[THERAPY UNSCRIPTED – A WEEKLY COLUMN]
You’ll definitely want to refer any client struggling with addiction out.
Addicts lie. They manipulate. They don’t make for good therapy clients.
You’ll burn out. Everyone does. It’s just a matter of time.
If I had a dollar for every time I heard these lines, I might be able to afford treatment for every single person suffering from addiction.
These were the warnings from elite professors toting PhD letters behind their last names. These were the general guidelines from textbooks outlining how to do therapy and be a good therapist. This was the overarching consensus, the loud and clear message, that addicts are simply unsuitable for help.
Working in the trenches will suck the life out of you. Get out as fast as you can.
These trenches- this population- is considered the dark and grimy underside of therapy work. The treatment is messy and convoluted, laden with the heaviest pains and horror of humanity. Most professionals want nothing to do with it. Addiction is merciless, in every form of the word, morphing into a monster of its own terrifying breed, often seeming untouchable and unreachable for the lives it impacts.
For what it’s worth, the professors weren’t all wrong. Yes, addicts lie, and yes, they manipulate. But, they tragically missed one important point. Addicts make for fantastic therapist clients. They provide a constant reminder of why therapy is so intrinsically powerful, and why I enjoy every single day of it.
But, let’s rewind.
I did not set out to pioneer addiction therapy, and my intentions in entering this particular niche were hardly altruistic or even intentional.
I stumbled into this population because I needed a job.
Like many bright-eyed, novice therapists, I fantasied about the alluring virtues of stereotypical “high functioning” clients with garden-variety anxiety and depressive disorders, relationship distress, and/or academic worries. I wanted people exuding high self-reflection, who were motivated to be challenged and work hard.
After all, can’t we only help those who want to be helped? That’s what those professors told me.
But, when you’re starting out and you need a job, you keep your options open and varied, and I applied to every position I could find. When I was hired on as therapist for a dual-diagnosis, residential facility, I was relieved that I had found full-time work.
Suddenly, I had a multitude of groups to facilitate and a caseload of individual clients to manage. I quickly had to learn and become fluent in addiction language, how to interpret and speak the basic ABC jargon from AMA to Zyprexa.
But, let’s be clear.
I started out incredibly naïve. I’m about as normie (another word one learns within about two minutes of working within this field) as one can be. I’m not an alcoholic or addict, and until this work, I hadn’t even seen most hard drugs. Drug use and greater drug culture was mystifying, like a shadowed labyrinth somehow lurking in every crack and crevice unbeknownst to me. It was in every race, religion, and zip code, and each client carried a different background and story.
I entered with textbook knowledge about addiction, about the therapy modalities used for treatment, about the powerful effects of drugs on the brain, about the family disease model. This barely scrapes the surface. I knew nothing about the intense feelings of this painstaking work, about what years of chronic drug use did to harden the soul and spirit of so many of my clients. The chaos and clamor of drug addiction is as intense as it was unforgiving.
Those initial therapy experiences were erratic and unpredictable; some clients were still physically and/or mentally detoxing, some experienced psychosis, and some had absolutely no desire to be in treatment much less be sober. Everyday yielded some kind of new crisis. The skills my professors told me were rare in practice, such as initiating a 5150 or assessing whether a client was high, were utilized routinely.
This was therapy in its rawest form, in the jarred and desperate and unedited complexity of humanity. It was therapy for the clients who everyone had seemingly given up on. It was therapy for the population who needed it to the most.
I relied on what I knew and embraced: emphasized support, continuous validation, unconditional regard, a lot of humor, and gentle confrontation and challenging. Most of all, I focused on complete, unfettered acceptance of the client sitting across from me and establishing our rapport. Today, years later, these are still the two most important facets of my therapy.
Addiction stumbled into my lap. But, isn’t that how addiction works for everyone, stumbling our laps without an invitation, without a real concern about whether we are ready to address it or not?
I did not set out to sit with the shaking and terrorized woman who recounted the horrific abuse she underwent as a child, who was finally able to verbalize anger towards the parent who had shot her up with heroin for her first time. I don’t even know what it’s like to live with people who care about me.
I did not set out to work with the client who had only known a working identity from dealing, jail, and the virtues of the fast streets. I never thought I’d make it past eighteen. It didn’t bother me, though. That’s just how it is.
I also did not set out to work with the client who died, who left treatment prematurely and overdosed in a rundown motel, cold and alone and with years of potential happiness ahead of him.
I don’t cure anyone. I can’t control the outcome. To expect anything remotely close to that undermines the severity of this insidious disease. Many relapse. Many disappear into the night and never return. Sadly, many die. We are in the midst of a horrifying epidemic, and the brutal statistics and death tolls continue to rise. As treatment gets better, so do the drugs. As recovery starts feeling hard, relapse starts looking easy.
Addiction is a universal problem without a universal answer.
I’m still in those proverbial trenches today, the ones I was supposed to burn out in, and I have no intention of “getting out.”
Through my experiences, through the anguish and pain, I have witnessed the purest, organic beauty unfold.
I see individuals navigate the first stages of sobriety with strength and candor; I see the unveiling of sparkling personalities and steadfast identities; I see essentially them “wake up” from the thick fogs they have been living in for years. It is absolutely insane, this healing process.I believe those facing addiction- and recovering from it at any stage- have the bravest, toughest souls in the world. They inspire and humble me. Over and over again.
Therapy is just an hour a week. It is just a comfortable office with dim lighting and two people exchanging stories and feelings. There is no secret elixir. I have no magic erasers to remove pain or cravings. There is only the gradual energy towards healing and revitalization. And, sometimes, there is only listening- really, really listening.
Just like addiction stumbled into my life, it stumbled into my clients’ lives, too. They didn’t choose this gruesome lifestyle, this slavery to substance. Nobody wants an unwavering bondage of uncontrollable compulsion and dependency. Addiction tricked and crept and rationalized, innocuously sneaked its way into their lives before anyone could really comprehend the magnitude.
I am convinced the work my clients set out to do in recovery is harder than anything I will probably ever do in my lifetime.
Let’s talk about a miracle.
So, yes, they lie. Yes, they manipulate. Yes, they do what they can to survive a world that can feel stacked against them. But, no they are not terrible therapy clients. And, no they are not terrible people. And no, I’m not leaving these trenches.
*While these are based on true experiences, all reasonable efforts have been made by this writer to protect utmost client and treatment confidentiality. Because of this, names, features, and identifying details in this piece have been changed, omitted, and/or embellished.