Episode 90

It’s a common thing people say about addiction: You can’t force someone to go to treatment. Well, sometimes adults can get forced to go to treatment. Sometimes as therapists we get clients who are mandated to see us. For a lot of therapists that feels bad and against what we learned as therapists. We want to respect our client’s autonomy and we want motivated clients.

 Today, I want to share with you that I believe that even court mandated clients can make progress. I believe they can get sober and make use of mandated therapy. After all, they are people with a whole history and a future. They just need some help navigating this time in their life. Check out this episode to hear my tips on how to have a therapeutic relationship with a mandated client.


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 90. Today we’re gonna be starting a new series addressing myths about addiction. If you were to Google addiction myths, you would find that there are a number of them. A lot of them overlap,  but the commonality between them, there’s at least over a dozen. I’m going to be covering one a month for the foreseeable  future. 

Today’s topic comes from a listener named Ben. Ben finds himself working at a community mental health center like many of us are or have done. He’s finding that there’s tension between his therapist self and the requirements of working with court mandated people. In his role there are evaluations that are done and potentially recommendations for treatment. Working with mandated clients can be really hard.  

Today’s myth is that people have to want to go to treatment and if you force them, it won’t work. I don’t believe that’s true. Because I truly believe that even court mandated clients can get sober.  

We all become therapists for various reasons. Somewhere in those reasons are that we wanna help people. As cliche as that sounds, it’s the truth.  We want our clients to feel comfortable. We want them to share their issues with us, and we wanna see them grow into a place where they’re feeling better and functioning at a better level. It’s easiest when clients come to us because they see a problem and they want it to get better. 

There are a lot of situations when adults are forced to be there. It could be through an Employee Assistance Program because they got written up for something. It could be because someone got a DWI, it could be because a court ordered it  based on a custody agreement, it could be related to a pending charge. It could be because of probation or parole. There are a number of reasons why not everyone who comes through our door really wants to be there.

Most of the time, we don’t have a whole lot of control over who shows up in our schedule. We accept clients based on what they tell us and we don’t always know if they’re coming there because the “have to.”

So when you’re in an intake session and you ask someone what brings you in today? And they say, I have to be here. My internal response is “No, you don’t. You don’t have to do anything.” But I saved that one and continue to explore what that means. 

In running the program that I ran. It was a mental health and substance use program along with a parenting skills program that was involved with child protection and in-home therapy for families.  We had a lot of involvement with the local government involving our clients. That could be anything from someone being on probation. That could be someone who’s involved with child protection. That could be somebody who’s lawyer told them to come get an assessment in preparation for an upcoming court date. 

In our mental health program, probably 25 to 30% of the clients at any given time had court involvement of some kind. That’s kind of high, I think for an outpatient mental health practice. However, this was community mental health, and we had a substance abuse program in house. A lot of our substance use clients ended up with referrals to mental health because it is hugely intertwined and we’d usually find that mental health issues needed to be addressed.

The relationship between your client and whoever is behind their visit to you is difficult. Let’s pretend that the person had a DWI, which is a Driving While Intoxicated in the United States for those of you who aren’t here and might not know that acronym. When someone has a DWI or a DUI (driving under the influence), there are lots of things they have to do. What they have to do totally depends on if this is their first rodeo or second or third, because each time there’s another DWI,  the consequences and the recommendations and requirements go up quite a bit as would be expected. 

So where I live, a DWI is going to be at the very least a DWI assessment which is different from a substance use assessment. And I talk about that a little bit in some of the assessment episodes. If you haven’t had a chance, you can head over to betsybyler.com and go to the podcast area. All of the podcasts are listed by topic and there’s also a list of all the episodes.  There is a subset of episodes, all on assessment. That will have the information about the different kinds of assessments and questions to ask. 

After the client has a DWI assessment, they have to follow recommendations. That can be really hard. I have worked with court mandated people, my entire career, and the first visit is usually similar. The level of irritation that the person has  at being forced to go to therapy depends. Sometimes someone’s outright hostile. Sometimes they’re begrudgingly accepting. Once in a while they feel like they need it too. 

The universal thing about therapists is that we’re in it for our client. We’re not in it to be an arm of the law. We’re not in it to be an arm of an employer or any other kind of requirement. We want people to be there because they want to be there because that’s how good change is created. So I can understand how people might think that forcing someone to go to treatment never works. I’m here to tell you that that is not true. 

