Session 12 – A Tough Crowd

• 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 clients struggling with addictions is separate from working with clients struggling with addictions who are pregnant.  Once children are involved, born or unborn, the issues become even more complex.  A pregnancy would change my approach to treatment in a way where I would feel as though I would need to advocate for the unborn child.  It would be very difficult for me to work with this client because of my own personal ethics and values, particularly if the client resists sobriety or maintenance.  For a client that does not resist sobriety and wants to get clean, I would help her find her way to a medical professional where the unborn child would get attention and the soon-to-be mother can receive prenatal care.  I would explore with the client the risks and harm that could be caused to the unborn child should the client continue using substances, as well as the potential harm that may already have been caused to the baby.  Helping the client sift through all of that information can take time as emotions and recovery plays out.  Getting the client to a medical professional promptly, would be my foremost concern, though.  It would affect treatment as, if the fetus is already dependent on the substance, it may not be best for the mother to completely stop taking the substance.  When in doubt – rule out the medical.
 

• 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?

     Advocating for clients and challenging bias takes guts.  It means standing up for individuals that the majority population either does not understand or that the majority population has misconstrued as not needing various services.  Becoming an advocate, I feel, is a very important role of a counselor, and one I anticipate needing to take on.  Sometimes individuals do not know how to help themselves.  Sometimes individuals are unable to help themselves.  Advocacy is necessary in both situations.  Working with children and adolescents diagnosed with ASD on the weekends has given me ample opportunities to practice advocacy.  I have worked with the local YMCAs, helping members there understand that these children are still humans and simply think and interact differently than the majority.  Finding ways for this population to become more involved in their community, despite their differences is sometimes a struggle.  As advocating for people with ASD is something I already do, this is a population I feel is ‘easier’ for me to advocate for.  The harder population for me to provide advocacy, I believe, would be to allow for more services for pedophiles.  My practicum experience at the sexual behavior unit has taught me that one of the ways to ensure the protection of children in the future is to help those who either intentionally or unintentionally have harmed or feel the desire to harm children.  This is a very controversial issue and one I do not believe there is much public support for, so advocating for this population, I think, would be very, very difficult.  This does reflect on my own beliefs, as I do not know of any research that says that the majority population does not want to help pedophiles, this is my own opinion of what the population feels based off of feedback from my friends and family.

 

• Using the Blog References, find and specifically report on at minimum of four websites that you could use for information regarding gender and/or LGBT issues in addictions counseling. Give a minimum of one paragraph of explanation for each site listed.

http://www.algbtic.org/

     The Association for Lesbian, Gay, Bixsexual and Transgender Issues in Counseling website is a fantastic resource.  This association has a mission to recognize individual and social contexts that represent the conflusence of race, gender, ethnicity, class, sexual orientation, ability, age, religious or spiritual belief systems and indigenous heritage.  It’s purpose it to promote awareness and understanding of the LGBT community among the counseling profession in hopes of improving the standards and delivery of counseling services that are provided within this community.  Identifying barriers to the growth and development of LGBT clients and implementing and fostering interest in chartiable, scientific, and educational programs is another purpose of the ALGBTIC.  There are resources available for counselors, such as competencies to work with the LGBT community as well as educational sources.  Another great aspect about this site is that it gives a list of the competent LGBT counselors for the LGBT community.  Another way this list could be used is for counselors interested in working with the LGBT community to get in contact with those who are competent in working with this population.

