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Editorial making a difference
Journal of SubstanceAbuse Tnwmenl,Vol.2. PP. W-80,1985 Printed in the USA. All rightsreserved.
al40-547245 f3.00 + .oo Copyright o 1985Pqamon PressLtd
EDITORIAL MAKING A DIFFERENCE 7 can make a difference. This patient can get better if only I can hang in there long enough. Come on . . . Keep trying! Don’t give up! . . .”
Analysis of this driving force to help others may reveal a kind of egocentrism or need for success that some find unpleasant to acknowledge. Yet, this same drive can challenge a patient to take responsibility for his life and survival. From this perspective, the drive to help represents the essence or “magic” of serving others. It does not, however, replace the demand to continually refine therapeutic skills. If we, as helpers, can provide a spark that ignites another’s inherent desire to heal, make changes, and begin to face life’s problems and joys, we have done something worthwhile. The helper’s task, then, is to accept this sense of drivenness, to recognize its potential to influence the lives of those we help, and to monitor how we expend such a precious commodity. Some may believe this need to impact on the lives of patients, clients, or families reflects a pathologic “need to be needed.” The need to be needed is present in most helpers; it often serves as the initial impetus to enter the profession. It, therefore, is not inherently inappropriate; on the contrary, finding ways to tap this inner reservoir of personal motivation to stay involved and committed is a continuing challenge to the helper who seeks to prevent burnout. So, perhaps the question is not so much “why bother with such a nebulous intangible?“, but rather “how can we sustain and replenish this reservoir?” One method involves development of a “need/involvement” monitoring system. What would this entail? First, each helper needs a helper! “Helper” can be defined as a supervisor, . . . but not in a traditional sense of someone “looking over your shoulder” to make sure basic competence is ensured. Supportive, stimulating supervision can involve both a one to one relationship with a colleague, a master therapist, or a mentor, as well as group supervision opportunities. During these regularly scheduled sessions, the therapist is encouraged to discuss case management problems and personal issues that may percolate to the surface as one works with patients/clients. Clearly, this kind of mutually supportive supervision can only occur in a trusting atmosphere; one that may not necessarily exist in the employment setting, but one that could be created in a different context. An ongoing supervision arrangement encourages self-monitoring, accurate feedback about growth as a therapist, and can impede burnout. Concurrent with this aspect of professional development is the previously described (Patrick, 1984) mandatory require-
How MANY TIMES DO THERAPISTS, nurses, physicians, and other helpers urge patients to keep fighting, not to give up, or to struggle to keep confronting difficult problems? This encouragement can be voiced directly to the client or repeated in a mantra-like manner in the helper’s thoughts. We seek to nurture, motivate, and teach patients/clients how to survive, grow, and heal the emotional or physical pains they experience. We may pray for recovery, become enmeshed in certain patient dramas, and find it difficult to let go when that time has arrived. Do we label this process “caring” or “promoting dependence”? Do we know where to draw the line between therapeutic involvement and over-involvement? Where do we learn the difference and the skills to actively determine how to avoid non-therapeutic dependence? These questions can plague the therapist who strives to provide effective helping while preserving one’s sense of competence and humanity. Crucial to retaining and enhancing therapeutic helping skills is confrontation of the involvement/ dependence issue. Seldom does the budding therapist or caregiver in training have ample opportunity to grasp the significance of becoming over-involved with the patients/clients. Our mentors may strive to warn of the dangers of promoting dependence, of the failure to limit emotional investment, and of methods to process through the transference phenomenon. Unfortunately, after leaving the security of the academic training environment, the therapist embarks on a life-time journey of professional activity that, at times, seems to resemble an “outward bound” expedition through the mine field of human need, pain, and tragedy. If we step on one of these emotional mines, the symbolic explosion can generate severe soul searching; “Did I handle this correctly?“, “Where did I go wrong?“, or “I shouldn’t have terminated so soon (or so late)“. As the therapist struggles to define the limits of involvement there often is an ongoing recognition that involvement is what makes therapy work. So, we are “back to one” . . . knowing that the essence of the therapeutic relationship is a combination of skill, knowledge, intuitive sensitivity, and the desire to serve another person . . . but not too much. 79
80 ment (purposeful redundancy!) to engage in self-care behavior. As the therapist cares for the self, there is less need to fulfill needs via needy clients! Again, the need to be needed is valid, appropriate, and “right”. When, however, the therapist has difficulty answering the classic assessment question “Whose needs are being met in this therapy hour?“, it is time to step back and self-monitor the need/involvement issue. There is no “recipe” attached to this brief statement. It is offered as a form of recognition for a powerful, non-measurable qualitative component of the helping role. It emanates from a firm belief that the drive to be of help to someone in need does make a difference. We often aren’t aware of how we made
Pamela K.S. Patrick
a difference, phenomenon
but must affirm to ourselves that the does exist. Pamela K.S. Patrick, Ph.D Halifax Hospital Medical Center Daytona Beach, FL
REFERENCE Patrick, P.K.S. (1984) Self-preservation: A non-negotiable requirement for the substance abuse clinician. Journal of
Substance Abuse Treatment 1, 85.
