person in active addiction is a source of trauma. Discussing issues related to fear, trauma, etc. CD Counselors doing couples/family therapy? Outside of scope of practice? It depends. Group Therapy Developed a psychoeducational/support group where clients could be present with their families/loved ones and learn together. Weekly 1-2 hour group Clients in group with their family member/partner Loose psychoeducational structure as well as opportunities for support and sharing among members Benefits: Disseminating information-done by the facilitator as well as other clients. Creates empathy on both ends, shared experience. Yalom s curative factors: Universality-This is especially important for family members/partners because living with a person in active addiction can create some unique experiences that make a person feel crazy and the me, too! factor can be helpful. Reduces isolation Instilling Hope-Seeing different family members/partners and their relationship getting better as well as other clients that may be further in the recovery process is helpful 5

6 Topics to include in psychoeducational/support groups Demystifying the treatment process Basic education about addiction and mental health trauma for both client as well as loved one(s) Communication skills/conflict resolution Developing boundaries and accountability Family systems: how addiction/mental health can affect a system Relapse prevention Education on community resources Demystifying the treatment process: Drop them off you fix them Information about what to expect in various stages of treatment and the usual course of treatment at your center Clients don t usually communicate this clearly and it leaves partners/families in the dark. Especially important to let families/partners know about services related to housing. Clients may ambush their families and not let them know that they have been recommended sober housing, etc. Education about Addiction and Mental Health: Be there to answer questions and have clients answer questions Information about mental health and COD Medication Compliance Information about methadone/suboxone/etc. if applicable Some basics about the brain as well as substance use in general why won t they just stop!?! This is useful to have other clients in there to help explain addiction and why they haven t been able to just stop. 6

7 Communication Skills/Conflict Resolution Basic ideas about communication: Non-verbal/verbal Passive/aggressive/passive-aggressive/assertive LISTENING SKILLS Conflict Resolution Skills: Taking breaks/ time outs Not bringing the past into current issues Not escalating the situation Monitoring defensiveness Family systems: Looking for patterns within their family or couple interactions Listing healthy and unhealthy rules that happen within a family system where there is addiction Family Roles: Scapegoat, Hero, Lost Child, Mascot, Enabler, Addict Interesting but not true for every system Often is an interesting topic for clients and their loved ones. Cause for examination of family of origin as well as within their own family. Developing Boundaries and Accountability: Defining boundary Discussing the concept of enabling List examples of enabling and normalize some of the old behavior Practice having discussions about boundaries I know was okay before but it isn t anymore. 7

8 Relapse Prevention: Defining relapse Discussing plans for how to handle it if a client were to relapse Better to do an evacuation plan before the fire than right in the middle of it. Include clients in on this plan while they are sober. Normalizing relapse (not saying it is okay but that it can happen) Defining relapse concepts: Triggers Warning signs Coping tools Community Resources: Referrals for couples and family therapy Referrals for individual therapy AA/NA meetings list How to find a meeting What to expect at a meeting Why meetings are helpful Sponsorship What is a sponsor? Alanon What to expect at an Alanon/Naranon meeting. There are some that may be more or less helpful Why is this our responsibility? Better informed/healthier families will lead to better outcomes for clients. These issues impact treatment planning and progress 8

9 Ethical considerations: Partner/Family using Do we do therapy and offer services to client s family members that are using? Is it enabling the use? no What do we do if someone comes to the group under-the-influence? Ask to leave group Address issue with the group while still maintaining the dignity of the person(s) involved. Ethical Considerations: Abuse History of abuse within the relationship as well as within each person s past. Discussing the issue of abuse is important. Mandated reporting Can be done with a general statement that opens up the issue for discussion It is not uncommon for there to be abuse in relationships where there is substance abuse. Not saying that it is okay but it is yet another demonstration of how substance abuse affects relationships, communication, problem-solving, etc. Better addressed in couples/family therapy than in a group. Ethical Considerations: Secrets As a counselor, you may know things about your client that their family/partner does not. Partners/family members may confide as well Develop a policy for how to handle secrets Recommendation is not to keep secrets but to help the system communicate difficult issues to one another Does not mean that the client needs to share all secrets with their family (past bx while using, etc). Keep safety in mind 9

10 Other challenges in groups Someone in the group appears to be under the influence Pull aside, ask to leave group Address issue with the group while still maintaining the dignity of the person(s) involved. Family member/partner becomes tearful, angry, etc. Address the emotion, block shaming of the client No one says anything This is the benefit of having psychoeducational material as well Can create time in the group to have members break off and discuss then come back to large group. 10