 

http://www.colage.org/resources/

     Colage is a great resource for counselors to use.  It unites lesbian, gay, bisexual, transgender, and/or queer parents together.  It fosters empowerment and self-confidence for the LGBTQ community.  It has resources available to read for LGBTQ parents and for people with LGBTQ parents.  This could be a great site to use when working with adolescents and children and school systems.  There are tips for coming out to children and resources explaining what happens and/or what it means when your parents come out of the closet.  These resources could be used when working with clients.  “In My Shoes” is a fantastic documentary available on this website focusing on the children of homosexual parents which normalizes homosexuality.  This is a really fantastic site!

http://soulforce.com/

     It is, in my opinion, important to consider the different issues Christians face in today’s society.  Being a Christian myself, I do not feel free to speak much about my faith because when I do, I am often automatically labeled as trying to convert people.  That has never been the case.  I feel as though the more I speak on my faith, the more I am persecuted against and the less I am listened to and/or respected.  Now, couple being of the Christian faith and being a homosexual.  I am not a homosexual, but I have friends who are and some of those friends do align with Christianity.  How difficult that must be!  Soulforce.com shares a positive view of the Bible as it relates to Christianity.  It brings into focus an ideology of what being a Christian and a homosexual is like and how to get connected within that community. 

http://www.hrc.org/

     The Human Rights Campaign fights for equal rights.  There are current issues shown on this website as for what is happening legislatively.  It showcases how people can get involved in the campaign and lists resources to use.  There is even a wedding registry for the LGBTQ community, providing a safe place for this population to prepare for and fund their weddings.  This would be a great resource to use in the counseling setting.

Session 11 – Perspectives

 What were your attitudes toward use of substances when you were a child and an adolescent?

     I was a youngster, I thought that drugs were different from alcohol.  My attitude towards substances when I was a child was that all drugs, except when given by the doctor or by mom, and alcohol were bad.  I was taught that drugs would only get me into trouble and that alcohol made you dumber.  My mother never allowed alcohol into the house and it was my mother who raised me.  My father drank at family events, though, and I would go up to him and tell him ‘alcohol is bad for you, dad’.  We were taught not to say anything to anyone we knew who did drink, including extended family.

     As an adolescent, my views toward substances shifted.  I still thought that all drugs were harmful and irresponsible to take.  Alcohol, though, I experimented with.  I did not want to drink at parties because I did not know how alcohol would affect me, instead, I would drink, in private, with my boyfriend.  We would get drunk together and play video games and watch movies and laugh.  His mother knew and was fine with it.  She would buy us alcohol.  My parents were in the dark about it, to my knowledge.  After awhile, I learned how to drink more responsibly and will now have a glass of wine after dinner, or after a stressful day, and maybe a beer here or there.    

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?

     My first experience with alcohol was with Captain Morgan.  To this day, I prefer Captain Morgan.  I would never drink by myself as an adolescent.  I was afraid that something terrible would happen if I drank alone, as I was still learning my limits.  I did drink at parties during my undergraduate years.  That is where I really learned my limits with alcohol.  I refused to smoke anything.  I remember trying hookah once and it burned my lungs.  That was a terrible experience and has kept me away from inhaling any substance.  I still feel as though taking drugs, unless prescribed, is just a bad idea.  I still view alcohol as okay, in moderation.

     To be quite honest, I am not sure I would feel any different working with clients making different choices than I made.  I would have more of a challenge to relate with them and empathize with their situation, but I feel as though that would be scenario when I would focus in on the innate human emotions leading to the different decisions.  I have family members struggling with addictions.  One family member has become pretty peculiar because of her drug use and her story is both scary and bizarre.  Thanks to her, I have been able to empathize with others who have made different decisions than I have made.  People are humans and humans are not perfect; therefore, people will make mistakes.  

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?

     These are great questions.  I cannot say who first advised me about drugs and alcohol.  It may have just been made clear to me that substances are bad being raised.  The first time substances came into my educational setting was in the fourth grade.  A police man came in and used puppets to teach us about cigarettes, weed, and alcohol.  My viewpoint that taking drugs and alcohol were poor decisions was reinforced.  Fast-forward a bit to the 9th grade.  My father had a discussion with me about alcohol and how I should not drink; he had a beer in his hand the entire time.  It was at that point in time where my parents had split up.  I had a hard time trusting him after my parents separated so that, coupled with the hypocrisy of telling me that drinking was irresponsible while he was drinking made me not believe him.  That may have opened my mind up a bit to trying my first bit of liquor.  As my life continues and I have children, I hope to emulate to them that substances can be very dangerous but the substances that are legal can be used responsibly.  I would educate them on what harm substances can cause to the human body, brain and cognition.  The same way I would educate my children would probably be the same way I would educate my clients.

