LIVING THERAPY SERIES Counselling a Recovering Drug User A Person-Centred Dialogue Richard Bryant-Jefferies Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business First published 2003 by Radcliffe Publishing Published 2018 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2003 Richard Bryant-Jefferies CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works ISBN-13: 978-1-85775-850-4 (pbk) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. 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Typeset by Aarontype Limited, Easton, Bristol Contents Forewords V Preface ix About the author xi Acknowledgements xii Introduction 1 The person-centred approach 2 Drug use 6 Setting thescene 9 Chapter 1 A new beginning 11 Session 1 11 Session 2 20 Chapter 2 Painful memories and the struggle to identify feelings 27 Session 3 27 Session 4 32 Chapter 3 Supervision 1 43 Chapter 4 Panic attack and using on top 49 Session 5 49 Session 6 55 Chapter 5 Making sense of the lapse 61 Session 7 61 Session 8 67 iv Contents Chapter 6 Supervision 2 77 Chapter 7 ‘Parts’ of Dan begin to emerge as he connects with his past 8 5 Session 9 85 Session 10 92 Chapter 8 Further ‘parts’ emerge and the metaphor of a jigsaw of self arises 99 Session 11 99 Session 12 107 The Jigsaw of Self by Richard Bryant-Jefferies 119 Chapter 9 Supervision 3 125 Chapter 10 A month later 131 Session 16 131 Session 17 136 Chapter 11 The past relived; attempting to stop the methadone 139 Session 18 139 Session 19 146 Chapter 12 Supervision 4 155 Chapter 13 Dan reflects on his goals for the future 161 Session 20 161 Author’s comments 171 References 173 Further reading 175 Useful contacts 177 Drugs 177 Person-centred 178 Index 179 Foreword The first thing that strikes me about this book is how readable it is. Usually when I read a book about a factual subject, in particular about medicine or other subjects related to my work, I tend to dip in and out over several weeks, as many textbooks I frankly find hard going. Not so with this book. I was riveted from the start as if I was reading a good novel. Counselling a Recovering Drug User: a person-centred dialogue has a story line which gripped me like a magnet from cover to cover. By the time I had read the book not only had I gained an insight into a drug user’s life and the complicated issues that can affect them, but I also felt that I had had a damned good read. I had also learned about the principles behind Rogerian person-centred counselling and some of the issues which may confront both the client and the therapist within this type of encounter. Throughout the book Richard Bryant-Jefferies manages to put across these issues, whilst at the same time gripping the reader in the story line. Another important part of the process is that of supervision of the therapist. The reader will not only see that supervision is a desirable facility for a health worker but is an essential element in supporting the worker and encouraging cri tical analysis and thus deeper understanding of the relationship and dynamics of the encounter. Having worked as a doctor for 22 years without ever receiving any formal supervision, after reading this book I feel slightly lacking and quite let down as the benefits are shown so eloquently in this book, not only for the therapist, but also for the therapeutic process itself. Aside from certainly enjoying this book, the reader will come away with a heightened awareness and increased knowledge of the complexities of dealing with people who have a drug-related problem. Richard Bryant-Jefferies evidently has a deep understanding himself and is able to communicate these issues in an easy-to-understand way, at the same time stimulating but not taxing the reader’s mind. Within the story line are inset boxes in which the author provides the reader with a commentary on the counselling process and explains some of the practicalities of drug using, thereby giving a greater depth to the reading experi ence. At the end of each chapter there is a useful summary and a list of points for discussion which encourage the reader to become involved in the counselling process and the issues which both the client and counsellor encounter. Many people will benefit from this book. The lay reader will find the book an engaging read whilst gaining some insight into the world of drug users and the vi Foreword counselling process. Actual and potential clients may read this and gain encour agement about the benefits of person-centred counselling. Health professionals will find this book provides an easy-to-follow explanation of Carl Rogers’ counsel ling model and a unique view on how the counselling relationship allows a troubled client to grow and heal. Anyone reading this book will not fail to notice Richard Bryant-Jefferies’ non- judgemental approach to the drug user, which is essential if any therapeutic rela tionship is to work. They will also not fail to question their own judgement of other human beings in light of the author’s humbling respect for others. I enjoyed this book immensely. If other textbooks were as easy to read I would have a much greater knowledge and a deeper understanding of many subject areas. As with his earlier book, Problem Drinking: a person-centred approach, Richard Bryant-Jefferies has a winner. I highly recommend this book to anyone who has an interest in drug users’ problems and the therapeutic relationship. Dr Peter C Robinson mb, bs, drcog General Practitioner, Farnham, Surrey GP with a Special Interest in Substance Misuse, Guildford, Surrey Hospital Practitioner in Genito-Urinary Medicine, Guildford, Surrey GP Tutor, St George’s Hospital Medical School, London August 2003 Foreword In the past decade, research has overwhelmingly established that drug abuse and drug dependence is a disorder with symptoms that manifest themselves in all aspects of life. It is no longer acceptable for anyone to view a person who has a drug abuse problem as a matter of a person being morally deficient and lacking sufficient amounts of willpower to change behavior. Persons with drug abuse disorders are also on the rise according to recent reports from the Global Burden of Disease and the World Health Organization. It is estimated 141 million people worldwide are drug abusers. Recent data from the UK Department of Health estimate the social and economic costs of drug use in the UK at £4 billion a year. Drug-related deaths have continued to rise in