Tuesday, 2 September 2008

Feeling lost

"A long-tenured addictions counselor sheepishly shared that he was leaving the field—that it was getting harder and harder for him to feel good about what he was doing. He elaborated as follows, "Something got lost on our way to becoming professionals—maybe our heart. I feel like I’m working in a system today that cares more about a progress note signed by the right color of ink than whether my clients are really making progress toward recovery. I feel like too many treatment organizations have become people and paper processing systems rather than places where people transform their lives. Too much of our time is spent fighting for another day or a couple of extra sessions for our clients. I’m drowning in paper. We’re forgetting what this whole thing is about. It’s not about days or sessions or about this form or that form, and it’s not about dollars; it’s about RECOVERY!"" From: Linking Addiction Treatment & Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches by William White and Ernest Kurtz

Anyone felt like this? Or heard something similar?


Anonymous said...

I wish anyone well that has served the community and I cant be that person nor he me,personally I find the change towards integrated care challenging and new.Im aware of discontent with pressures to see more clients than one should was one comment I heard,supervision should hopefully sort problems out.I see the new integrated care assessment form looks great,it,ll keep all information together and track a clients progress.No one department or person is going to fix,(I actually heard someone use this label), a person and no one should feel obliged to take this on.Clients find their own empowerment and stage management will help them towards their goals,bureaucracy and paperwork will attempt to de-personalise the process of recovery though neccesarry records help delivery of treatment from well assessed clinical interventions.Motivation of staff as well as clients is essential to prevent burnout and dropout.Change takes place for us all and a suggestion is for to look at alternatives were you feel your skills would benefit clients best,remember solutions towards recovery and use regular supervision.If clients are coming back they are getting something out of it.

Unknown said...

I see the new integrated care assessment form looks great,it,ll keep all information together and track a clients progress.

Anonymous said...

How very sad and yet understandable, it seems as though a healthy therapeutic alliance is being sacrificed to bureaucracatic, and possibly politically expedient procedures, which have little or nothing to do with recovery. On the other hand a strong therapeutic alliance is often more effective than techniques or procedures in bringing about beneficial change(s)

Fortunately I don't work in the public sector, but in common with those who do, not infrequently I encounter client resistance, at which point I take an inventory of myself as follows:
Have I spent enough time in establishing an effective therapeutic
relationship with this client before introducing specific techniques into
the work we are carrying out together?

Am I paying sufficient attention to and listening carefully enough to the
real needs that this client is trying to express?

Am I trying to 'steal' my client's problems from him so that I can 'fix'
them my way, rather than helping him find his own way to resolve his

Am I properly aware of the impact of power balance(s) in our work together
(e.g. "have now decided to get my client to do ....")?

Am I more concerned that a case formulation should fit a preconceived
theoretical model rather than make 'felt' sense to the client?

Perhaps it might also help you to know that all my clients develop their own
case formulations to build on - my job is to facilitate them as needed in
doing so.

However, to be fully effective in our work together their case
formulations must also make 'felt' sense to me.
My 'felt sense' arises not just from an empathic awareness of the emotional
impact of my client's difficulties, but also on my understanding of the
cognitive, psychosocial and other relevant processes involved in this
specific case - an understanding that derives both from my previous
experience with other clients and from my knowledge of the theoretical
underpinnings that can help 'ground' my client's descriptions.

Sharing our mutual understandings of the evolving case formulation within a
pre-established 'safe and trustworthy' working relationship usually forms an
effective and problem free platform for further work towards resolving the

Hope that helps. On the other hand if you're too busy having to tick the right boxes with the necessary coloured markers, there wont be time for any of that.

PS there's some interesting comments on recovery in 'Addiction Today' that's worth a look.

Anonymous said...

This what happens when you tie yourselves to medicine by adopting the idea that addiction is a "disease". In the US, where there is no National Health Service, all payment is through reimbursement from insurance companies--who require mountains of paperwork and justifications for treatment as their primary reason for existence is to deny care! I wonder how much this is a problem in other countries?

This is also reflective of the move toward "professionalism" as the speaker mentions--when you take what started off as a mutual support group (AA and other 12-step groups) and turn it into the primary treatment modality that you use for treatment of a medically defined entity--a "disease", you lose the basic function of the group--people helping each other overcome a mutual difficulty, without compensation other than the satisfaction of having helping a fellow human being!

David Clark said...

A lot of people here moan that they spend so much time filling in performance measure forms. There is often far too much paperwork. And this is often used to justify the worker's existence, which is another gripe. You can imagine what this can lead to.