Detox Diary - Chapter 1

September 28, 2003

As I drive to work each afternoon (I work the late shift from 2:30 PM to 11 PM) I try to focus on what I what I want to do that day. Since I am learning different methods of therapy in my classes, I thought I would actually try some of them out while working with patients. In particular, I am learning about Rogerian therapy this semester, so I decided to try it out tonight.

This type of therapy takes a positive view of people, believing that most people move toward becoming fully functioning. It emphasizes caring and understanding rather than giving advice. Therapists strive to be "genuine" and to truly understand the client. Carl Rogers, who developed this approach, felt that if patients are able to perceive the therapist's desire to be empathic, therapeutic change can take place. In other words, the client will get better if he believes the therapist understands him and accepts him as he is at any given time.

Since I was in detox tonight, I never know what to expect. Some of the patients are so sick it's hard for them to talk coherently. Though I can manifest an intention to use Rogerian therapy, there is no guarantee that I will have the opportunity to actually use it, or that it will even work. So perhaps it may be more realistic to work on my listening skills as Carl Rogers suggests in his works. I will listen intently and with purpose.

I only had four patients tonight which was great. I was able to give each one a good portion of counseling time. But even with four patients I find it very challenging to listen effectively. As the oldest child I always want to take charge; to listen intently I have to ignore that impulse completely. When a patient told me she planned to return home immediately after detox, I wanted to say, "No, no, you need further treatment," but as I listened carefully I realized she had her mind made up and nobody was going to stop her from leaving. As a counselor in detox I am often faced with a patient who has their mind made up to go back to their old lifestyle, to refuse additional treatment, and I have learned that these patients are not ready.

A year ago, I would have argued with the patient and spent an hour telling her how she HAD to stay longer if she wanted to remain clean and sober, but this night I just listened. What I heard was a woman who was not ready at this time to give up her drugs or to give up the drug lifestyle.

The best that I could do was to let her know what help was available if she wanted to stay at our facility, and to talk with her about Narcotics Anonymous, a support program, and offer to help her set up outpatient counseling. I knew what I was saying was falling on deaf ears at that time but it is policy to never let a patient leave treatment without offering to set up some sort of aftercare. This woman will leave with the name of an outpatient counseling agency (we'll arrange the actual appointment if she'll agree). We'll give her an AA book and an NA pamphlet so she'll know where to go if she decides to make use of either of those groups.

I did listen carefully and what I heard was this: "I am not ready at this time." It's a hard message to hear as a substance abuse counselor.