In our program, we worked really closely with the probation and parole department. They were our biggest referral source for our substance use clients and we worked with them weekly if not daily. I recall being at different meetings with the agents and we would sometimes come to a conflict  because their goals are not necessarily my goals. 

For instance, their goal is to protect the community, that’s what they would tell you. And the way they do that is by making sure that their person is following through with all of the recommendations and requirements of probation. This would come through in moments when I would get asked by an agent, if my offender relapses, will you call me? Well, maybe? 

As a mental health therapist, No, most likely not.  As a substance use program, maybe. Depending on if this is the first time they relapsed, how bad was it? How do they feel about it? And can we work with it in house before it gets reported? That feels really obstructionist to a probation agent and I get that. We have information they feel like they need. And we’re therapists. My role as a therapist is not to be in criminal justice. My role as a therapist is to be there for the person, not the offender as they’re often called in probation circles. 

Another conflict came up when we had someone who had a warrant out for their arrest and they showed up to treatment. Well, a warrant can get issued for any number of things. In this case, the warrant was issued for not showing up for their agent. If a person on probation or parole doesn’t show up for their scheduled visit they will get a warrant for their arrest.  Not necessarily the first time, but if they’re continually evading their agent, that’s gonna happen.

The probation agents wanted to know if we would call them if somebody with a warrant was there (if we knew about the warrant) and I said, absolutely not. Our building, our program had to be safe. I have had police show up and ask me to get someone out of the group. They would show up and say, we believe that so, and so is in this group this morning. Will you bring them out to us? And my answer is absolutely not. 

First of all, there’s no crime being committed. Secondly, Confidentiality is in place unless someone is a threat to themselves or others. It was a dilemma because the person was there in the treatment group, trying to do the right thing and the police were there to potentially take them back to jail. It puts the therapists in a difficult position. 

Now I had already stopped them from trying to come into the group and asked them to wait outside rather than in the lobby. Mainly because we can’t have people getting arrested in the lobby or else anyone involved with the court isn’t going to come anywhere near our building.

I remember the therapist in the group worrying about whether or not they should warn them that the police are there and have them go out the back door. Well, Nope, we can’t do that either. We have to just let whatever happens when they leave our building happen. Whatever is happening between them and the police has nothing to do with us.

Our job is to be to the side, not to be in the middle. 

I was always surprised when people would show up for treatment groups and have an active warrant for their arrest. I’ve talked to people about it and I’m like, Hey, you have a warrant. And they’re like, I know. And you’re here because… and their answer is “cuz I had treatment.” Like it’s the most normal thing in the world for them to show up. 

That is the power of what we are able to do. Even with court mandated clients, to the point that we can be so integral into their lives, that they stop showing up because they have to and start showing up because they want to. And that my therapist, friends is what it’s all about. 

It is so awesome when that happens, where the person stops talking about their agent, the court, their lawyer, whatever the case is, and they are just talking about themselves. And I can tell you that over the years, a high percentage, well, over 90% of the clients we had that were mandated were able to make that switch.

Yes, they showed up and they were generally pissed off to some degree that they had to be there. It feels like an invasion of privacy to be mandated to go to therapy. Therapy should be something that is always voluntary. Unfortunately it’s not always, and there are people who need services anyway. That can feel really difficult to a lot of therapists.

And initially, when a client feels like they’re being defensive or resistant or any of those types of adjectives, It can feel like we’re maybe wasting our time. It can feel like this is pointless. Why am I doing this? There are other people who want to be here. I don’t want anything to do with this. And what I wanna encourage you is that that is just their presentation to start with. We can work around it in most cases. 

The cases where it doesn’t happen, where we can’t work around it is because there’s other stuff going on in my experience, then we’re dealing with a little more antisocial behavior. I’m not saying that all these people have antisocial personality disorder, just that we’re dealing with a little more antisocial behavior  and that has been the common denominator when clients are not able to move past the reason why they came to therapy to begin with.

Our goals are going to be different from the court than child protection than law enforcement. Then probation. We are going to want what the client wants.  When there is a disconnect and dissonance between what the mandate says and what the client says, we have to navigate the middle ground.

Hearing someone talk about why they have to come to therapy can be kind of annoying. They’re often blaming and justifying and thinking people are out to get them.  You can hear that in the way they talk and in how they explain the situation.  Sometimes they’ll come in and be like, yep, I fucked up. That’s why I’m here and that’s easy. Most of the time though, there’s some defensiveness, some bitterness, some resentment about.