Session 9

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?

 

I have experienced many different forms of stress throughout my life; stress is something I am familiar with.  The scenario I will share seems, to some people, as a ridiculous thing to do.  I was working a full-time 8:30 AM to 5:00 PM job, and was enrolled at Towson University as a part-time post-undergraduate student working towards a certificate, while I was enrolled at Johns Hopkins University for a graduate degree in counseling.  At the same time, I was working part-time as a behavior therapist giving a mild form of ABA to children with Autism Spectrum Disorder, and I worked part-time as a bartender.  I also had a boyfriend and relationships require time to build and maintain.  What I did not have was time for myself.

I had three jobs because my full-time job would not allow for me to pay my bills and have money to afford food.  I decided to move forward with my education to give myself a better chance at having a more comfortable life and to allow myself to work in a field that more closely aligns with my skill set.  Finding a different full-time job was an option, but that would also mean that I would not be working in the field of psychology.  My energy reserves each night were low and how I coped with the stress of maintaining good grades and keeping my three jobs led me to make some poor choices.

One day, I looked in the mirror and decided that I needed to make some changes.  I met with my parents and asked for help.  That was a huge thing for me to do.  You see, I have two younger siblings.  One of which is an alcoholic and has so many legal financial obligations now that he lives back at home with my parents and they have to pay his legal fees for him and the other sibling is getting her undergraduate degree paid for by my parents.  I felt like asking for my parents to help me financially would undermine my sense of self-worth because I knew that I was able to make ends meet.  I could not make ends meet, though, without subduing myself to a massive load of stress and energy depletion.

Thanks to my parents, I was able to leave my two part-time jobs.  I finished my certificate program and now I have a full-time job and am in the last part of my program at Hopkins.  I had a lifestyle change and my stress level is much lower than it was and I am able to sleep 7-8 hours a night every night.  I also have time just for Sarah.      

Session 8

• How does 12-Step facilitation of treatment relate to your personal theory of life? What parts could you integrate if desired?

There are parts of the 12-step facilitation of treatment that I can relate to my personal theory of life.  For example, one of the steps is that a higher power can restore us to sanity.  I do believe in God and that my life is in His hands.  It comforts me to have an all-powerful being to turn to.  This leads into another of the twelve steps which incorporates making a decision to turn our will and lives over to God’s care.  I believe that step four of the facilitation process is continuous throughout the lifespan.  I think we continuously need to look at our personal morals and values as this world changes.

• How does 12-Step facilitation of treatment relate to your preferred counseling orientation? What parts do you see that you could utilize for treatment?

The 12-Step facilitation of treatment relates to my preferred counseling orientation as I feel as though I am an integrative counselor.  I relate most with CBT.  CBT deals with changing behavior through changing thoughts.  The 12-step program is, at a basic level, a thought changing process.  It is changing the thought that I have control over my life and altering it to the thought that something higher has control over my life.  Implementing the steps into treatment, I could use step 8.  Step eight is making a list of all people we have harmed and making amends to them all.  This, I think, is a great part of any healing process.  It helps make your mind clear knowing that you have done right, or made right, with the people in your life.  I know that having doing right by others makes me feel calmer at the end of the day.  It would be the same for clients, I am sure.  This process can be used with atheists and agnostics, too, as there are groups where the steps have been altered slightly so that no one is offended.

Session 7 Post

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?”

