It’s Up To Us

Episode 4

Why is addiction treatment training important for mental health therapists?

How will addiction treatment training help you better serve your clients?

This is part 4 of the five-part discussion about why addiction is absolutely the business of mental health therapists and why we all need to know how to assess and treat addiction in our mental health clients. 

In this Podcast:

• Some people aren’t sure addiction is our (therapists) business. I maintain that it is completely our business. 
• It’s been overlooked, but I don’t think it’s been on purpose.
• Relationships are the key and foundation of therapy and a huge part of why people get better.
• Transferring someone can damage your relationship with them and keep them from moving forward.
• You don’t have to transfer your clients who struggle with addiction. You can treat them yourselves. 
• Your clients want you to be competent to handle their addiction. 

Helpful Links:

Addiction Treatment Training for Therapists

Free Treatment Planning Tool  https://betsybyler.com/treatment-tool/

Quiz-How ready do you feel to work with substance use? https://betsybyler.com/quiz/

Transcript:

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse 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 confidence needed to add substance use to their scope of practice. 

I take topics that are typically aimed at substance abuse counselors and share them with mental health therapists in a way that is relevant and tailored to meet our needs. By adding substance abuse to your scope, you can expand your ability to treat the whole person and better meet your client’s needs.Bringing more hope, healing and freedom to the people you serve.

Doing therapy is hard work. Made harder when addiction is thrown into the mix. Many of us didn’t get the training we needed to deal with substance use and finding the knowledge that you need to fill that gap can be difficult. Each episode, I’ll bring you information on substance abuse, topics that impact our work, helping you gain knowledge and confidence. In a relatable and practical way. So join me each week as we talk about All Things Substance.

In the last podcast, we talked about the reality we face as therapists once we are licensed and fully into the job of being a therapist. This week, we’re going to talk about substance abuse and why it’s up to us to bridge the gap between mental health and substance use for our clients. So I wonder when I talk about substance use and I suggest that you, the mental health therapist really do need to know and be competent at this. I wonder how you feel.

When you get a person coming into your office and you know that they have substance use, what happens inside? Does it fill you with dread? Do you feel kind of competent, but a little concerned? Maybe some of you are really competent and I love that and I think it’s great. And for those of you who don’t, I believe that we can help you, not just feel competent, but actually confident in your ability to assess and intervene in someone’s substance use.

Now, there are some who may disagree with me, or there are some that aren’t sure it’s our job. So let me talk about that a moment. It would be a reasonable conclusion to think that substance use isn’t really our responsibility or in our scope based on our programs. We could assume that our programs knew more than us and designed themselves to show us all the things that we needed. We could look around at other programs. We could look at publications of people in mental health, and we might come to that very same conclusion. 

My argument is that it isn’t that our programs didn’t think substance use was important, it’s that they had to develop their programs based on what the licensure said they needed to teach us. And the licensure based itself on some of the preexisting programs, which probably had to do a lot with psychologists. Now, psychologists aren’t really taught about substance abuse either. There have been articles from the APA to Psychology Today, that substance use isn’t something that they’re trained in.

Here’s an example. I was looking at getting CEUs attached to a training that I was providing. So for my license, I’m a licensed professional counselor. And so my CEU board would be NBCC. So that’s the National Board of Certified Counselors. And I went to look at their content areas. And I noticed two things. One they’re almost identical to the NCE content areas. And the NCE, for those of you who didn’t take that one, that’s the big test that we have to take us as professional counselors. And the second thing was there was no area for substance use. And so it’s really reasonable for people in the mental health field to feel like substance use is outside of our scope.

But I want to challenge that because it’s literally in our manual. The diagnostic statistical manual has substance use in it for us to look at, assess, and diagnose. Now, there are a lot of things in the DSM that we will never diagnose. We all know that there is a handful of diagnoses that we use all the time. And then there’s the next layer that we don’t use a ton. But it’s there. And then again, there’s a third level that we use rarely, but we still know about it. Outside of that, there’s a  whole bunch of diagnoses that unless we’re in some sort of special niche, we don’t really pay much attention. And that’s not that we’re being negligent.

It’s that they don’t come up that often. We’re talking probably a plus three standard deviations from the mean. Substance use isn’t one of those things. So I’ve made the argument and I’ll repeat it here. That I believe that substance use touches the lives of almost all of our clients. I would say all, but there’s going to be a few that they just don’t have that in their world.

