Substance Use Counsellors’ Experiences Working with Mandated Clients Lucy McCullough Counselling Psychology Ontario Institute for Studies in Education University of Toronto

Importance of Research Counsellors voice is missing from literature about coercion and mandated therapy Addictions counselling presents unique clinical concerns Outside the traditional rubric of training Supports rehabilitation rather than criminalization.

Probation Referral Criminal Offense - drugs or alcohol involved Probation with substance use counselling as a condition Probation Officer (PO) refers you to a counsellor/group Assessment Counselling begins…

Child Welfare Referral Mother flagged by Children’s Aid/Protection Worker recommends substance use counselling Counselling service receives her file Assessment Counselling begins…

Participants Working in mental health programs of Toronto hospitals, women-centred substance use counselling agency, child and family focused services Interviewed 12 people, 1 interview lost 9 women, 2 men 9 counsellor participants, 2 key informants

Interview Topics Perception of work over time Typical therapeutic process Challenges and successes with clients and the system Therapeutic model Personal motivation and self-evaluation

Sustaining Commitment Themes System Decisions Coming to a common understanding of the client’s best outcome Clarifying Your Role Mandate as Motivator? The Mystery of Change Sustaining Commitment

System Decisions “like I see two clients and I can see the difference: this one is working so hard, she’s worked with me for a year and done absolutely everything she needs to do and this client is doing okay but her CAS worker is amazing and the other’s is really not hearing everything so one ends up having her child given for adoption and the other has her child coming back to her. So it’s very important how we deal with children’s aid. We do lots of case conferences, so that helps.” (Sapna)

“So I think Probation Officers like to see clients move, and they feel that because this one goes to see Richard that you know that the drinking’s going to change, and sometimes it doesn’t. Most times it doesn’t. I don’t have any magic wands. Their perception or expectations are very high that the counselling process is going to work.” (Richard)

Coming to a Common Understanding of the Client’s Best Outcome “We have different policies we follow, Children’s’ Aid has different policies they follow. The Police Service has completely different policies that they follow as well, which sometimes could be in direct conflict with what we feel would benefit the woman. So that’s why a lot of times we find ourselves at odds with other systems. And it doesn’t make either person or either agency bad or horrible, it’s just the way the system is…

…We try to negotiate and try to make both our systems fit somehow, we try to draw on whatever we can to tie it altogether … And you do a lot of wordplay, a lot of acrobatics, a lot of navigation through the system. You do back-flips, and I don’t know what. But at the end of the day, it’s all worth it.” (Mirah)

Clarifying Your Role “I tell my client ‘I’m not a children’s aid worker but I’m an advocate for you. I’m the only person who can inform the children’s aid worker about the great work you are doing. I’m going to be here to help you, not to help CA. I’m going to be here so you can have your goals in your hand.’ I think the first two or three meetings I don’t even care about their drug use.” (Sapna)

Mandate as Motivator? “For every woman, their circumstances are different, their buy-ins are different. But if I had to generalize, more often than not, the legal system is not a good motivator. So I would really try to find what their motivator would be, what their buy-in would be, and try to take it from there.” (Mirah)

The Mystery of Change “Sometimes you can meet a client and they don’t seem to be in action stage, they really don’t. They don’t even seem in contemplation stage. They seem to be pre-contemplation and then all of a sudden something happens and it’s like a total fluke that seemed to happen overnight.‘Now I sense a change in you, a change in attitude whatever, what happened?’ They’ll tell you exactly what happened. Sometimes it could be something obscure, something that you would never really think about, but for them it had relevance and it was enough for them to turn a corner.” (Deborah) What about changing? And how is it conceptualized. Quote Many counsellors felt their clients motivators for change varied and were very individualized. And while many of them understood the stages of change model and used it as a reference point – a place for assessment, they generally did not see their client progress in a prescribed way through the stages or predict progression. More of a mysterious personal conversion. So finally, if change is so mysterious and there are few certain success in this work, what keeps the counsellors engaged and enjoying their work.

Sustaining Commitment “I do think that a lot of the people who really worked on their addiction, I find them really appealing as people. They have a certain honesty with themselves and with other people, they’ve been through something quite terrible and maybe they’ve been quite terrible and they have a certain perspective of what’s important and on themselves and on life that you can see, or that I see …

…the thing about addictions work, you see people change …the thing about addictions work, you see people change. You do see people go into recovery and do well, and that’s encouraging, that’s inspiring. So seeing that, that’s sustaining.” (Matthew, Expert Informant)

“As long as my clients are happy with me that means I’m doing a good job. The clients show you. Like for example, a client called me and said ‘Oh my god Sapna. I’m so grateful to have you in my life.’ They can make you feel so much better, even with one sentence. Because for her, just my presence in the court made so much difference.” (Lainey)

Summary Negotiating the referral, both with the client and the referral agent Mandates may provide an opportunity for change Change happens in many way, for many reasons Focus on small achievements and good team/supervision to sustain comittment

Recommendations for good practice Communicate regularly with the referral agent Educate the referral agents to accept realistic goals and rewards for the clients Team based approach to mandated counselling?

Acknowledgements INTEGRATED MENTOR PROGRAM IN ADDICTIONS RESEARCH TRAINING http://www.addictionsresearchtraining.ca/ I encourage you to apply – students, post-docs and community practitioner-researchers! Thank you to the counsellor participants who generously gave their time and shared their stories with me. Our Partners Canadian Institutes of Health Research University of British Columbia BC Centre of Excellence for Women’s Health BC Women’s Hospital & Health Centre

Thank you! Lucymccu@yahoo.ca

Suggested Readings Wild, T.C. (2006). Social control and coercion in addiction treatment: Towards evidence-based policy and practice. Addiction, 101, 40-49. Sutherland, C., Naymark, M. & Shuggi, R. (2004). Working with Mandated Clients. In S. Harrison and V. Carver (Eds.) Alcohol & Drug Problems: A Practical Guide for Counsellors (p. 625-650). Toronto: Centre for Addiction and Mental Health. Rowley, W. J., & MacDonald, D. (2001). Counseling and the law: A cross-cultural perspective. Journal of Counseling and Development : JCD, 79(4), 422. Contact: lucymccu@yahoo.ca