Thought of the day

When things get tough, look in the mirror and tell your self that control is a decision away.

Getting in to Rehab: How and Why

I have had a few people send me emails, messages, and phone calls about how to get into a Rehab. Likewise partners or relatives have asked me about the same issue of how to get their loved ones into a Rehab. The best way to answer this question is via a procedural point form.

• The person that has the issue needs to ring the Rehab. This is because the person with the issue needs to own their choices. Secondly the Rehab will want to do an assessment on the person with the issues. I suggest ringing a Rehab first, before a Detox centre because your waiting list at the rehab may be months. Once you had a date to book in to a Rehab get into a detox centre at least 28 or 30 days before the date for the rehab. This is because if you have a Diazepam addiction you need 28 days to detox, for other drugs and alcohol the time may be shorter. If there is a long wait between detox and rehab the risk of getting back on the drugs of drinking increases, this is a vulnerable time if you as the addict is going back to the same environment and friendship group.
• Ring a Detox once you have the Rehab date booked. Many if not all rehabs will not take clients if they have not gone through detox. The same as before the person suffering will need to do the phone assessment with the detox. At detox there is a great likelihood that you will not be allowed to smoke, make phone calls, and leave the unit.
• Now you have a date for Detox and Rehab, what do you take with you and what to leave at home?
  • Only take your mobile phone if you are going home with public transport. The mobile phone will be taken from you on arrival.
  • Do not take any sharps apart from your razor. All seizors, tweezers, knifes, needles, and keys will be taken from you on arrival.
  • Do not take any computers, portable DVD players, DVDs, or radios with open speakers. These items are seen as sleep inhibitors and can cause issues with other clients, also they will be taken from you on arrival.
  • Take your MP3 player if you like your music. Pick your music to help you be calm and relaxed.
  • You do not need to take sheets or blankets unless directed to by the assessment officer.
  • Take open and closed shoes for indoors and out doors. Also take a pair of thongs (flipflops) to wear in the shower.
  • Finally clothing that will last you at least a month, you will be able to wash your clothing at the Detox and Rehab.

  As for the people that are left behind while the loved one is in the Detox centre or rehab. First of all don't worry, you do not need to ring them every day and worry about them. I bring this up because all to often loved ones think they are giving support to the person in the centre but give them reasons for leaving the unit. To constantly tell them how they are being missed and all the things they are missing out on, drives the client to leave the unit and sabotage their recovery.   So how about we make a list of what to do and what not to do when a loved one is at Detox or Rehab.

• Find a counsellor or an AOD worker to talk to so you have more knowledge about what an addict is going through. This will teach you about triggers and ways to change your life style. I say this because the past life style may have promoted the addiction. More often than not you will be left out of the loop so a counsellor or AOD worker will help you to be in the loop.
• Ring the centre to satisfy your self that the person has gotten there ok, but then only ring when your loved one wants you to ring. That is, if they are allowed phone calls. Also be prepared that staff will tell you nothing, this is because of confidentiality and because the staff does not really know if you are the one you say you are.
• Treat the centre like a training course away from home, because that is what it is. So know that the only thing the client needs from home is support and talk mainly about what the client is going through.
• Right letters and send photos. This will help motivate the client to succeed in recovery.

 

But what can be expected in Detox and then Rehab?

Detox

Detox is all about the body, so do not expect deep and meaningful counselling. Detox is a place to go to get over addiction while making the detox symptoms less painful and to get the substance out of the body. All types of people go to detox so do not buy into any of the stories or games that the other clients play. Some clients will be trouble and others may be intimidating, so the trick is to concentrate on your self and your plans. Furthermore, be prepared to suffer the consequences of years of abuse from your addiction, depending on the drug you take the body will let you know that it is suffering. This includes lack of sleep, bad dreams, joint pain, head aches, bad moods, and agitation. If you have been taking drugs as a form of self medication for mental illness, the mental illness will come out again, this is a good thing in a way. With the drugs out of the system a proper diagnosis can be made and real help can be found, also you may find that the opposite is true, it could be that the drugs were giving you mental instability.  

