I have been thinking about the subject of continuity of care a lot lately. When we become counselors, we are charged with the responsibility of caring for our clients without causing them harm. However, I have witnessed many agencies that seem to disregard this very basic tenet when it comes to group counseling dynamics. When a counselor is shifted from one location to another suddenly without the ability to provide closure on the relationships they have established with the individuals in one group, is that not essentially or potentially causing the client harm? People don’t like change. Addicts seem to dislike change more than normal. When a substance abuse group is forced to deal with changes in counselors every few weeks, continuity of care is lost. It is not just a matter of the person remaining in the same group, it is also about remaining with the same counselor as long as possible.
When agencies don’t take into consideration the feelings of the clients when counselors are shifted around, many things can occur. For instance, one client might think that complaining about the new counselor will bring back the old one. The fact is that when a counselor moves on, it is imperative to give the new counselor and the group time to adjust to each other. Every counselor brings with them a different style, even if there is a set curriculum that is adhered to. How much time should be given? For each situation, this may be quite different. For one group it may take several weeks or even a month or more. Some groups will test boundaries a couple of times and then get on with the business at hand. The point is that no one can say for sure how long this adjustment is going to take. Often when group members are required to participate either because of court order or because they can’t live at home if they don’t get sober or get some help, animosity lurks just below the surface. A sudden change of any kind can bring this animosity to a head rather rapidly, and can have a negative impact on the others in the group, even the counselor.
Making sure that client welfare is of primary importance should be as much the job of the agency as a whole and not just the counselor(s). When administration in an agency thinks that switching counselors around is a good idea, they need to speak with those who are on the front lines and see how they can make the transition as smooth as possible instead of just having a counselor “suit up and show up” to take over a group not knowing what they are getting into or who they will be working with. Continuity of care is a heavy responsibility and one that administration cannot continue to take lightly.
Linda Magnelli is a counselor who works in Phoenix as a substance abuse and mental health counselor specializing in difficult cases.