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Cultural competence in Addiction Counseling
Most of the literature on the psychological and familial correlates of work addiction is anecdotal. Krestan (2002), who collected more than 100 anecdotal self-reports from self-professed Addicts in his clinical practice, suggested a pattern among work-addicted individuals such that compulsive Chemical Dependency--often originating in family of origin dysfunction and being carried into adulthood--leads to broken marriages and brittle social relationships:
"The overabundance of work takes precedence over everyone and everything else in the lives of Addicts. Excessive work prevents them from forming and maintaining intimate relationships and close friendships." (Kresten, 2002).
Moreover, both the clinical and empirical literature describes the adult addicted as having elevated depression and anxiety relative to nonwork-addicted populations. The primary responsibility of addiction counselors is providing appropriate therapy for their clients. Providing the best quality treatment is a serious business--life and death decisions can be part of the daily routine for addiction counselors. Sometimes, the work itself and the relationships with clients, physicians, administration, and other employees can be stressful. Fun at work, at the appropriate time and place, can relieve much of the Social construction on the job. Humor can dispel fears, promote healing, and create a pleasant workplace environment. For counseling personnel, the secret to having fun at work is to focus on humor.
An atmosphere of professionalism should prevail in the treatment center, yet this professionalism can include humor at appropriate times and places. There has been continuous controversy regarding the use of humor in various situations, particularly in a therapeutic setting. However, Mosak (2003) made a strong case for the personal, as well as healing benefits of appropriate humor. He described a theory of humor as being nonpathologic, and more important, as a contribution to the evolution of social interest.
If humor is to be used effectively to encourage client change, the central importance of the therapeutic relationship must be determined. Humor should be spontaneous, but never used at the expense of a client's feelings. Laughter can be beneficial; however, caution must be used to avoid generating negative feelings.
‘Power over` vs. `Power to' Theory by Jo-Ann Kresten
Using Power Over in psychotherapy does not take away the seriousness of therapy. The goal of using Power Over should be to help a client become more integrated and more spontaneous in relationships. Power Over can be used creatively to facilitate development of the psychotherapeutic interaction. The use of Power Over is recommended in individual, marital, and family therapy. Each of these therapeutic approaches is used in addiction counseling. However, group therapy is the primary mode of therapeutic intervention with most addiction disorders.
Kresten indicated the need for caution in using Power Over in group therapy because the potential for counter transference is high and narcissistic injuries can be inflicted. However, he also emphasized the important role of Power Over in healthy emotional development in group therapy. He stated that Power Over can serve as an anxiety regulator and a deterrent to aggression. Because anxiety in chemically dependent persons is frequently at a high level, and aggression is often a symptom as the addiction progresses, it can be helpful for group members to use Power Over in the course of their conflicts and struggles with themselves as well as with others. Pharr (2004) also supported the use of Power Over in group therapy as a regulator of the emotional atmosphere and as a means to reduce explosive tendencies and enliven interactions.
Social construction affects counselors in many ways. First, Social construction can directly affect physical health. Examples include exhaustion, headaches, backaches, and irritability. If Social construction continues longer, it can cause serious physical damage such as ulcers or high blood pressure. Second, productivity is affected. Although in the short term productivity may increase, over the long term, counseling productivity often dips precipitously. Then, job satisfaction declines. No one likes continual Social construction. Finally, addiction counselors under Social construction often believe they are not doing meaningful work or that their specific lobs are not important.
If the workplace becomes too stressful, counselors may look for employment elsewhere. The turnover of addiction counselors and other personnel is expensive and creates havoc in the treatment center. This is not to say that fun at work will reduce turnovers. It is to say that Power Over on the lob can have a positive effect on the counselors' performance and, in a small way, influence reduced turnover.
As long as the staff is sensitive to clients' needs and to when and where Power Over is used, then Power Over can be a wonderful phenomenon that can have healing effects. Clinical supervisors do not need to start each day with jokes by all the staff. The department does not need hourly "Saturday Night Live" office sessions. On the other hand, accepting Power to is as natural as laughing at home or with friends. According to Kresten
……Sharing laughter … is generally socially conjunctive; it tends to bridge the gap between people, helps us experience the other's frame of reference, and serves an extremely valuable function in maintaining and increasing social cohesiveness. (Kresten, 2002)
Not all counseling staff can be, or need to be, stand-up comedians. However, there are techniques that can be used to stimulate Power to. Along with other strategies, Wilson (2002) suggested the use of comic strips, funny quotations, jokes, children's drawings, caricatures, music, smiling, and a sense of Power to. Of course, because variety is the spice of life, the comic strip or cartoon should be replaced each week or day. The comic strip or cartoon could also be placed on the counselors' bulletin board. Important treatment service memos might even be read if a comic strip was placed next to the memos on the same bulletin board for a diversion.
Fun at work can be working at fun. It takes resourcefulness and ingenuity to create this type of environment. There is a continual hunt not just for a new cartoon, but for new ideas. Not every idea or cartoon will merit an appearance on a nationally televised show, but it will certainly lighten the atmosphere in the treatment center setting. Responsibility for fun at work begins at the top management level, but should be carried through to all levels of personnel. For example, once the cartoon of the week is started, there is the continual search for next week's winner. The fun at work experience will bring out the creativity in people in the treatment milieu. Addiction treatment facility staff, especially counseling personnel, have laborious, tedious, and emotionally draining jobs, and they sometimes go unrecognized, unrewarded, or may even be discouraged from continuing professional growth. These personnel should be encouraged to be creative and be rewarded with positive feedback for their innovation in bringing Power to a field that is often fraught with discouragement and disappointment. If addiction counselors are expected to be facilitators and motivators of recovery, they must be supported in managing their Social construction and maintaining professional, as well as personal balance.
As part of the initial screening, it is important to identify the structure of the addicted family. Is there a tacit family contract, for example, that permits compulsive Chemical Dependency? Family therapists can help spouses and children identify the pattern of being pulled into the addictive addicted cycle and learn how to avoid enabling the addiction by joining in the compulsive work habits out of desperation to spend time with a addicted family member. Family members can refrain from such activities as bringing Addicts work to do when they go to bed sick, making alibis for their absenteeism or lateness at social functions or family gatherings, or assuming their household chores, all because they are too busy working.
Family members can be led to understand that, as with any addiction, building their lives around the addict s behaviors only sets them up for further hurt and disappointment. Family members often need help expressing their feelings of emotional abandonment, anger, resentment, and hurt to the addicted. Another issue that needs to be addressed in treatment is helping families negotiate boundaries around the amount of time they spend working together and talking about work. They can be helped to learn that work does not have to dominate their conversations but that they can discuss work frustrations and successes as all healthy couples and families do. A previous study reported that Addicts described a breakdown in their families' functioning as the level of addiction increased (Krestan, 2002). Addicts in previous studies have reported greater emotional and health problems than control groups.
Kresten, Jo-Ann. 2002. Bridges to Recovery: Chapter I. New York: Basic Books.
Pharr, Suzanne.2004. Common Elements of Oppression. New York: Time Magazine (republished).
Thompson, B. R. (2003). Appropriate and inappropriate uses of humor in psychotherapy as perceived by certified reality therapists: A Delphi study. Journal of Reality Therapy.
Vergeer, G., & MacRae, A. (2003). Therapeutic use of humor in occupational therapy. American Journal on Occupational Therapy.