Rehab

At Rehab you do all the mental hard work, you will be attending Group Therapy sessions 4 or more times a day. You will be helping doing chores, such as cooking, sweep and moping, washing, and cleaning. Depending on the focus of the Rehab, may do AA or NA groups several times a week along with doing the AA book and work through the 12 steps. If it is a CBT Rehab there will also be book work and self monitoring that you will be doing. Each Rehab has rules that you must follow and if these rules are broken you will be kicked out, so learn these rules, which will be given to you on arrival. Rehab is all about helping you the client to find new and affective coping strategies, find your weaknesses so you can accept them and live with them not fight against them. Many people go to weight loss fitness camps so they can pump iron, you will be going to Rehab to pump neurons. It is not al work, you will be going on outings and doing some fun stuff, all of which promotes socialisation.   There are lots more to talk about, but for that you will need to book an appointment with me.

Self-disclosure in a counselling session: what do you think?

You may have been told at work that self-disclosure is a great "no no", you do not do it, I certainly have. Like wise as a client you may have wondered why the staff (or certain staff) in an organisation do not self-disclosure to you or other clients. This may be the same when you see a psychologist or counsellor. Well, when we are getting trained we are taught not to self-disclosure, because it may bring about transference or the information within the self-disclosure can be used against the therapist. Personally I was taught to be couscous, and only tell others what you can put in the news paper, because you have no idea where that information goes with that client. As a therapist we are bound by Law and Ethics that the information that a client tells us remains confidential and can only be told to others with the clients signed consent, this is not the case with clients. But at the core of this issue is, is it beneficial to the therapeutic process for the therapist to self-disclosure?   Personally, my opinion is yes, it is beneficial in some cases, the trick is to know which clients will benefit with knowing the therapists personal experience of what ever the issue is. I have had some clients tell me more of their plight because they know that I know what they are going through , because I may have had a close friend suffer from the same thing and it touched me deeply. This builds a working relationship a lot faster than if I would not have self-disclosure. Like wise respect is built in a shorter time and the client is more likely to follow advice or do the work in the CBT in their day to day living.   But this is all great if I am telling you about what I have experienced in my vocation, and it is up for debate. Barrett and Berman (2001) discuses this issue and have performed an experiment with a group of therapists, with each therapist self-disclosure to 50% of their clients and not at all with the other 50%. The findings match some of my experiences.   It is argued that self-disclosure takes the focus away from the client and interferes with the process of therapy, because the therapist is supposed to act as a mirror or "blank screen" for the client's emotionality (Barrett & Berman, 2001). Self-disclosure is thought to enhance the ethos of honesty, understanding, and empathy to build the working relationship (Barrett & Berman, 2001). Barrett and Berman (2001) investigated what are the outcomes of self-disclosure from the therapist. The interesting thing was that the symptoms of distress in the client were significantly reduced, and the therapist was liked significantly more with the therapist self-disclosing (Barrett & Berman, 2001). However the research did not show a significant increase in client's self-disclosure when the therapist self-disclosed, thus the level of therapist self-disclosure has no impact on the amount information the client opens up to the therapist (Barrett & Berman, 2001).   So in a nutshell do what you want as a therapist if you feel comfortable with what you are doing. I am an advocator to light levels of self-disclosure with in mind that you should only self-disclosure what you can put in the News Paper, Facebook, or and social media so the world can know about it. It is because as soon as that information is given out you no longer have control over when that information ends up. This is not the issue that the client needs to think about, because they are protected with the working ethics that therapists must work by.        

Bibliography

Barrett, M. S., & Berman, J. S. (2001). Is psychotherapy more effective when therapists disclose information about themselves? Journal of Consulting and Clinical Psychology , 69 (4), 597-603.  