My general approach goes along the lines of a technique found in motivational interviewing, which is a modality created by Miller and Rollnick to work on positive behavior change. The technique is called rule RULE.  Rule is an acronym R stands for resist the righting reflex. U is understand the person’s own motivations. L is to listen with empathy and E is to empower the patient. 

The very first thing is listening to what they have to say without correcting them. I have heard people tell me why they weren’t responsible for something and sometimes those stories have been super ridiculous and clearly not accurate. And it can be hard to stay in a place of validating their experience, but that is what we’re doing. 

We’re not going along with their delusion or anything. We’re not also justifying their behavior. We’re just hearing it. What you wanna be listening for is how they’re feeling. If they feel like they got the short end of the deal, if they feel like someone’s being overly harsh, we can join with them.

I would recommend talking with them about the story and I’d say, okay, it might go like this. Okay so last time you let me know the situation that happened, that got you on probation and that meant that you had to come here. I feel like I’m missing some details and I really wanna understand  what happened.

Sometimes they might say things like, well, didn’t you get paperwork or  didn’t my agent tell you. And most of the time we don’t get that kind of stuff. And even if I did, I’ll say, yeah, I got a report, but I want to hear from you what happened and where things are.  Being invited to tell their story makes a big difference and so they’ll tell you. And what I want you to hear is a place where you can join with them , wow, that seems kind of like an intense recommendation or anything that you can hear, that might sound a little bit difficult.

We’re not criticizing the justice system. We’re not bashing on cops and probation agents. We’re just hearing it. I guarantee you that their experiences with court mandated things and other types of agencies are gonna have some flaws. There are many times that I have been in the middle of supporting the county’s work with child protection and feeling like the county was being a little judgemental, a little bit harsh, a little dismissive.

I’m able to say those things without compromising relationships on either side. I can easily say, so your agent said to you, this thing. And I can say, I don’t love that. That must have been hard for you to hear. How did you respond to that?  These people are just like any other person. They want to be heard and understood. 

While you are hearing their story, you’re noting the things that they keep saying, the themes that they have. Because I am betting you that those themes also show up in other places in their life. If somebody feels like they got the short end of a stick, then they probably feel like that in another area of their life. If they feel like they weren’t heard and no one cared what they had to say, they probably feel like that in other areas of their life too. This is all great information. 

What I’m working towards with them is a place of acceptance. That what happened in the past has happened. That they can’t change the judge’s ruling and so they’re stuck in the middle and so what are they gonna do about that?  

Here’s where we’re understanding the person’s motivations for being there. Maybe it’s to satisfy a court requirement, maybe it’s to get their probation agent off their ass. Their current motivation isn’t necessarily going to stay the motivation. For the most part, the reason people come to treatments, isn’t the reason they stay in treatment. And the reason that they get sober in the beginning, isn’t going to be the reason permanently. 

Lots of people come to treatment for someone else and they end up staying for themselves. That’s what we’re after. While they’re telling their story and we’re understanding their motivations we’re listening with empathy. We’re not there to judge the story. I usually set aside any kind of note taking stuff that I might have and just hear them and understand their perspective. 

More times than not. In fact, most times once I have heard the story, I am able to use that information multiple times in the future. And I’ve also made the person feel like I might get it. When they feel like I might get it. That’s a huge win. 

So step one, here is to hear the story of how they got mandated, resisting the reflex to write their cognitive distortion. The second step is to find something to validate about their experience. About how it sucks to get forced to go do something about how it’s hard to have to take off work, to do this, about how it’s expensive to have to pay for it when they’re already paying all these other fines. 

Could be that they feel like they got set up or that they did get set up. There is a lot of stuff that goes on in law enforcement, where they’re using confidential informants to set people up, to find out who’s selling drugs and whatnot, and it’s a hundred percent legal, but it does happen and I’ve seen it a lot. 

The last part of the rule is what we’re good at, empowering the client and this is where the work happens. We’ve heard them, we’ve validated there experience in an honest and authentic way. We’ve understood why they’re here and what they want. Now comes our response. This person was court mandated to see a therapist in some shape or form.

You as a therapist, we’re not court mandated to see them. You don’t have to, the person can choose who they see. They can also choose whether they show up or don’t. What we wanna do is remind them of their choices even if those choices suck, which is get forced to go to therapy or go to jail or get forced to go to therapy or don’t get your kids back. Those choices might suck and there’s still choices. What we are doing is stepping to the side. 

