Doing this work is a constant tension and relief experience. The only way I have found to remain relatively unscathed by the milieu, the possibility of overwhelming doubt and by the prospect of guilt when things don't turn out as expected, is to keep rules for myself and my clients.
I ask that clients be as honest and consistent as possible. On my part, this requires me to struggle with the "everyone is doing the best that they are capable of" concept. People do the best they can, even the client I wrote about in a recent article who was caught selling drugs at my program. But the nature of the "best they can" concept does not absolve the person from responsibility.
This "best they can" concept is tied in with the "when they are ready" concept. They may understand that what they are doing is harmful, dangerous, likely to put them in jail, cost them jobs, make them homeless, lose their family and friends or even kill them. They may have this realization hundreds of times, maybe thousands of times over many years but, until they accept it, internalize it, until they are "ready" to change, it can just go up in smoke [cliche/pun intended].
Here is a story about Vicky, who seemed ready. When she came in, she cried then stopped, relieved to be getting into the program. When the case manager Marci, who did the intake brought her into the acupuncture clinic her sense of relief was palpable. Relief quickly changed back to anxiety. Marci and I asked why? at the same time. Vicky replied she had a Child Protective Services hearing downtown at 3 p.m. It was 11:30 a.m. and even at public transportation's worst, there was plenty of time but, she was anxious about staying any longer.
Marci asked if the meeting was a TDM [Team Decision Meeting]. Then Vicky cried, just a little but, the torrent was at the surface about to burst out. She was afraid. She had no one to go with her to the Child Protective Services hearing and she was afraid of losing her baby who had been born exposed to cocaine eight days ago. Marci said, "You sit here and let Greg do your orientation I will be back in a few minutes." Vicky sat down and started to tear up again. We started the orientation.
Marci returned to say "I will go with you" and continued in a stern mother voice, "I changed my schedule to do this. You have to be on time, do you understand? I will meet you at the Child Protective Services offices but you have to be on time and you have to do what I tell you. DO YOU UNDERSTAND?" Vicky stopped crying, even smiled and promised to be on time and do everything Marci said to do. We finished the orientation but, she was too nervous about being on time to stay for a treatment. I wished her luck and she left.
That was on a Friday and I didn't see Marci until Tuesday afternoon at the staff meeting. I had two questions for her: What is a TDM and what happened with Vicky? A Team Decision Meeting [TDM] happens with the Child Protective Services worker, the client and his/her representative; be it a case manager or a lawyer or both and the court-appointed lawyer for the child or children. When a parent or parents catch a Child Protective Services case, a plan is instituted and this is a follow-up meeting. If chemical dependency is the basis of the case, a program is required. Parenting classes are required. Anger management classes are often required. While Child Protective Services cannot take a child or children away from a parent or parents, it is a rare occasion when a judge does not follow the Child Protective Services recommendation.
This is what happened: Vicky was already at the Child Protective Services offices when Marci got there. She did everything Marci told her, especially no outbursts. She was agreeable to going to a residential treatment program in another county which would give her six months away from her neighborhood with all its temptations. The theory being it will help her stay clean. Then she could move on to the next phase: training and hopefully a job and housing. But, Vicky would have a hard way to go with two other children ages 8 and 5; away from the neighborhood temptations but, also family support systems. She was diagnosed with bipolar disorder and suffered from depression but, on the plus side, willing to take her medication.
The other thing she had going for her was she understood how "lucky" [for lack of a better word] she was to have this opportunity because residential programs that took clients with children were hard to find. In this economy, programs were closing or losing the money to provide full services and governments were cutting more and more money from programs. She was referred to a more affluent program in a more affluent county. They accepted her and her children. She understood just how lucky she was to get this chance. We all are breathing a tentative sigh of relief; step one has been accomplished.
But Vicky epitomizes one of the more difficult forms of a rule for myself: "I cannot care more about a clients sobriety than they do." This can be a difficult one. You have to care about the clients or what is the use of doing the work?
It is always difficult to watch a client lose their struggle for sobriety and fall back into "the life." Finding the balance between doing all that you can and not sacrificing your energy to their addiction is difficult. If Vicky falls, I will feel bad for her and especially for her children. But, I had so little contact with her that it will be relatively easy to be OK; I will feel a normal amount of sadness but, with clients I have worked with for months this can get more difficult. I have to remember that I did the best I could and the rest is up to them.
A subset of the above rule is: "I am not your friend." Maintain a professional distance. This is not to say I am cold or aloof, just the opposite; I enjoy my clients. Often as we get to know each other they turn out to be quite interesting people. Often more well rounded than first impressions lead one to believe.Another rule: "Leave the work in the clinic." This is not to say I don't ever think about the clients away from work; of course I do. I even talk with friends and family about issues and clients [using code names of course to protect confidentiality] but, I have many other interests. I try to keep my personal life separate from work.
The most important rule for myself has been to recognize the privilege of being a part of a person's journey to wellness, even if it takes years, even if it doesn't happen. It is a privilege to be part of the healing process. It is important to maintain a sense of humility; I am a conduit for a healing process, clients do the real work.
Click here for previous articles by Gregory Ross, LAc.