In my work with substance abusers in residential treatment, I’ve noticed that the ability to initiate the recovery process is a two-decision process.  Before I get into that process I want to address a phenomenon that occurs with practitioners working in this field.  We often have clients who seem resistant to treatment or counselling and for the most part this is normal.  Not everyone comes to treatment super motivated, and some come to alleviate pressure from family and friends.  Some clients going through treatment or counselling will not comply with all programming or homework assignments and this is just where they are.  When clients are showing some of this resistance many of us assume they are “not yet ready for treatment,” or they “just aren’t finished using yet.”  For some clients this is true, but this assessment can sometimes be a mistake with others.

The client who actually isn’t ready for treatment did not choose to quit yet.  I even say that statement with caution because we don’t really know this.  People are complicated and our resistances are there to protect us, whether one calls it denial or something else.  Someone may go to treatment and come across a personality type in their counsellor that keeps them from moving forward with being open.  We all then decide that client isn’t ready.  This may or may not be true.  What is going on behind a person’s resistance and defenses is not knowable until it is.  We can make some general assumptions and logical inductions, but we don’t really know what is or isn’t motivating that person.  Let’s say that client did not make the choice to really quit, that his/her parents, spouse, friends, etc, pushed her/him to come to treatment.  That client has not yet made the first decision in the process of recovery.  The first decision is to stop and want a different life.

Isn’t that enough?  Wouldn’t that motivate someone to get clean?  No, not completely.  Someone could decide to stop, go to treatment, but not fully benefit.  They say they want to stop but yet, seem to be standing still.  There is an old adage in the addiction treatment community that if you want to change you have to change everything.  That can be quite scary to most people.

So what does the second decision consist of then?  The second decision is to move forward with doing the work. We talk quite often in the addiction treatment world of “doing the work”, and this really entails the examining, changing, and processing of one’s emotions, thoughts, behaviors, and relationships, to keep it simple. Doing the hard work sometimes is about being vulnerable enough to allow other human beings to help. Doing the hard work sometimes means exploring events of the past that continue to keep one stuck.  Doing the hard work sometimes means deciding who one wants to be.  Doing the hard work sometimes means taking medication.  Doing the hard work sometimes means taking more responsibility for one’s life.  Although I describe this as hard work, it can be, and usually is, very rewarding and transforming.  The pain that most people are in emotionally is about the fear of their pain, not the actual pain.  Facing our own demons and pain is not as painful or scary as the fear about having that pain.

To quit and be successful, these two decisions might need to be revisited or renewed often in early recovery.  It is also important to determine what one needs in order to follow through with both decisions.  Sometimes that is support from others.  Other times it is letting go.  I have watched clients stay “on deck” like a batter on a baseball team and not step up to the plate.  It is like they are in a holding cell.  This assessment is not a negative judgment toward those clients, it’s just where they are.  I wonder, “what does this person need to move into the batter’s box?”  They’ve obviously decided to play this game (i.e. recovery, treatment, counselling) but they sure are having a hard time “getting in there.”  As practitioners it is our job to help them navigate fears and hesitations so they can step in when they are ready.  Once they make that choice, the recovery process becomes a lot more doable.  There is no cure here, or arrival, but the second choice is necessary in the way any of us change something about our lives – we actually have to DO something.

Lastly, I want to say this is my own observation in doing this work for several years.  The change process is quite complicated and this portrayal is only an aspect.  Take it for what it is worth.

Two Decisions:

1. To Stop
2. To Do the Work (actually start changing)

Post written by:  Jason McCarty, Outpatient Therapist

This entry was posted on Wednesday, January 13th, 2010 at 4:17 pm and is filed under Clinical Insights, Treatment Strategies. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.