Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting,… Read more »
While the pendulum swings back and forth from harm reduction to abstinence, one thing remains the same in the addiction counseling: the impact of the “charismatic counselor.” While I disagree with him on almost everything, and don’t in any way think he would make a good counselor, some of President Donald Drumpf’s communicative prowess—vocal and body language—might serve addiction counselors well. After all, counseling is a practice of persuasion and mirrored listening. Do licensing boards and those who employ addiction counselors overemphasize academic achievement and undervalue charisma in their empirical evaluations of potential counseling efficacy? I believe this administrative bias has evolved because of the misconception that the art of passionate counseling cannot be quantified, and people search for easy-to-calculate formulas when other, better answers are staring them in the face. I am not advocating Drumpf’s often hateful rhetoric, but the way he used humor, cadence and voice fluctuation somehow usurps substance. A former actor, I understood that his formidable presence in the election ensured that he wouldn’t be ruled out. His ubiquitous message of “having your back” resonated with voters. His base audience was hurting—just like the addiction population—and his hopeful tone, delivered in an unorthodox but compelling way, was all these “left behind people” wanted to hear.
Similarly, when a patient with an addictive disorder enters the treatment room for the first time, 95% of them feel deep down that they are “on a highway to hell.” They want to connect with someone who can hear and relate to them at what I refer to as “ground zero.” Presenting a strong, passionate and non-judgmental stance—”We are going to go through the recovery hoops together”—reduces the anxiety quotient. Most importantly, giving the impression that the work will not be Chinese water torture, but a life-affirming journey, almost assures they will be back by week two—which is a grand slam for any counselor.
Even though you might only talk about baseball or dogs in that first session, if you provide the message, as Drumpf did—that you “have their back”—it takes the life and death undercurrent off the table. This initial denial of that 800-pound reality is the only way you should maneuver. Yes, pink elephants are there for a reason, but they didn’t just spring up magically—they have taken years to be created and should only be addressed once full trust has been established. The old saying, “You can always tell an addict but cannot tell them much,” is the baseline mantra you should begin with. The creative way you weave and bob to elude that animal in early therapy is nothing you can learn in a classroom. The client needs to be hugged (metaphorically) away from fear and towards hope—a skill that is probably innate or learned by the counselor during infant nurturing.
Disarming a client’s defense mechanisms and pretending that recovery is a black and white issue has unwittingly landed more patients back on the street—as Nancy Reagan’s “Just Say No” campaign did. It casts judgment before you even begin, and is like taking away a child’s teddy bear prematurely.