tag:blogger.com,1999:blog-4845992337963104415.post3754508665218715376..comments2023-07-30T13:37:17.999+01:00Comments on the prof speaks out: How Clients Make Therapy WorkDavid Clarkhttp://www.blogger.com/profile/08173564089937759693noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4845992337963104415.post-70794951302664037102008-10-14T11:39:00.000+01:002008-10-14T11:39:00.000+01:00I wholeheartedly agree with the philosophy on whic...I wholeheartedly agree with the philosophy on which the book is based, and also the comments of ‘dr dave’. <BR/><BR/>It is an approach that is integral to ‘The Process of Change’, which has more than withstood the test of time; an approach which I refer to as treating the addicted rather than the addiction.<BR/><BR/>I intend no criticism when I say that apart from the knowledge of addiction and the clearer understanding of it’s effects on the addicted, which science has revealed over the past 15 years or so, there is nothing new in the philosophy which can be traced back to the beliefs of AA and NA, and which regards addiction as a condition affecting mind, body and spirit. Without addressing all three within the framework of Prochaska and DiClemente’s work, we are failing those who seek our help, insofar as helping them to recognise that within the limitations of the mental, physical and spiritual harm that addiction has inflicted, their condition is healed with their own inner resources.<BR/><BR/>It is my firm belief that the process of healing and recovery begins at the moment my client accepts that he/she is the only one with the power,the authority, and the responsibility to permit the necessary changes.<BR/><BR/>Sadly, there is no room for such an approach has no place in either ideological or political agendas.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-75750650582708031372008-10-14T09:09:00.000+01:002008-10-14T09:09:00.000+01:00I agree whole-heartedly with the sentiments in thi...I agree whole-heartedly with the sentiments in this blog Dr Dave. This is a great response!!David Clarkhttps://www.blogger.com/profile/08173564089937759693noreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-3813415366626753512008-10-14T08:07:00.000+01:002008-10-14T08:07:00.000+01:00The development of self-efficacy is essential if r...The development of self-efficacy is essential if recovery is to happen and there are a variety of techniques we can employ to help the client find this. Motivational interviewing is a powerful tool in this regard.<BR/><BR/>As a doctor, I have some concerns about throwing the baby out with the bathwater as far as the medical model is concerned. Many clients have co-occurring mental and physical health issues needing diagnosis and treatment. Where I work we assess nutritional, dental, bood-borne virus, immunisation, sexual health, mental health status. All clients get a thorough physical examination. I don't think we've ever treated anyone who has not had an unmet medical need secondary to their addiction. Our treatment services are encumbered with a medical language still. We make a diagnosis of substance dependence based on ICD or DSM classification. We 'treat' people. The neuroscience shows clear evidence of brain disorder and structural changes. <BR/><BR/>There is a wealth of evidence now to show higher function impairment, low drive, anhedonia and reduced capacity to make healthy choices in addiction. We need to bear this in mind when supporting clients. In the intial stages many will need boundaries and structure, some of which they may not choose for themselves and here the balance is between 'do what you choose' and 'here's what works'. This can be a difficult tension.<BR/><BR/>I fully agree that we need to enable, support and mentor the client to the point where healthy choices, self-efficacy and empowerment are second nature. Abandoning all the elements of the medical approach would not serve our clients well I fear, although I don't think that's what you are advocating!Anonymousnoreply@blogger.com