Learning Journal 5

I have realise the need for a strong and clear foundation from working with clients in my drug and alcohol setting. But being 'Johnny Shortcut' has meant that in training terms at least, its always been something I've struggled with despite knowing how important it is. I remember writing one out for the level 3, like a script. I could never remember it and I have some anxieties around that.
From my own experience in RISE, a drug and alcohol service I know that it pays to be really clear about time, boundaries and expectations going into both one to one and group work. By setting out with clear explanations and expectations and boundaries that I may have a good deal of questions to ask and assessments to complete, I am letting a client know to some degree what is available at this time, in this session. This can prevent them having false expectations and being confused or unclear and, not in any small part with the often intoxicated client, that it is not a chance for them to deviate too much unload their life story and troubles. While I have let offloading and unburdening happen on frequent occasions, its not always the best move given that I may have to change tack so abruptly later in the session, which may leave them feeling ignored or not heard. Also and specific to the role the cost to me has been that I then have not achieved my goals as a recovery worker, to risk assess, to put someone into suitable treatment options, to signpost and reduce harm. Being a recovery worker is a very different role to counselling although the fact that I am in a one to one scenario often, that I offer a place for that person to talk and because the majority of what I do is about the relationship that we form, I feel that their are many similarities. Far more similarities than differences.

As a recovery worker I would go about letting a client know the time of the session by letter, and by name it in the letter that it is an assessment, for example. Then once they arrive they have it in their head that the session is about fact finding, not counselling/one-one. Once they arrive I will let them know how much time we have and that it is going to be quite a lot of questions and that they should feel the session is confidential beyond certain responsibilities I have to the safety of that person and others. I always let people know they can make a complaint and how to do this, and I always ask that mobiles are off. I also include a good deal of asking what they want out of treatment. How do they see their recovery happening? How have they had successes before? What has/hasn't worked? I'm also quite brutally honest that as a recovery worker I am not the one that's going to be doing the real work, not if its change they seek. In this way, by querying what it is they really seek from treatment, I'm pushing to see if they actually want change. I guess in a sense some of this is starting to become the therapeutic side of the contract, as they see what it is will happen between us and us working out what they want out of treatment as a thing. However given that the service I provide encounters a very specific medical need, I feel that it is ethical to be upfront about the actual reality of owning denial in readiness to change and at least letting the client know that I have put it out there that there is real chances that they are not ready but that this can be difficult to know. I need them to question the relationship that they have with substances from the off, and continue to do so. In that respect the person centered aspect of what I do is very much there as we need to get to what they want from treatment, but also that I have a duty of care to not mislead the intoxicated client by waiting around for them to realise that they have been fooling himself. Its a fine line and requires a good deal of skill I have learned, not to be insulting or patronising but honest and caring in the clients best interests for them to reveal to themselves what is really going on.

This is very different to what I did as a counsellor in the practice role play we did on Thursday. We practiced handing the business contract over to one another. I worked with Christine and tried to explain the nuts and bolts of the business contract with her. It felt very under-rehearsed. There's an awful lot to get through in terms of the list of actual boundaries that govern the practice of counselling such as the supervision, confidentiality and actual specifics about the session time, frequency and costs. Here I explained about the supervision that I have, my level of proficiency/training and also covered confidentiality, in some depth. I studiously went through a list of what I could recall would need to be said, but it as yet felt clunky as it wasn't my own words yet. The specifics about length, time of day and frequency of session were all made up on the hoof which didn't help the concentration. When moving on to the therapeutic part of the session I began to relax more, as this part doesn't have a script. I can play jazz with this a bit. I explained how I worked in a non-directive and non-judgemental way and what that meant in terms of valuing her as a person and allowing her to find her own way. Then I was able to open the floor to ask Christine what she wanted from counselling was the first part of our therapeutic contract. At this point we got to her goals at which point we stopped.

I guess in my current role as a recovery worker a big difference on the contracting is that I have goals, in counselling I would still have goals but the emphasis would shift to the clients goals as they are seeking a more person centered level of support than recovery work is designed to be. As a counsellor I will very much still have my own rights and responsibilities, as would the client, but in counselling it may be prudent to make these clear and mutually understood by both parties. This is surely ethical as well as practical so that the client knows that they in good hands. My rights and responsibilities as a counsellor are there in black and white as part of the contract but I feel also need to be delivered verbally as this checks understanding and clarity. Also from this verbal delivery the counsellor can explain and check agreement with the client. Further the client can explore their expectations and understanding of the service and relationship they can expect.

I created my very own client contract after a session exploring what we as a mini-group felt that we would like included within it. This contract spells out what my rights and responsibilities are as a counsellor in training within Addaction Chy, a secondary rehabilitation treatment centre in Cornwall. I will be offering counselling to those leaving the main building and going into the move-on flats and so forming part of their care package. What I have constructed is most definitely a business contract. It is measurable, quantifiable and clear, I hope, about what is and isn't allowed, acceptable, and what is provided so as to be clear about what the client can expect. I spell out the need for them to be drug and alcohol free, for the amount of sessions to be agreed, for the length of a session and that I receive supervision etc. these elements are not negotiable. These elements have to be in place for there to be a robust and boundaried and ethical service to be provided.

While the amount of sessions and time of day that the session will occur will be negotiated, there is a very different type of negotiating that I feel needs to happen on top of the business side of things. Negotiating what the client wants from this counselling period.  this is obviously the therapeutic element of the contracting process and also a very important part of the laying of shared understanding about what is to happen. this is what Tony calls the alliance. We have to be on the same page, to work towards the same goals, even if they keep changing or evolving, we must both be knowing of this.

In working with clients at Chy, I hope to be able to negotiate with them what they want to aim to achieve. What are they hoping to get out of counselling? do they fully appreciate I will not be there to diagnose them, to give advice and solve problems for them. I hope to let them be aware of the way in which person centered therapy can work with my respect for their autonomy. Basically can I unpack the core conditions in client friendly language? I feel that I can and will be able to explain that I am not there to tell them what to do, more to listen and hear them in a non-judgemental manner. That being non-judgemental is just that, to listen without prejudice. And also that I will try to understand how it, whatever it is, has been for them. Then and only then we can explore new areas of understanding and clarification to help them make sense of their world.

We had an inspirational visit during this session. A lady who had been through various treatments and finally found one that had supported her at the right time to give up drugs and alcohol. "Once the client begins to feel you are interested enough in understanding how it really is for them and are taking the trouble to learn about their individual model of the world, they will be more willing to let you lead them into new areas of exploration and clarification" - taken from Working With Others. This quote I feel sums up how much it means to have the therapeutic relationship in doing supportive work with people, in helping them. What the guest described was that previously maybe this hadn't been the case, and no matter if this was true or not, it certainly showed that this person was reached by a counsellor. She had been helped and brought into a truly positive place and now was enjoying life. Not only that but that this person was ok enough to share all this with us. She had experienced enough negative relationships in her life but had still had room to trust another, given the respectful and non-judgemental and empathic person was sat opposite every week to hear her model of the world. Brilliant.