There’s this tension between them and whoever’s making them come there. We’re not standing firmly on their side. We’re not standing on the side of the law and government. We are in a totally different parallel position where we step to the side and our client comes with us. 

Because truthfully, they’re not gonna be on probation forever for the most part. They’re not gonna be involved with the court forever. This is a short period in their life. So we need to approach them like this is temporary. Your life from here forward isn’t gonna be always court. So what do you wanna do about that? 

Everybody that comes in has family, has friends, or has had them, has likely had their heart broken, potentially has been in love, has fears, has insecurities and worries, has questions existential and otherwise why they’re there is irrelevant when it comes to the future work that you’re doing.

So I have two things that I go with. One is, well, sounds like there’s no way to get out of going to therapy. Is that right?  It doesn’t sound like there’s any wiggle room here and they’ll say, yep, I have to go.

Okay. So. Court says you have to go and you’re choosing that. You’re gonna go along with that even though you don’t want to. Yep. Okay. So what you have to decide is first of all, who you wanna see. You don’t have to stick with me just because you gotta sign to me because I’m telling you therapy needs to be with somebody that you feel like you connect with and so it’s really important that you have someone that you dig. If you don’t, we need to get you someone else. 

I am happy to see you. You go ahead and keep scheduling with me and I will be with you during this whole thing. I am not part of the county or part of probation or whatever. I am on the outside and I know that you have to do this for a requirement, but we can work on stuff that you actually care about; things that you actually want to do. 

The court and probation and parole, or all of those justice system related people, don’t usually care about the contents of our sessions. In my experience they care if the person shows up and if they’re engaged, And by engaged, they mean, are they talking and being generally decent and pleasant? That is what the justice system cares about. In most cases, the justice system is trusting us to do our job with the content.

I usually explain that to the client. I’ll tell them that my role is not to report on them. And if they have any questions about what I have to say then we’re gonna side step again. And talk about that before we step back into, what am I gonna document?  

Truly we are not there to be the arm of the justice system. That’s just how they got to us, which is unique and it’s not the entire thing that’s happening in their life. Let’s find out what’s under. 

So I talk with them about their choice of therapist and how they wanna do things. And then I say, if you decide to stick with me, I’m happy to do that and we gotta find some things that you wanna talk about because it sounds like there was other stuff going on when this situation happened. Doesn’t sound like life was going that great. Sounds like you were struggling with depression or anxiety or whatever the case is.  Maybe we can talk about that so that when this court stuff is over, that you actually feel better. That is powerful. 

Right now, someone who’s court mandated in any way feels like that is the biggest thing ever and it is all they see. We can help them see the other side. We can help them see life beyond it. And that this is momentary. Let’s figure out what was happening before this situation, because I’m guessing life wasn’t awesome. And so we find things that they care about.

In this way. We are empowering the client. That this treatment or therapy that they’re in can be about them. It does double duty because it is meeting a requirement, but it’s not just for the court. It’s for them, for their partner, for their family, for their children, for themselves. People get behind that. 

I will usually challenge them and say, okay so I want you to think about what that would look like and what you might want to be going better for you if you’re gonna keep seeing me, if you see me, then we’ll work on things. But what I don’t wanna do is spend the next, however many months, having you feel frustrated every time you come here, having it make you more angry or more upset or more resentful. I want this to be a place where you feel heard and where you feel like we’re actually working on shit you care about. Obviously, you’re gonna say that in your own way.

I have a lot of experience working with people who absolutely do not want anything to do with me. They don’t wanna talk to me. They don’t wanna see me and they fucking hate everyone. And I love that population. Because it doesn’t take me very long to get past it. 

What those people need from you is for you to be a real person, understanding that now, as an adult, someone is in control of their life. It may be their fault that that’s happening, but you can understand how that would be scary and how they might feel.

I have found that once people stop needing to defend themselves, they will walk themselves around to the parts that they can own. I do not help them avoid responsibility. I do help them own what they can. That they were using this drug, or they were in possession and they shouldn’t have been, or that they were driving when they had too much to drink. They might not have meant to, but they still did it and therefore are responsible. 

I can do that and at the same time, validate that they feel like the cop was too harsh or they feel like losing their job was unfair based on it being their first DWI or something like that. We don’t have to pretend that somebody is a victim of the justice system when they’re not.

There are times when I have clarified a story with an agent or somebody and found out that indeed this person kind of got a raw deal. I usually ask why something happened and get some clarification. And is there any way that the person can advocate for themselves or change anything? And if the person’s stuck, I acknowledge.

