Category: Articles

OPEN RELATIONSHIPS

By

Raymond Guddah

BSc, Dip, MBACP

Senior Counsellor at DARA Koh Chang

CLIENT CONFLICT

I began my career as a counselor in London, and as a member of an ethnic minority group, initially I found it very difficult. Clients would question me about my credentials, and quiz me on the criteria for being a counselor, in an effort to assess whether I was ‘good enough’ for them.

These early challenges left me wondering whether I had in fact chosen the right career path. Luckily however, I received mentorship from other counselors, which allowed me to experience a very useful paradigm shift, and a resultant bump in confidence. This gave me insight into what was really important if I was to create positive outcomes for my clients.

I discovered that, according to the researcher Alexandra Bachelor, successful therapy needs to be based on a relationship of authenticity, trust respect and empathy between therapist and client ¹

So, my concern switched from ‘how can I validate myself to my client’ to how can I foster trust, empathy and mutual respect in a genuine way?’

CULTURAL CONTEXT

The UK is a multiculturally diverse place, and therefore my focus was often on establishing a good therapeutic rapport with clients who were from culturally different backgrounds to me. I realised the importance of viewing people as not only existing within a cultural context, but also as unique individuals.  I had to develop wide-ranging skills to assess, intervene, approach and engage clients if we were to emerge with a positive outcome from therapy.

Counselling is a nurturing and meaningful interaction between two or more individuals where goals are set and challenged with trust, respect and empathy, with a focus on a robust prediction of the outcome of the quality of counsellor and client relationship. ² I therefore decided to aim on working with the transference and counter transference feelings within my relationship with my clients.

Transference is a phenomena which often arises in therapy, and is simply when a client redirects feelings for others onto me in my role as therapist.

Countertransference can happen as a reaction to transference, and it occurs if I transfer emotions back to the person in therapy.

It is worth acknowledging that in most therapies, there could be moments when tensions and probably strong feelings (i.e anger, frustration, disappointment) may arise between the therapist and the client. Feelings of boredom, frustration or a sense of being ‘stuck’ in therapy can actually serve to highlight potential challenges in the establishment of a good therapeutic alliance. Once highlighted, these challenges can then be worked through.

Based on these factors, my goal then was to start making my clients feel safe by being non-judgmental, authentic and congruent and being aware that what one client might consider safe, may not be safe for another.

WHO ARE YOU?

I was also frequently checking in and identifying with who ‘I was’ to my client. This was important because if the relationship lacked authenticity, my client would not feel safe and there wouldn’t be a genuine investment in the work from both the therapist and the client.

A relationship based on trust is crucial in multi-cultural therapy and it requires patience and exploration of the clients’ perspective of the nature of therapy they feel they require. It is also helpful to explore and process painful and difficult experiences of racial, cultural and social nature right from the beginning of therapy. ³

As a Therapist, I started to consider the role of my identity and professional awareness of competence surrounding issues of ethnicity, power and privilege, as these are fundamental in building a therapeutic relationship. ⁴ With this in mind, I started developing the practice of listening actively to my clients.

I would allow my clients to  ‘Feel their feelings’ and to be ‘themselves’ without telling me what they felt I needed to hear. I would ensure that my client had enough confidence in me to acknowledge that I knew what I was doing and not show any sign that I could or would reject them.

CREATING THE SPACE FOR CHANGE

As a therapist I feel that our clients need to know that we are hearing them and for us not to jump in to ‘save’ or advise them and this experience of feeling heard and acknowledged (maybe for the first time for some) can be transformative. Clients who have had the opportunity to express their feelings, fantasies, fears and desires in a safe process can then make sense of the need to consider change.

Working with transference has been very significant for me with my background in Psychodynamic Psychotherapy. I am aware of the possible triggers that lie within my role, my personality, my cultural background and my ethnicity. Transference is neither good nor bad, and sometimes it is almost unavoidable!

Sometimes it can actually be a useful tool to work with thus providing therapist and client with an opportunity to address the issue of the ‘elephant in the room’. For example, let’s say I remind my client of an abusive partner in terms of appearance, accent, mannerisms, whatever. The realization of this and acknowledgement by the client that I inadvertently bring up these emotions in them and they are projecting assumptions onto me as a result, can give us vital material which we can then work through to help the client deal with these difficult thoughts feelings and emotions.

I have managed to admit to myself that as a social being my core values, core beliefs and my perceptions of the world, can influence the development of my therapeutic relationships with my clients. I am still ‘learning’ to allow myself to embrace the concept of ‘openness’ in order to address issues of race, culture and its relevance to my work.

