Monday, December 24, 2012

Drug and alcohol use history of the therapist


In my book I discuss a situation that all drug and alcohol counsellors fear. It lurks in the back of the mind and can surface at any time. The client can raise it at anytime and leave a conundrum for the counsellor. The client can ask, 

“What is your drug and alcohol use history?”

In my experience I have not been asked this question often but it does happen from time to time. How does one answer? There are two schools of thought on this.

Jump woman
Should I choose the red or the blue?

First the counsellor can in essence refuse to answer the question and say that it is not relevant and move onto another topic. Others may use the distraction technique and answer the question with another question:
Client:  “What is your drug and alcohol use history?”
Therapist: “Why is that important to you?”
Sooner or later however the client will realize the therapist is not going to answer the question.

Second the counsellor answers the question and does some self disclosure about their history of alcohol and drug use.

I think the first response is not a wise one to take. It in my view builds intrigue you do not want. The client is left wondering why you ‘really’ refused to answer. Is there something you are ashamed of or maybe your drug and alcohol use history has been extensive. Also you are asking the client to disclose many things, some of them quite intimate and then you refuse to disclose something to the client. This may leave them feeling problematic emotions about your refusal.

Woman smoking

If you take the second option and answer that you have had little or no history in this way then some clients will feel you are somewhat ignorant about such matters. To most it probably make little difference but there is a group to which it is quite important and it can damage your potency as a therapist in the eyes of the client.

If you answer that you have used drugs and alcohol at times in the past then that can leave some clients feeling that you do know what they are talking about. However it is also permission giving to the client to take drugs. If you are a strong transference figure to the client this can be particularly so. If you stopped using drugs when you were 30 and the client is only 25 some could take this as permission to keep using for 5 more years. Other clients may view you as hypocritical. You are suggesting a client do something that you did not do yourself. 

Then of course there is the situation of the counsellor who is currently using significant amounts of illicit drugs or abusing alcohol. That can also provide permission to the client and is a more delicate clinical scenario.

Cry baby

On the positive side it can engender trust in the client towards the therapist. If the therapist reports a history of drug and alcohol use the client may respect the therapist for being honest with them by reporting previous ‘bad’ and ‘unprofessional’ behaviour. If you say you don’t have any significant drug and alcohol use history the client is going to wonder if that is true or are you lying to them. To tell such a truth can build respect of you in this way.

Graffiti

41 comments:

  1. Tony, this is a question that plagued me all the time. Its interesting though that you will not find someone with schizophrenia or ocd asking the same thing. But i find that the need to be mirrored tends to be so huge in the population. i have always told the client right away that its a personal question and move on to helping the client understand why the question was important. often i'll uncover some unmet childhood need or early demand- like not feeling seen of understood or being denied validation. I wonder if you have the same experience from your years of work with the population... soon i'll ask you in supervision since i still have some hours to complete with you!

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