Usually I’ll say, do you mind if I talk to your agent and have them tell me , what’s happening here? Why is it this much time? I’m not gonna talk to them about what we talk about, but I just don’t understand why you have this much time over your head for this charge. And they’re usually super open to that and really appreciate it.

Cuz they want someone to answer that question too. And if I come back and I don’t have a great answer, they’re gonna be like, yeah, I kind of figured you’d hear that, and I’ll say, I don’t see any way around this. So here’s my thoughts. Let’s work on this, this and this, or let’s talk about this or let’s try to get you moved into this situation.

They want a way out and they want to be able to see clearly, and you can do that. And I’m telling you, it feels fucking awesome when you realize that the person who was like, fuck this, I don’t wanna be here is all of a sudden, like I got the text about therapy and I was so excited about that cause I have a lot to tell you. That is inspiring. 

Getting the trust of someone who was determined not to trust you. That’s awesome. So when you’re working with mandated clients, The first thing is to hear their story.  Resist the need to challenge them about their cognitive distortions or blaming or any of that. You’re just hearing them. 

Understand their motivations and what’s going on for why they’re there and listening for anything that tells you what they would like to be different. You’re listening with empathy and you’re validating their experience, a feeling out of control or feeling resentful and then it’s time for you to paint a new picture about what therapy could be like. 

We’re empowering them to look at this opportunity of therapy as how they can take some time to think about themselves and what they want. And that you were there to help them with that. And yes, you will sign off that they showed up and engaged. You will only share the information that is necessary and not things about their trauma and all sorts of other things without their permission. 

Yes, you need to be careful about how you’re documenting, but we’re careful anyway. And if you’re not  you really should be. I have been cross-examined on the stand for more than two hours, and that really changed how much I write things down. There is a middle ground between doing really short notes that mean nothing and really long narratives that are like a play by play of a session. 

You’re basically working to get an agreement that you’re gonna help them meet this requirement and that once that agreement is made, it’s on the back burner, because it’s not that important. What’s important is the person in front of you. 

If this isn’t working and if the person is getting belligerent and argumentative, that’s when you step to the side. You Dodge, just like we do with teenagers. I don’t engage in some kind of a fight about why they have to do this. I’ll say, look, I don’t know about your conditions. I don’t know what’s gonna happen if you don’t. What you’re telling me is you’re court ordered. 

You’re not court ordered to see me specifically, and I’m not court ordered to see you. If you wanna see me, I want it to be because we’re gonna work on some actual stuff that matters. Not because you’re just pissed off and gonna sit in this chair every week. Like I’m not doing that. And it’s a waste of time for you. And I’m pretty blunt about that. 

I don’t bust that out unless I really can’t get them to turn the corner so to speak. But when all those fail, I will say that. And I’ve probably had, let’s see, I have kicked two teenagers out of my office and I think four adults out of the agency in 14 years.

 The teenagers were pretty antisocial and the adults for some egregious things that they did to the staff or in a treatment group or whatever, following protocol and warnings and all that kind of stuff. But six people when we had 14 years of 12 to 15 therapists. Like that’s a lot of people. Most people are just people, they wanna be heard. 

Last thing I’ll talk about is when you have to make a recommendation and you know, it’s gonna piss off the person. So if you have to do an evaluation like Ben working in community to mental health, he might have to recommend more sessions for someone.

Usually what I say when they come in and I’m doing an evaluation and they’re not necessarily gonna see me, I will say, okay. So here’s how this goes. I’m gonna ask you questions. You’re gonna tell me what you tell me, and then I’m gonna tell you what I think. Whether you follow through on the recommendations I make, it’s up to you. It’s got nothing to do with me. My job is to give you a recommendation about what it is I think might be helpful. 

First of all, what that does is take you out of this Ben’s making me do this thing. You still are doing all the steps. I talked about hearing their story, listening, validating, et cetera. At the same time, you are fulfilling the requirement that you have to say what you think. And all you can do is say, okay, based on what we talked about today, here’s what I’m thinking. I know you’re not gonna wanna go to a group. I know you’re not gonna wanna go to therapy or whatever it is. I think it would help you because I heard you talk about this, this, and this.

That’s gonna be my recommendation, what you do about that and where you fulfill that recommendation is up to you. You can do that here. You can do that at another agency and I can give you names and numbers, but that’s gonna be the recommendation that goes forward and I wanted you to know that so that when you get to your agent court, lawyer, you aren’t surprised. 