 

 

1 Bachelor, A. (1995). Clients’ perception of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42(3), 323.

2 Lambert, M. J. (2013). Outcome in psychotherapy: the past and important advances.

3 Lopez, F. G., Ramos, K., Nisenbaum, M., Thind, N., & Ortiz-Rodriguez, T. (2015). Predicting the presence and search for life meaning: Test of an attachment theory-driven model. Journal of Happiness Studies, 16(1), 103-116.

4 Helms, J. E., & Cook, D. A. (1999). Using race and culture in counseling and psychotherapy: Theory and process. Allyn & Bacon.

 

Philip Townshend

PhD, PG Dip Clin Psych

This is a really interesting time for drug policy as jurisdictions around the world are implementing extreme and widely divergent approaches to dealing with recreational drug use. These measures will essentially amount to an amazing series of social experiments into how to address drug problems.

PARADIGM SHIFT IN PORTUGAL

Portugal represents one end of a liberalisation continuum. Since the early 2000s they have approached drug use as a ‘health’ rather than a ‘justice’ issue, thus encouraging treatment protocols, whilst still conforming to the World Health Organisation’s (WHO) treaties on dealing with class A, B and C drug categories.

Some Public Health proponents predicted that the result of such a paradigm shift towards more lenient policies would result in increased drug use as a result of increased availability. In fact, the reverse has been true, with most categories of drug use declining and a significant decrease in the reporting of drug related health problems and criminal events. The resultant health benefits include fewer overdose deaths and transmissions of blood borne viruses. The crime rate has of course dropped, in part because the police and judicial system were no longer prosecuting drug users, however the reduction was greater than could be accounted for by this alone.  Most notably there were disproportionately significant reductions in drug related violence, theft and road accidents. The resulting openness about drug issues seems to have increased treatment utilization and the approach is widely acknowledged as having been effective.

Liberalisation has worked in Portugal, however these policies may not be able to be exported ‘wholesale’ to other countries, on account of cultural or demographic factors which might inhibit such a shift towards leniency from gaining sufficient grass roots support.

PUNTIVIE MEASURES IN THE PHILLIPINES

On the other end of the liberalization continuum lies the Philippines. Their hard line President Rodrigo Duterte has announced a policy of killing drug users and dealers – often without trial. Some of these assassinations are carried out by police and some by vigilante contractors.

The Philippines’ stance represents an extreme interpretation of the ‘war on drugs’ phenomenon. This approach of a kind of abstract war mongering – vigorously promulgated by polititians and policy makers across the world – has been all but abandoned by many states and countries due to its ineffectiveness.  The US saw its prison population quintuple as a result of its own ‘war on drugs’. There had previously been a shift to downgrade the criminality of minor misdemeanours such as possession under Obama, but future policy directions of the US remain to be seen under the new Trump government.

Furthermore, liberalisation of drug policy is currently inhibited by the WHO conventions on drugs[i].  This convention places drugs into categories that have been politically assessed in terms of drug harm and judicial responses to the use or sale of drugs within these categories is thus prescribed. This politically based assessment of relative drug harm is often at odds with the scientific assessment of ‘harm’[ii].

NORTH AMERICAN CHALLENGE

Many countries have recently challenged these conventions, most notably Canada, which is leading a move to change the WHO drug rules and is intending to legalize cannabis in 2017.  Many states in the US are similarly moving towards legalisation of cannabis. In Colorado for example, advertising of cannabis products is allowed as long as no more than 30% of expected viewers are under 21.

The issue of addictive drug use in the States is by no means confined to substances that are categorised as ‘illegal’ in the classical sense of the word. Prescribed opioids (that are directly marketed to the public) were associated with 28,000 overdose deaths in 2014. This represented a 200% increase since 2000. Half of these deaths were attributed to prescribed opioid pain relievers, in particular oxycodone and hydrocodone. This means that ‘big pharma’ is now a significant dealer in dangerous recreational drugs. With its political clout, intervention and regulation may prove difficult.

ANARCHY IN THE UK

Finally, no discussion of drug policy could exclude the UK 2016 drug laws that have been widely criticised. Any psychoactive substance is categorized as a drug, potentially including foods and vitamins, but notably alcohol (that significantly accounted for the deaths of over 8,000+ people in the UK last year), and nicotine (which accounted for the deaths of approximately 80,000 people), are excluded.

INTERNATIONAL APPROACH AT DARA

At DARA we are truly an international rehab. In 2015 alone we hosted clients from 52 different countries. This gives us a unique view on the effects of drug policy in various countries, in terms of how they affect the addicts themselves. We notice huge global differences in terms of the relative prevalence and abuse of different varieties of drugs. What is popular in one region may be essentially an unknown entity in another. This represents a challenge for the clinical team, as different drugs can have markedly different effects and withdrawal profiles. Regardless of nationality or substance of choice however, the essentials of treatment remain the same. At DARA we treat people with dignity and understanding. By improving knowledge and increasing self-awareness we aim to provide clients with the tools for recovery, wherever they are from.

