Interview With Social Worker: Ms. A My

Interview with social worker: Ms. A

My interview was with Ms. A, a substance abuse counselor, who organized group meetings for people in recovery from drug and alcohol abuse. She described the work as challenging but rewarding. Very often people who are recovering from addictions have an ambivalent attitude towards the recovery process. While some are willing, others are compelled into the group because of legal reasons (such as a conviction for DWI) or because of family pressures. Ms. A must be mindful of these different attitudinal perspectives on the process of navigating recovery. It cannot be assumed that everyone 'wants to be there' and that everyone consciously wants to rid him or herself of addiction.

Group therapy can be valuable for individuals in substance abuse recovery because it enmeshes members in a supportive environment of people who understand what they are going through. It can be very difficult for non-users to comprehend how someone can go through rehab and then go back to using drugs within a few days of being released. Group members understand the temptations of other members and can empathize while still supporting one another to take a more positive view of a future without drugs. This means that when members are engaging in self-deceptive behaviors, other members of the group are aware of the negative thinking patterns of addiction and can highlight this when someone is attempting to justify lapsing into old behavior patterns. Group therapy also provides a vital support system to replace that of the friends fostered by drug and alcohol addiction. Instead of finding a social life in drug culture or a bar, group members now have a circle of friends outside of their negative behavior patterns. This is one reason why group therapy is often more beneficial than individualized therapy alone for substance abusers.

The group therapy of Ms. A is informed by a cognitive behavioral approach (CBT). One of the advantages of CBT is that it is highly structured and designed to set specific goals for group participants. The theory behind CBT is that if people change negative and unproductive thinking patterns, they can change their behaviors. Individuals struggling with substance abuse often have difficulty changing their behaviors because of self-defeating thought patterns such as: "I can't get through my day without using x drug." Or "everyone else is having a few drinks, why can't I?" CBT identifies irrational thinking patterns and forces the person being treated to view their lives with a more rational, less black-and-white attitude. As well as changing thinking patterns, CBT also stresses the need to change actual behaviors in the real world. Group members are often given goals from session to session, such as staying away from potentially dangerous situations and people who encourage them to use. They have positive goals that help them to develop more better coping mechanisms to deal with stress, such as talking to a spouse or child who is irritating, rather than taking a drink.

Although the CBT model is the dominant modality of the approach taken by the social worker, Ms. A stressed that she was not a slave to the theory and its highly structured approach. Each session contained an element of individualization to the group members' needs. Some groups were better at self-regulation than others; while other groups needed more directed facilitating and goal-setting. However, she did stress that CBT has been proven to be one of the most useful approaches in dealing with substance abuse, versus a more psychodynamic approach of focusing upon the individual's past problems alone. Ms. A prefers to stay focused on the present, rather than dredging up past traumas. The focus is on improving the behaviors of clients in the here and now rather than on their childhoods and adolescents. There is a practical reason for this. Many clients need help finding jobs and patching together broken lives. Staying focused on the here and now is not simply beneficial for the recovery process; it is a practical necessity.

Ms A's philosophy of the group process was that the group provides structure and positive reinforcement, and acts as an accurate mirror of the participant's behaviors. It is very easy to be self delusional when in the grips of an addiction, and CBT is a way of enabling the individual to see that it is 1. realistic to expect recovery but that 2. 'slip ups' are normal and do not invalidate the process. The group also helps the sufferer establish an identity that is a true self and is not defined by the addiction.

As a facilitator, a CBT approach requires the social worker to have a strong sense of what individuals really mean, or their latent vs. manifest content. Even though CBT is behaviorally-focused, Ms. A notes that delusional thinking is often so predominant in the expression of members of the group (such as blaming others rather than the addiction for bad life decisions); the discussion cannot dwell on surface content alone. When someone talks about how an employer or parent doesn't understand their problems, Ms. A must dig deeper to see if the resentment is linked to the fact that the speaker is angry because they cannot 'use' while at work or at a family function.