I feel a little nervous addressing this topic and that makes me smile. The reason is, that working in addiction has been one of the most thrilling, scary, rewarding and satisfying experiences of my life after being a Mother. I like the fact I can still feel nervous about tackling addiction, even with over 10 years experience in the field; because it reminds me that I am not complacent, I do not feel I know it all, I do not have a need to feel like I know it all and I am still open to learning after all these years. In fact, for anyone who is thinking of working in this field, that would be my first advice, keep it real, stay open-minded, the minute you think you know it all, is the minute your mind could become closed and you risk losing your skills.
When working with someone who has experienced addiction, you will be faced more often than not, with someone who has become skilled at lying, deceiving and manipulation. That sounds kind of judgemental maybe, but it is a fact and anyone in recovery will tell you what an important fact that is. It is an extremely challenging field, as you are mainly working with life or death situations, especially in a rehab environment. As a worker, you know that you have to be on form as best as possible, to help the person in front of you so desperately needing help, and so entangled in their own destructive behaviours. You can be faced with hearing about the darkest corners of this world and the types of things people can be involved with or a victim to. All of that can feel a little overwhelming to say the least, at times. So as a worker there can be some pressure to fall into the trap of trying to focus on appearing capable or competent when in reality you are as a human maybe more ‘shell-shocked’. In addiction you are working with people who are fine tuned at using or spotting manipulation; who can often read people with the skill set of an expert psychic. When someone has mixed in circles of addiction, they often have needed to develop these skills to read people, to survive; so the minute you fall into the trap of worrying about how you appear, in front of someone who has been in addiction, you are at risk of losing rapport straight away, and can risk losing an opportunity to help that person who will so desperately need help, because they will see right through anything that is other than genuine.
I have had conversations with other counsellors who I respect highly about counselling in general, how some counsellors can begin to ‘act’ like a counsellor, taking on some front of professionalism in sessions. When you are a counsellor, you are tied to professional bodies and required to represent those professional bodies and behave accordingly. I totally agree with that and believe strongly in the ethics of my career. There is a fine line though in my opinion of how to balance congruence, genuineness and responsibility as a counsellor, whilst being true to yourself and living a life just as anyone else would. My choice is to be me, and as myself use a certain skill set I have been trained to use and making sure my behaviour is within certain boundaries of my profession but most of all, making sure my behaviour fits in with a choice I make for myself. I strongly believe that my choice to remain true to myself and to integrate the counselling into my way of being, is what has helped me develop good rapport with the people I have worked with over the years. Counselling in addiction requires genuineness, more than anything, because often the people you work with are desperately needing that, due to coming from a world that is often ruled by deceit. The minute a person in addiction senses anything less than genuine; and believe me they will spot it a mile off, then their guards and defences will be up. If you are not skilled enough to be congruent, then you will not be skilled enough to help that person.
My heart warms at a sudden realisation, that the many people I have worked with, have actually helped me ‘be me’, that it is something we have worked on together, with the benefits happening for both of us. No wonder I find counselling such a special heart-felt bond with others.
So once you gain rapport, and take yourself into that session and not some professional card board cut out, you can then begin. That is where the tingle in my belly begins. It would be impossible to write a straight forward account of my work. Every person is different, every experience is different, every experience of addiction is different and every background is different. You often end up with a tangled theme of similarities with each person at best, to claim as ‘experience’.
Safeguarding is the most important factor when you start work with addiction, assessing risks and safety of the person and anyone around them. That can range from health concerns, blood borne viruses, risk of psychosis, depression, anxiety, malnutrition, homelessness and so on; to threats of violence or suicide. Luckily in rehab a person is as safe as they can be, with a good routine and set of basic rules in place to promote stability from chaos. As a counsellor, it is a great opportunity to be able to start working with someone who is more settled in a rehab environment. I worked in a day care setting for 10 years and trying to help people who were living in constant chaos, surrounded by risks was more than challenging, to say the least. Day centres, known as tier 3 services, are better for people with problematic substance misuse issues. Rehab’s are known as tier 4 services and offer more intensive support for those more vulnerable and at risk.
In a rehab setting, when working with someone you need to make sure that the person is settled enough and that they are engaging well in the programme. When counselling is working well, it can be very difficult for people initially, as they begin to address pain they may have been carrying for a long time; if people are not settled you could do more harm than good. If someone has been using substances for a long time, they have often been suppressing most of their feelings and feeling every day feelings can be challenging; so to begin addressing painful and possibly suppressed feelings can be extremely challenging for them.
Exploring painful experiences, can help a person let go of ‘baggage’, feel lighter, happier and help them make sense of why they may make certain choices and/or why they may have behaved in some ways. This is a valuable skill in recovery which provides a rich set of information and awareness of vulnerabilities which can link with triggers for relapse prevention. Self awareness is the key to behaviour change and gives more control around choices.
I love my work with a passion. There is a downside though; I can struggle with ‘small talk’ and can find things like face book challenging. When you hear almost daily, some of the most extreme hardships and experiences that a person can face, adapting to something like face book and seeing who has taken a dislike to who for whatever reason can feel confusing, in a way that I find myself wondering, why would that matter? When you work constantly, with people brave enough to admit their darker sides, and see them move towards their potential as a result, you can not help but feel dismissive of anyone who may show their darker side with no sense of responsibility or awareness. Being inspired by the people I work with, can make me less tolerant of the people around me out of work. I need to find a balance as everyone has a darker side, we all do. Working on my own darker side has been one of the best primers for the work I do today. Working at such a deep level of awareness and honesty, can really make general interactions feel strange for me. If there is a downside to my work, it would be that.
People in recovery are amongst the most inspiring people I have ever met, so much so, that they can make it difficult for me to get along with people who are living their lives, appearing ok, but not really waking up and learning who they truly are. I will find a balance one day. For now, I am doing my best and that is always good enough.
So a little insight into addiction counselling. Despite the challenges I love my job. How many can drive to work smiling?
Angela Neild Counselling Manchester