Evidence based practice 'V' Best practice evidence

I sometimes wonder what best practice is. Is best practice the over riding need to follow evidence based practice, which is practice based on what has been researched and published. Or is it best to practice what feels right, what makes sense to you the therapist. I know that Art Therapy is used for people that are striving to explore their emotionality, therapeutic community, or in relationship therapy. Also I know that the 12 step AA and NA program is all around the world and many people swear by it, but this program did not start with evidence based implementations. I also know that some therapists are using Maslow's Hierarchy of Needs as a therapeutic tool and form of measuring client's advancement in a program, even when there are reported flaws in the theory of Maslow's Hierarchy. Now the confusion that I have is that Psychology and therapies are based on Art, not Science. Psychology at University is part of the Faculty of Arts. The problem all started with how psychology started and in the era that it started, Psychology was in competition with pharmacology (Chemistry), and the other sciences like metallurgy, physics and alike. So the issue is, Human behaviour is an art because human behaviour does not act like any other contemporary science. Human behaviour follows a bell curve which is a curve of probability. Where as other sciences, apart from quantum physics, does not work with a probability bell curve, they know the outcomes when mixing chemicals with 100% certainty. Whereas a therapeutic treatment does not have certainty when treating a group of people with a therapeutic technique that it will work 100% of the time. With psychological testing tools, they usually are self reporting questionnaires, observations with a reliability test. All of which are governed by statistics that measure people on a probability bell curve comparing them with a larger group of individuals. Thus in order to have a treatment passed as being best practice with evidence that it works a hole host of things need to be done that follows the psychological science procedure. Firstly a target group is used for the therapy  is needed, so if we use addiction as a target group, the experiment must discriminate between all the types of addictions that people have. Thus people that inject cocaine will be discriminated from those that snort cocaine. Now we need to measure the level of success which will make a probability bell curve, thus some will benefit from the treatment and others will not. The next stem is to measure the level of success with other therapeutic treatments, and the two probability bell curve from the treatments are compared with each other to compare the value of the treatment against other established treatments. So you can imagine for a service that uses only evidence based practice, that their practice would be 10 to 20 years or more behind the latest treatments and even if new treatments are very successful, it would need to be researched, reviewed, and then published, then adopted by therapists'. Also many self reporting questionaries and tests are designed people of a particular socioeconomically and cultural group with others discriminated against, although experimenters in human behaviour now try to safe guard against this unintentional discrimination. I know of a psychologist in Australia that has researched the correlation between the spiritual connection with their deceased relatives and the land with the level of their grief and loss. This psychologist is not recognised within Australia and the work he has done, but is recognised overseas.  Although evidence based practice is the bases of our hospital system and research in keeping people in physical health and should be because it is designed as such. But when it comes to human behaviour which is not as cut and dry as health, human behaviour is subject to many more variables than health. There are a few people that look at this subject with out much care because they are not impacted as much as some. Thus when it comes to health always look for evidence based practice, but when it come to therapy, go with what feels right with a person that you trust. We through around key phrases such as, CBT, DBT, NLP, Psycho-theatrics, Psychodrama, AA 12 step, Rogerairen Counselling, and Hypnosis. If evidence based practice would be the cornerstone of treating people in the science of psychology, we should only have one type of therapy that works with every one. I am not picking on Psychology or therapists, I recognise their good work, What I am criticising here is the use of "evidence based practice" with in the art of psychology. Psychologists should be open to new treatments and keep their own records and listen to client feedback  to see if the treatment is beneficial. And as always, ant treatment is better than none unlike Health Treatment. If the wrong treatment is given for the Health the patient will die, this is not so in psychology. OR Is best practice evidence informed practice. There are treatments out there that are sold as psychology and treatment for problems, but can cause more harm than good. One or two of these treatments have come to the light in the media and do cause a great deal of psychological damage to consumers, such as "emotional-expressive therapy" for crisis debriefing or "Scared Straight" programs for delinquency (Stuart & Lilienfeld, 2007). To find the evidence that fits your therapeutic style can be impossible to find, so we try to find a best fit so practice can "be informed by evidence but not necessarily driven by it (Stuart & Lilienfeld, 2007). One source of evidence that a treatment is working is with client feedback, and evaluate cases on an ongoing basis (Stuart & Lilienfeld, 2007). Furthermore try to find all the research you can on a therapy that has been used in the past by others. Granted this is difficult to do when the therapy is new or you have linked information from other disciplines to make a hybrid type of therapy. At the core of all medical and therapeutic professions is the understanding of "first , do no harm" (Primum non nocere). Also with the American Psychological Association (APA) is the ethical dictate that we must "take reasonable steps to avoid harming their clients/patients (APA, 2002, p.1065). Thus it is clear that the therapist needs to undertake research to satisfy them-selves that a therapeutic method is safe for the client. With all the differences in the styles of therapists and there clients some therapeutic method may hinder or slow the recovery of clients (Lilienfeld, 2007). To think that any treatment is better than no treatment is a naïve understanding (Lilienfeld, 2007) of the treatment process and the cognition of clients. It is suggested that between 3 to 10% of clients do get worse after treatment, and for people suffering addiction to substance the result is higher from 10 to 15% getting worse after treatment (Lilienfeld, 2007). Though we must not forget that in some cases that these figures may have a level of error in them, with some clients getting worse with or without treatment (Lilienfeld, 2007). Furthermore, there are a number of clients that have been through the mental health system numerous times with social workers intervening in employment agencies and social welfare agencies. It is in these cases that people may have had many counsellors, psychologists, psychiatrists, and social workers all telling the client different things using different methods to get different outcomes. Where does that leave the client? Confused, and bewildered with no real direction. Lilienfeld (2007) suggests the following criteria in order not to use a treatment method:

1. They have demonstrated harmful psychological or physical effects in clients or others (eg, relatives).
2. The harmful effect are enduring and do not merely reflect a short-term exacerbation of symptoms during treatment.
3. The harmful effects have been replicated by independent investigative teams.

Thus as a result not all treatments are treatments, just as not all oils are oils. The client must be monitored and give their feedback with every session, and the therapist be flexible enough to change their approach. Bibliography

• Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Association for psychological science , 2 (1), 53-70.
• Stuart, R. B., & Lilienfeld, S. O. (2007). The evidence missing from evidence-based practice. American Psychologist , 615-616.

Sarahs Last Wish

[caption id="" align="alignleft" width="304" caption="http://www.sarahs-last-wish.com/"][/caption] I heard the interview of the Author on the Radio and felt that it is worth while putting a link to her page on my blog. I have read a book about Doctors and Heuristics and feel that this book sounds like the same sort of mistakes that Doctors make.   http://www.sarahs-last-wish.com/ Mark Westley and his wife, Dianne raised their six children on a charming country property. The Westleys were a typical, close-knit Australian family who enjoyed happy, healthy lives – until the day eleven-year-old Sarah was struck down by a severe mystery illness. Sarah's parents rushed her to several small country hospitals in search of help. Yet before adequate tests had been performed, doctors announced that Sarah was pregnant – an outrageous misdiagnosis that triggered a devastating chain of events for the family. It was only when Sarah was finally transferred to a large teaching hospital that doctors discovered the true diagnosis: a rare condition they had never seen before…and wanted to study.

MAP of Rehabs in South Australia

The information I have on this website about Rehabs in Australia is not complete, so I hope you can assist me by emailing me about other Rehabs you know of.   This Map will be constantly updated as information is gathered.

MAP of Rehabs in Western Australia

The information I have on this website about Rehabs in Australia is not complete, so I hope you can assist me by emailing me about other Rehabs you know of.   This Map will be constantly updated as information is gathered.