They will appreciate the frankness in the way you told them, because they feel like the law and the court system isn’t being upfront with them because there are all of these statutes and written rules and unwritten rules and things that they don’t understand because the criminal justice system and lawyers speak in a totally different language than us. They will appreciate you being frank and open with them and validating that it sucks to have somebody tell you what to do when you’re an adult. Letting them know that you did think about the recommendation and didn’t just judge them because they have a charge.

It helps. It really, really helps. It diffuses some of the most angry sessions I have ever been in. One of the things I love is that later on, as I know this person, I can call them on their shit, I can say.

Okay. Okay. Okay. Now I know that you’re pissed and I agree with you that it seems like  all these recommendations, it’s a lot for you to do, and you did kind of have drugs on you. Right? The relationship with them allows us to call them on their stuff and to validate their experience and help them feel like, yeah, you don’t have power over this thing in your life, but you do have power over all these other things. Let’s focus on that. 

I believe that the majority of people that we see can be worked with, I have seen people come to treatment for substance use and get sober. They end up coming initially because they have to, and then they stay because they want to. People often get sober because they have to or they’re gonna go to jail or for their children or for their partner. 

If you ask sober people who have a long term sobriety, they can tell you why they got sober. And then they’ll tell you that now they stay sober for them. I will take whatever reason they have. If their reason is to get probation off their ass. I’m good with that. I don’t need to correct that. My thing is alright, that’s why they’re showing up. They’re showing up and they’re engaging with me, fine, but the reason shifts, and I don’t usually point it out unless they’re at that place of insight, but it’s really cool to watch.

I really wanna encourage you when you have someone that’s coming in that’s mandated. I wanna encourage you to shift your mindset from feeling like, fuck, this is gonna be a pain and a waste of my time and I hate this. The mandated clients don’t change, to a different place of  as soon as you get past the wall of the mandate, it’s just like therapy with anybody else.

The myth about addiction and substance use is that someone has to want it. I can tell you that  they do want it. They do want things to be better. They may not know what that means and sobriety is scary, but what we’re doing is providing them an opportunity to talk about it, to have feelings about it, to be confused, to be unsure, and that’s all they need. There is a desire to change in almost everyone. We just have to get past the resentment to find it and who better than us 

Whether a person is mandated or not, we have to determine whether or not they’re right for outpatient therapy. Sometimes when substance use shows up, it can be difficult to know whether this is in your wheelhouse or. Is their use appropriate for outpatient therapy or does this really need a substance use specialist? There are times when a substance use specialist is needed. In light of that, I created a free tool for you called the Substance Use Decision tree.

The decision tree helps you quickly determine if the person needs a substance use specialist. In addition, it also helps you look at how ready they are to talk about their use. The idea behind this is that if the person can be seen in outpatient therapy, that you need to know that it’s okay for you to work with them and I’m giving you my opinion about where I think that line is. 

I will say this. If they do need a specialist, I would encourage you to stay on as their mental health therapist, because they will need you. Substance use specialties are oftentimes not master’s level therapists and that person might have some mental health training, but they’re not a mental health therapist.

Underneath addiction and substance use, almost always, there are mental health struggles that are happening. So even if you go through the decision tree and it comes out that you need a specialist, I encourage you to stay on. And let the person know that you feel like they need another person on their team, but that you would really like to work with them if they still want to on the other issues such as family, anxiety, depression, whatever the case is. They will appreciate that you are not farming them off to someone else. They will appreciate that. You’re telling them they need to do something more, but that you’re gonna walk with them. That’s huge. 

You can download the Substance Use Decision Tree for free at my website, go to Betsy byler.com/tree. You just pop your email address in there and you’ll be able to download it right away. 

I wanna say thanks to Ben for reaching out to me about working with mandated clients. I encourage any of you who feel like there’s something coming up for you in your anything related to substance use and mental health. I am happy to answer. I will either answer you an email or it might even be a podcast episode. 

Please feel free to reach out and you can email me@betsybetsybyler.com. Or you can use the contact form on my website at betsybyler.com.

Next week we’re gonna be talking about the reasons people use and what that means. I hope you’ll join me for that podcast and until then have a great week. 

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links

RACGP – Motivational interviewing techniques – facilitating behaviour change in the general practice setting

Understanding Motivational Interviewing | Motivational Interviewing Network of Trainers (MINT)

Motivational Interviewing: Definition, Techniques, and Efficacy