In working with individuals who are struggling with co-occurring mental health problems and addiction, its not totally uncommon to have a client arrive to session intoxicated to a degree. This raises a number of ethical questions as well as the dilemma of whether or not to continue the session. Client safety is paramount of course. It makes sense to me that a person struggling from the intense emotional overload of psychological trauma or severe depression may self-medicate with a substance such as marijuana, yet therapeutic work with an individual who is intoxicated is typically of limited substance.
During a recent session, a client arrived admittedly intoxicated on marijuana. As I shifted to addressing issues of client safety, I was reminded of how important positive regard can be. Shame tattooed itself all over this client’s face as they struggled with the reality of that day’s relapse after much hard work to sustain sobriety. Questions of what the probation officer would say if the next drug screen came up positive resounded. Shifting hats from addressing client safety to offering positive regard, the client began revealing struggles with self-acceptance after the traumatic event. These struggles were amplified by today’s relapse and the expectation of this client to receive yet another lesson in rejection from yours truly.
And to think, I nearly stepped into this role of professional rejecter in the name of weighing out ethical dilemmas in vivo! This client reminded me once again how powerful it can be for a professional to offer acceptance when working with someone who has just relapsed. In fact the literature in the addictions field suggests that a “slip” may be prevented from becoming a “full blown relapse” by a client’s being able to process the slip as or shortly after it occurs.
Yet what prevents so many clients from coming into our places of employment to process their recent slip after all that hard work in and out of session to achieve and sustain sobriety? Perhaps it’s the transference and fear of that serious look from the eyes of another authority figure as the person struggles with the reality of “screwing up…again.” Yet if I were that client struggling with the load of psychological shit flowing in the wake of such severe and long-lasting traumatic experiences, I seriously doubt that I could avoid the temptation from time-to-time to escape reality and pain. Don’t we all do this in part after all by escaping into television, a pint with friends, or my personal favorite, a nice heaping bowl of ice cream at the end of a tough day?
It’s amazing the power of this client’s lesson to me that day. When we professionals and “authority figures” offer full acceptance to an individual in the midst of their relapse it may serve to deconstruct their sense of shame, if only in a small part. For this client it was a powerful step in the healing process. I am reminded of the lessons taught by Dr. Gabor Mate (http://drgabormate.com/), a physician who was instrumental in starting the only supervised injection facility for heroin addicts in North America. While the medical staff at this facility do not provide heroin for their patients, Mate contends that it is more ethical for the staff to provide medically monitored injection to prevent infection and to provide medical treatment in case of overdose. Challengers have argued that this is a part of enabling. While this treatment facility does offer addiction treatment in addition, it takes a decidedly harm reduction stance. Mate argues that it is more ethical to provide treatment to the addict despite their addiction rather than denying them treatment because of their disease.
It seems we as professionals are often faced with a similar decision. It is astounding the power a kind look and acceptance despite the moment can offer in catalyzing healing. I am reminded anew by this client how meaningful such regard can be!
Stephen Ratcliff is a Counselor in private practice in Albuquerque, NM. He specializes in helping Children and Adolescents with Addiction, Psychological Trauma, and Attachment Disorders. For more information or to contact Stephen, please visit www.familiesfirsttherapy.org.