ACA Blog

Kimberly Beck
Feb 22, 2011

Substance abuse and self-determination

I have two clients both are substance abusers, One client is 11 days clean from alcohol and cocaine, he's also done many other pills.  The other is hooked on heroin and Roxy's.  Both are in treatment with me.  As of today both are clean, but they are as different as can be.  The one hooked on heroin and Roxy's we'll call her Lily, she is 23 and now in a residential treatment program for substance abuse for 1 month.  The other one we'll call Mike, he is 33 and is doing IOP individually with me.  Lily was forced into treatment by her family threatening to stop her from seeing her 2 year old daughter.  She already lost custody of her because of drugs. Her probation officer said it is either treatment or jail.  She is not invested in her treatment, she is manipulative and doing what she has to do to get out as soon as possible.  Mike sees me 3 times a week and attends AA once a week, he is working hard and doing it for him he wants to show himself he can do this, he has a strong will to "beat this" but has almost an arrogant overly confident strong will, which is not necessarily a bad thing, however, he admits he keeps having urges to drink.

As counselors we encounter clients with the same diagnoses, however the treatment is not cookie cutter treatment, it can't be.  The clients have their own self-determination.  What they want to work on may not be what we think they should work on.  So back to basics, start where the client is.  I am frustrated because I know Lily will go back to using because she is in treatment because others wanted her in there not because it was what she wanted to do. Then Mike who is so overly-confident might fall hard into reality, he is so determined, but thinks he will never use again, I am afraid his over confidence will cause him to relapse.

I guess why I wrote this blog is to just remind all of us counselors that each client is individual and has unique treatment needs and goals. I used to work for an agency that made counseling "cookie cutter counseling" where they made us use a manual for each client with a certain diagnosis, that is not counseling !! The clients with the same diagnoses are quite different.

Kimberly Beck is a counselor and a doctoral candidate with a special interest in Self-injury. Other interests are PTSD, trauma, and Borderline personality disorder.

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