Now, maybe it’s not your clients that are using, but someone in their orbit. It could be, a partner, a friend, a parent, a cousin, a daughter, a son, a roommate, a coworker. Addiction doesn’t stay with just the person. It spills over onto everyone around them. There are different research studies that estimate who is affected by a person’s substance use. One of the articles I’ve read suggests that addiction affects six people for every addict or alcoholic. Those of you listening, in your own world that have addicts or alcoholics, you know that this is true. It does affect the people around them. And if it’s not your client that’s using, then they need you to help them understand addiction and understand their loved one’s actions.

The things that addicts and alcoholics do when they’re in the middle of their use are incredibly hurtful. They don’t mean it that way typically, and it can feel incredibly personal. And part of your job is to help reframe the use to help your clients see that it’s not about whether or not they love them enough and it’s not personal that the person keeps using.

And in order to do that, you have to really understand addiction. And I believe that the message has been that it’s not our business. And I argue, yes, it is. It’s in the manual. It’s people’s lives. People use substances. People have always used substances. People in history, every culture, even in tribes that haven’t had any contact with modern civilization, there is substance use.

It’s just part of the human experience. And so, we have a business to take care of this. Now you may be thinking, okay, I buy that substance use is a problem. We should know it. I don’t know if I need to know it though. And I’m going to make the case that you do need to know it. You specifically. So when people come to see us, the very first session they’re thinking about, do I like this person? Can I talk to them? And they have to sort of open themselves up emotionally to determine whether or not you’re going to be even a decent fit for them. And they’re doing this thing of, “am I going to come back” pretty much the whole time they’re in your office. They’re debating. “Hmm. Do I like them enough to come back”?

And so that’s when they start the relationship with you and each time they come back, they add to it. So two months down the line, when you get a sense that their substance use issues. The idea of having to tell them that you have to transfer them. It’s going to be really hard for them. And most of them won’t follow through with the referral.

There was an EAP company that our agency used and one of my coworkers was going to use her EAP. So she went to see an EAP therapist for three to five sessions and decided that she wanted to continue therapy. What she was told was that she had to switch therapists. That she couldn’t continue on with the therapist that she had. This was a huge blow. And what she was told was that the reason they had this policy was that they didn’t want therapists to be artificially filling up their caseloads. And so each person who had EAP, if they wanted to continue, had to begin again with someone else. Now, this therapist absolutely did not want to do this. And so she didn’t continue. Imagine an average person doing that. 

Okay. As therapists, we know what it takes to build a relationship with someone. And we know what it would take to build a relationship with a therapist we were going to see. That relationship is incredibly important. And I would argue that it is the most important thing that everything else falls short of the importance of the relationship.

The relationship is what brings people back. That’s what encourages people to tell you more about themselves and to tell you those deep secrets that they need to share in order to get the most amount of freedom in their lives. And it isn’t necessarily about the therapists competence. So I’m going to tell you a story about an experience with a therapist I had when I was in graduate school.

So in my program, we were all encouraged to go to therapy. And it would turn out as we move forward that we kind of needed to, because as I said before, grad school was kind of a crash course in facing your own issues. Even if your issues weren’t that large, you can’t sit in classes and have them talk about things and not recognize yourself in some of them. And, I think it’s really important that we do our own work and that we know what it’s like to be on the other couch. It gives us an insight into what our clients are going to be going through. 

I didn’t have health insurance. And so I needed to go to a place where I could pay cash and being a grad student, didn’t have a lot of money. And so I went to someone who was working on her hours. And I’m sitting in the lobby and I’m waiting. And I’m not really that nervous. I’ve been to a therapist before, as I told you guys about in the first episode, and I’m comfortable, ready to talk. And the whole way there, I’d been thinking about what I wanted to talk about and what things I wanted to focus on this time in therapy. 

So I hear my name and I turn, and I look at this woman and I know instantly it’s not going to work. And I go through this really quick thing in my head, and I decide I’m going to grow. I’m going to do this. I’m going to talk to someone that isn’t like me. Now a lot of you are going to be thinking, how could you judge someone the second they walk in the room? And the thing was, I wasn’t judging her competence, her character. It was merely that she reminded me of a very particular stereotype when I was growing up. And it’s a stereotype that was really hard for me. And it played a pivotal role in me trying to become something I wasn’t in order to fit into this particular world. And I had come past that and had accepted that I am the way I am because I was built this way. And that, that was perfect. Not that I was perfect, but that the way that I was made, emotionally, my energy, the way I’m out there in the world was perfect for me. 

So I go back with her and I decide I’m going to be open. I am going to do this. And I tried and she was competent. She absolutely knew her stuff. She knew how to join with people. She knew how to make you feel comfortable.  And I stayed with her for a year, one full year and it didn’t work. We had pleasant conversations. We talked about things, but I didn’t get real.