 

[i] There are three drug related major drug related treaties, as below, the first two codify internationally applicable measures in order to ensure the availability of “narcotic drugs and psychotropic substances” for medical use and to prevent their diversion into illicit channels. The three treaties are:

1. The Single Convention on Narcotic Drugs of 1961 Amended 1972
2. The Convention od Psychotropic Substances 1971
3. The United Nations Convention against Illicit Traffic in Narcotic and Psychotropic Substances 1988

 

[ii] Development of a rational scale to assess the harm of drugs of potential misuse,

Prof David Nutt, Leslie A King, PhD. William Saulsbury, MA, Prof Colin Blakemore, FRS

Published: 24 March 2007

DOI: http://dx.doi.org/10.1016/S0140-6736(07)60464-4

 

We all know about alcohol. Most know about other types of drugs, popularized over the years by television, cinema as well as rock and pop music. Cocaine, heroin, meth – all words that most people know and understand to be drugs. Less than a hundred years ago, these words would be more common in medicine and healing topics but have since been dethroned due to further studies in their damaging side and after effects.

What is the first thing that comes to mind when mentioning cold medicine? How about hand-sanitizer or even nutmeg? These and many more regular everyday items are being abused for their mind-altering properties. Usually experimented on by kids who would otherwise have a hard time getting their hands on more recognized drugs.

Lock up everything?

Is it ok to drink bleach? No, of course. Everyone knows that, right? But what if drinking bleach would make you high? The answer would still be a resounding “no”, at least to a sane person, but there are many other household items and chemicals that can and are abused to get high. Even granddaddy of all drugs – alcohol is abused in new and rather genius ways, most usually by children, specifically teens.

It is impossible to outlaw everything. There are only so many things we can put behind locked doors and deem them unsafe. Dishwasher liquid if consumed will earn you a trip to a hospital for quick stomach pumping at best, or kill you outright at worst. Does this mean we should make all dishwasher soap liquids banned and outlawed? There is such a thing as common sense – a quality more and more people lack these days, yet for children who are still learning how this world works the idea of common sense is a strange one. Everyone knows that the best way to get a kid to do something is to tell him, that he is not allowed to do it. Combine that with the rebellious nature of most teenagers and you have a nasty and rather dangerous cocktail.

Most know that sniffing glue and paint is a thing. Serves to reason there are many other items out there that can be abused in a similar way, so let us have a look at few of them.

Alcohol

Drinking alcohol is so 2016, according to some. These days among kids trying to get drunk in a sneaky or unconventional way one of the best practices is to soak a tampon in alcohol and insert it into vagina or rectum. Likewise inhaling the alcohol vapor can serve to intoxicate oneself as well. Burning alcohol in a closed chamber and then rapidly inhaling the leftover vapor is a sure way to get drunk quickly and kill a couple thousand brain cells at the same time.

Not all of the kids have access to pure alcohol, thank god. Those that do usually get it by asking an irresponsible adult to buy it for them or they simply steal it from their parent’s minibar. For those that cannot afford such luxuries, as long as they get some hand sanitizer and use salt to reduce and distil the alcohol in it, can treat themselves to a highly concentrated and unrefined shot of alcohol. Blindness, chemically burned esophagus and organ failure are on the house.

Cold medicine

It was discovered that teenagers have been hoarding cold medicine like Coricidin to achieve similar high to using PCP – a hardcore pain relieving drug. To be more specific, it not only relieves pain, it turns it off outright, by limiting your brains capacity to read your nerve receptors. Often the cold medicine comes in neat pre-portioned sachets and can be abused discreetly and efficiently. High on its active ingredient – dextromethorphan, they risk severe organ damage and even death in prolonged abuse cases.

Nutmeg

A spice that most household kitchens will store for food preparation. Innocent really, until used on its own and in drastically increased quantities. Loaded with myristicin, this seemingly harmless spice can lead to hallucinations and increased blood pressure. Common effects of nutmeg overdose are coma and even death.

Air refresher

This is a rather popular and quite old technique to kill some brain cells and get high. “Chuffing” or inhaling pressurized air refresher through a cloth produces a similar high to being drunk, but lasts only a short while. This technique is also called “Breezing”, derived from the most popular brand of air freshener usually used for this activity – Febreze.

 

Kids and teenagers love to try out new things, especially if they feel it will make them more popular with their peers. While our classic understanding of drugs covers most bases, it is important to understand that there are plenty of regular household items that can be used to hide or mask consumption or simply abused by themselves to produce a dirty and much more dangerous high. Protect your loved ones and consider professional help, it is never too late to make things right.