I do support the use of pharmacotherapy in the treatment of addictions.  Some addictions are too risky to not allow the client to wean off of the drug through supplementing with another drug; it can be deadly not to allow drugs into the treatment plan for a drug addiction.  Using drugs to help clients become less dependent on their primary addiction could help instill hope in the client that they are able to lower their dosage and be okay.  I do not believe, however, that pharmaceuticals should be the first consideration for every client being treated for addictions.  Rather, I believe that helping people become empowered and instilling determination and self-confidence may serve the client better.  Helping the client to work through their addiction without the help of other drugs may take a longer amount of time, but it would also mean that the client is less likely to develop a similar addiction to their treatment drug.  Placing the client in a situation where they can abuse a drug, again, whether it be their primary addiction or their treatment drug, could be more harmful than helpful for someone with an addictive personality.  If I were an addictions counselor, I would first try to help the client overcome their addiction without the help of pharmaceuticals and if that proves too challenging for the client, then I would turn to pharmacotherapy. 

Week 6

• 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?  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”?

 

     My current practicum site is at a Sexual Behavior Clinic in Baltimore.  The people who come there come with all kinds of sexual issues, including pedophilia, voyeurism, fetishes getting in the way of their relationships, exhibitionism, sex addiction and porn addiction.  I, truly, do not have the issues these clients have; however, the addictive tendency of the porn addicts and the sex addicts I think I do have, at some moderate level.  A few months before I began my placement I made sure to get individual therapy.  It is very difficult to see what is happening within yourself, sometimes, without the help of someone else.  These clients are similar in that way, too.  They are gradually able to see what is happening within them and how to help those tendencies with the guidance of another.

     Going to therapy helps me stay in contact with my inner client.  I have even begun to practice deep breathing exercises and yoga to help me stay in touch with myself.  Having such calm means that there is crazy (you really can’t have one without the other).  It helps me to realize that the only real difference between myself and my clients is that we have made different choices that have led us to where we are in our lives.  I am a human being, just as my clients are human beings.  We are equals in a helping relationship.  My role is to help guide the client to make decisions that they can comfortably live with, and their role is to help me see another outlet of pain and then transformation that being human can mean.  Life is a beautiful gift and, in a strange way, clients can help bring that to light, just as we can do the same for them.

Week 5

• Required:  Which of the foundational philosophies of counseling are you most comfortable with and why?

     The foundational philosophy of counseling I am most comfortable with is Adlerian therapy.  Adlerian therapy uses a lot more silence than other theories and I am very comfortable with using silence.  Family histories were also used, and I do believe that our families influence/or have influenced our present behaviors.  I am also very comfortable with the mindset of Cognitive Behavior Therapy.  I believe that behavior can change with a change in thought.
 

• Are you a hopeful person? Are you motivating and encouraging? Do you have a judgmental attitude?

     I am a hopeful person.  I am also motivating and encouraging and I have an open-minded attitude.  I have been this way since I was a young girl.  My grandmother taught me that I should look for the good in everything and that there is always something good in even the worst situations.  When I was in the sixth grade, a suicidal and depressed girl on my bus route called me Miss Sunshine because I always look at the glass half full and, apparently, I was the most optimistic person she had ever met.  I would like to think I would have the same mindset towards clients (hopeful and encouraging).

Week 4 Post

•  How do I consider this substance/behavior pattern a beloved “friend”?  How is it sensual (appeals to my senses)?  How does this substance/behavior pattern provide “healing” or is a “balm” to my emotional wounds?  How my addictive substance/behavior pattern is hated – what has it “cost” me?  What might be a good resource or treatment method for a behavior change?

     The behavior I am thinking of is considered a “friend” because it helps keep me comfortable.  It is familiar; it is something I am used to.  Even though it may be unhealthy and harmful, I would rather keep it and feel comfortable than stop the behavior and feel lost.  It is sensual in the essence of touch.  It is a familiar feeling that calms me.  This behavior pattern provides healing to my emotional wounds.  It reminds me of a similar feeling I used to have in the past, when life seemed simpler.  It is hated because it has cost me some self-confidence and freedom.  A good resource or treatment method for a behavior change could be making more time for my support system.

Session 3 -Mike and Carol

• What biases do you find in yourself about process addictions? Are there some behaviors your more readily accept or reject as being problematic or addicting?  What shapes your views of these processes?