It wasn’t that I was lying because I wasn’t, I just wasn’t myself in terms of being vulnerable. And at that time in my life being vulnerable was not a normal instinct.  I did not grow up in such a way that being vulnerable was something that we talked about, or that was expected. We just sort of we’re in a world of, well, you’re not bleeding, move along.

I remember about halfway through the year, I realized that I wasn’t really getting real and I tried to address it. And I don’t know that I explained it very well because I wasn’t really sure how to explain it. But I remember talking about the fact that she and I were really different. She was very calm and quiet and mild. And I’m kind of, not really those things. I mean, I’m calm. And as I’ve gotten older, I am far more chill and relaxed than I ever was, but I definitely would have stood out in a crowd where she wouldn’t have. 

And so I was just talking about this and she asked me for an example, and I said, well, let’s talk about swearing. I kind of say, fuck a lot. I enjoy the word and I know that some people don’t like it. And so she said, well, I don’t mind curse words. K. So if you’re a person who uses the word, fuck a lot, you don’t use the phrase “curse words”. Now that could have been cultural, but I’m pretty sure she and I grew up in the same area. It’s just not really part of her vocabulary. And that’s okay. The fact that I didn’t mesh with her had nothing to do with her as a person. We cannot be anyone other than who we are. We have to be ourselves. Otherwise what’s the point. 

And so I kept trying and I kept staying and showing up and I tell you, it just didn’t work.  And I’ll tell you, it wasn’t that I didn’t get anything out of talking with her. One of the more important things that I realized I got from talking with her. So she asked me one day when I last felt sad and I thought about it and I was like, Oh, I don’t know if I really get sad, upset, maybe, but not sad. And so she challenged me about that, asked me what I thought about the word, sad. What it meant. And so I was thinking about that as I left the clinic. And so I’d like, Hmm. So I called my sister and I was like “hey dude”  And she was like, ”what”? And I was like, when was the last time you felt sad? And I kid you not, she said, “I don’t really get sad, upset, maybe, but not sad.”

Fuck. So that’s when I knew I didn’t do sad because my family didn’t do sad. And so that started me thinking about why is that a problem for me? And it was an important realization. At the end of my first semester in grad school. I decided that it just wasn’t working for me and her. And so I decided to go to a different therapist who a number of people in my class were seeing. I think six of us ended up seeing him. And I never, in a million years thought I would see a male therapist only because my experiences with them when I was a teenager were not great But a lot of my friends would see this guy and they really liked him. And his name was Steve. And so I called him and I headed down to his office.

And he opens the door and he is super cheerful. I mean, like could be Mr. Rogers’ neighbor. In Dockers and a short sleeve plaid shirt, glasses, and he’s just all smiles. And we sit down and we start talking and within the first five minutes, I think he said, fuck like three times. And I was like, Boom. All right. I think we can do this now. Steve and I were really different people, but he spoke my language and it’s not that I have to swear. I know that sometimes people get funny about that. It’s just that, because that’s who I am when I’m being real. I needed to know he could go there with me and be on the same level.

And once that was decided, I was perfectly okay to just be vulnerable and let him lead. It’s part of why I chose to use the normal language I would use in this podcast, even though it means that I have to list myself as explicit on iTunes, which sort of killed me. But. It is what it is. I decided I wasn’t going to do a podcast where I had to be cleaned up because frankly it’s not who I am. 

I always tell my clients that there is freedom in being yourself and not needing to change that, to match other people’s expectations. Doesn’t mean that you have to be allowed and in charge all the time, just that you need to live authentically. That relationship between you and your client is where that occurs.

You are authentically you with your clients. They respond to that authenticness and it’s you that they need. So I want you to imagine what it would be like if you felt competent in substance use work. I want you to imagine that you had all the information that you needed in order to do a good assessment and figure out treatment recommendations for someone. I want you to imagine that you would be able to treat their addiction right there in your office. This is not to say that I don’t think, I think that structured treatment programs aren’t important. I absolutely do.  

I ran in an outpatient treatment program for the last 12 years. They have their place and can do amazing things.  And the things that they’re really good at are building community, having a group sense of accountability, psychoeducation, introducing people to the concept of sharing about their addiction and getting real. I think that outpatient treatment programs are great. And I think they’re a great add-on to mental health therapy, even better If you can work together.

In the next episode, I’ll be talking about what’s next. For those of you who want to expand your skillset to better serve your people. Just because we didn’t get the training doesn’t mean we have to stay there. And next time we’re going to talk about how we can evolve.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist, friends, and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s 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..