England, Wales, Scotland and Northern Ireland. These numbers have a significant impact on individuals, families and communities at local, national and international levels in relation to public health problems associated with drug abuse. Richard Bryant-Jefferies’ book is well timed and critically needed because it is a unique focus specifically working with the individual drug abuser which is written within the framework of Carl Rogers’ person-centered approach. Why is this important? It is important because for far too long it has been a belief in the drug treatment field that persons having drug problems are in denial due to personality deficits, and are immoral. A mainstay of treatment has been aggres sive confrontation treatments which may demoralize a person and attempt to coerce positive behavioral changes. Counseling behaviors, however, using such approaches have been shown to predict treatment failure. An almost exact oppo site approach, use of empathy, has been associated with successful outcomes of treatment. Humanistic approaches have been utilized for other psychological problems for a number of years but very few times have these approaches been used when treating a person for drug abuse. In a classic paper in 1936, Rosenzwiez introduced the concept of common fac tors. Common factors are not specifically unique interventions or approaches used but are factors, such as warmth, attention, understanding, and encourage ment, which are central to, and play an active role in, client improvement. Pro ject Match, a study in the USA, supported evidence of the importance of these types of common factors as criteria for success for persons treated for addiction problems. Project Match studied outcomes of persons who were substance depen dent and found that all patients who participated in the study showed sustained, significant improvement with positive outcomes. The improved outcomes were viii Foreword found to be related to the high quality of care each person perceived they were receiving, not one of the three different behavioral approaches used in the study. Other recent studies support the effectiveness of a therapist’s style using empathy with successful client outcomes. Furthermore, regardless of the treatment tech nique used by a counselor, the counselors who create a strong therapeutic alli ance and relationship with their client have better improvement outcomes for the client. Bryant-Jefferies’ book, Counselling a Recovering Drug User: a person-centred di alogue, does exactly this. This book is matchless and deeply insightful. It brings alive the work formulated by Carl Rogers in defining and utilizing the necessary and sufficient conditions, which Bryant-Jefferies demonstrates, to bring positive behavioral life-style changes for a person experiencing a drug problem. Bryant- Jefferies offers critical wisdom from his many years of counseling persons with substance abuse problems and brings into the text the guidance and skill of an experienced supervisor. This in turn offers counseling suggestions, which are within reach for all who read this book. The therapeutic alliance at work within the pages of this book describes brilliantly the relationship of three people work ing together, the client, the counselor and the counselor’s supervisor, to actively improve the life of one person struggling with a drug problem. No doubt Bryant-Jefferies’ book will remain a reference for a long time to come for all of us working in the field of counseling persons with drug abuse problems. Dana Murphy-Parker rn, ms, cns Professor of Nursing, Arizona Western College Board of Directors, The International Nurses Society on Addictions Chair, Education Committee The International Network of Nurses (TINN) Interested in Alcohol Co-Founder, Tobacco and Drug Misuse August 2003 Preface Few general counselling training courses include a great deal on the subject of working with people with drug problems. Yet counsellors and other health and social care professionals are being faced with clients who, for one reason or another, have developed a drug-using habit, or may have had one in the past and may still be carrying the effects of drug use. The counsellor in the GP surgery, the nurse in the accident and emergency department, the social worker concerned with a family, the housing support worker in a city centre hostel can all expect to encounter people with drug problems. In fact, the list is endless: drug use is so wide spread these days that you are likely to encounter it anywhere and everywhere. I am aware of the growing need for a wider understanding of the issues to be addressed and ways of working with this client group if we are to ensure that damage is minimised, both to the user and to others. There is so much prejudicial and judgemental thought around in relation to this group of people, and I hope that this book will help to emphasise that the drug user is more, much more, than their drug use. The client in this book is not a stereotype; recovering drug users are individual with their own set of experiences and meanings that they attribute to their drug use. This book sets out to provide material to inform the training process of counsel lors and many others who seek to work with this client group. It is intended as much for experienced counsellors as it is for trainees. It provides real insight into what can occur during counselling sessions where the client is seeking to resolve issues related to their drug use, reflection on the process, and helpful summaries and points for discussion in the wide range of training courses for which it is intended. Counselling a Recovering Drug User: a person-centred dialogue will also be of value to the many healthcare and social care professionals who are likely to encounter patients or clients, or relatives of these, with this kind of problem. For all these professionals, the text demystifies what can occur in therapy, and at the same time provides useful approaches and frameworks that may be used by profes sionals other than counsellors. Importantly, I have also written this book for the person who has thought of seeking help for issues underlying their drug use, offering them insight into the process that they might expect in order to resolve their difficulty. However, one book can only convey part of the story. There may be common factors, but essen tially each person is unique, using substances for their own reasons. These need