 

     My view about problem behavior and addiction is that it is only a problem if it significantly negatively impacts social life, emotional states, work or home life.  Once one or more of those areas are impacted by one behavior, and that behavior persists for a long period of time, I would consider them as being an addiction.  Those four areas shape my view about whether someone has a process addiction.  I do believe that almost everything can have an addictive component and I really am not sure I would more readily or reject one behavior from another.  I can see a sex, work, food, gambling, and shopping as being addictions if they do, indeed, impact that individual’s and that individual’s family’s life.  The bias I have towards process addictions is that drugs are not necessarily needed to treat them.  I am a strong advocate of choice and, as long as that individual does not have a chemical dependence on a substance, I believe that that person can alter/stop their process addiction behavior through exploration, support (e.g., Gamblers Anonymous, Overeaters Anonymous, etc.), and motivation. 

• Are you more likely to call something an addiction if you are uncomfortable with the behavior or view it as undesirable or unhealthy?

     I like to think of myself as an open-minded person.  The comfort level I have with a behavior is not what would impact my calling it an addiction.  For example, I find it unhealthy and undesirable for adults to have an addiction to child porn; my personal feelings towards the behavior does not change that that individual has an addiction.  I would still call it an addiction as long as that person’s social life, emotional state, work and/or home life was impacted.  If those areas were not impacted then it would be a perverse habit (specifically speaking about child porn).

• How might your own beliefs, morality, or spiritual beliefs shape your views of your client’s problems?

     All counselors need to be aware of how their personal beliefs, morality and spirituality shape their views of their clients’ problems.  The reality is that our values shape our view of the world which means that how we are inclined to help clients is affected.  I do not believe that there is a way around our clients being impacted by our values because our values permeate how we give therapy.  What we can do is control how much our beliefs, morality and/or spiritual beliefs impact our therapy.  In no way should we allow our beliefs to be pushed onto our clients and that is something I do not think I would consciously do.  I believe that having sex outside of marriage, without agreement from both partners, is not okay.  I also believe that having sex outside of the marriage with agreement from both partners does not allow for the relationship to last long; I believe it is detrimental to a healthy relationship.  Now, I would not tell a client that that is what I believe because that would be unethical and could impact the client’s decisions.  A client that is acting on those particular beliefs of mine I may view as an immoral person, but that, again, should not impact the actual therapy.  Working at a sexual behavior clinic, I have found I am surprisingly very good at blocking my thoughts about what the client is telling me (most of them are pedophiles and talk about their experiences around or with children) and focusing more on the issue at hand – the present and helping the clients to build a better, healthier future.  Certainly, our personal beliefs affect our views of the problem at hand.  

Session 2 – Sahira

• After reviewing the web references for this week, discuss what types of approaches are you more comfortable with?

I am more comfortable with the Cognitive Behavioral approach to therapy, as well as the Adlerian approach.  I think that I would be comfortable starting an Alcoholics Anonymous group, and not so comfortable starting a Narcotics Anonymous group.  The reason being that I have had direct family experience with alcoholics and not so much experience working with other groups of addicts.  I appreciate how the NA website is attractive and easy to navigate.  I really like that it has information embedded in the website for narcotic addicts.  I have always found it important that clients understand, as much as is possible, what is happening to them physically, as well as other capacities.  Acting as an informer with a client is something, I believe, I would be comfortable with.

• What strengths do you have as an individual to assist someone similar to Sahira?

I think that I can be very direct, yet gentle at the same time.  I believe that an individual like Sahira would do well with my style of counseling.  I accept that the client has a need that they are meeting with the drug, and I think that by acknowledging that need, therapy can really begin to make an impact.  Once the client feels that you understand why they are taking the drug and trust is gained, then guiding them into finding alternatives to the drug that meets that same need can happen.

• What are areas that you might feel you need to work on?

At this point in time, I feel that I would need improvement on motivational interviewing.  I am a naturally empathic listener and have gotten a lot better at asking mostly open ended questions.  I think that with some training I would be able to use this technique effectively.  It is one I would like to learn, actually, as it focuses on motivational processes within the person that facilitates change.  That is something I have been interested in for quite a long time.