al40-547245 f3.00 + .oo Copyright o 1985Pqamon PressLtd
EDITORIAL MAKING A DIFFERENCE 7 can make a difference. This patient can get better if only I can hang in there long enough. Come on . . . Keep trying! Don’t give up! . . .”
Analysis of this driving force to help others may reveal a kind of egocentrism or need for success that some find unpleasant to acknowledge. Yet, this same drive can challenge a patient to take responsibility for his life and survival. From this perspective, the drive to help represents the essence or “magic” of serving others. It does not, however, replace the demand to continually refine therapeutic skills. If we, as helpers, can provide a spark that ignites another’s inherent desire to heal, make changes, and begin to face life’s problems and joys, we have done something worthwhile. The helper’s task, then, is to accept this sense of drivenness, to recognize its potential to influence the lives of those we help, and to monitor how we expend such a precious commodity. Some may believe this need to impact on the lives of patients, clients, or families reflects a pathologic “need to be needed.” The need to be needed is present in most helpers; it often serves as the initial impetus to enter the profession. It, therefore, is not inherently inappropriate; on the contrary, finding ways to tap this inner reservoir of personal motivation to stay involved and committed is a continuing challenge to the helper who seeks to prevent burnout. So, perhaps the question is not so much “why bother with such a nebulous intangible?“, but rather “how can we sustain and replenish this reservoir?” One method involves development of a “need/involvement” monitoring system. What would this entail? First, each helper needs a helper! “Helper” can be defined as a supervisor, . . . but not in a traditional sense of someone “looking over your shoulder” to make sure basic competence is ensured. Supportive, stimulating supervision can involve both a one to one relationship with a colleague, a master therapist, or a mentor, as well as group supervision opportunities. During these regularly scheduled sessions, the therapist is encouraged to discuss case management problems and personal issues that may percolate to the surface as one works with patients/clients. Clearly, this kind of mutually supportive supervision can only occur in a trusting atmosphere; one that may not necessarily exist in the employment setting, but one that could be created in a different context. An ongoing supervision arrangement encourages self-monitoring, accurate feedback about growth as a therapist, and can impede burnout. Concurrent with this aspect of professional development is the previously described (Patrick, 1984) mandatory require-
How MANY TIMES DO THERAPISTS, nurses, physicians, and other helpers urge patients to keep fighting, not to give up, or to struggle to keep confronting difficult problems? This encouragement can be voiced directly to the client or repeated in a mantra-like manner in the helper’s thoughts. We seek to nurture, motivate, and teach patients/clients how to survive, grow, and heal the emotional or physical pains they experience. We may pray for recovery, become enmeshed in certain patient dramas, and find it difficult to let go when that time has arrived. Do we label this process “caring” or “promoting dependence”? Do we know where to draw the line between therapeutic involvement and over-involvement? Where do we learn the difference and the skills to actively determine how to avoid non-therapeutic dependence? These questions can plague the therapist who strives to provide effective helping while preserving one’s sense of competence and humanity. Crucial to retaining and enhancing therapeutic helping skills is confrontation of the involvement/ dependence issue. Seldom does the budding therapist or caregiver in training have ample opportunity to grasp the significance of becoming over-involved with the patients/clients. Our mentors may strive to warn of the dangers of promoting dependence, of the failure to limit emotional investment, and of methods to process through the transference phenomenon. Unfortunately, after leaving the security of the academic training environment, the therapist embarks on a life-time journey of professional activity that, at times, seems to resemble an “outward bound” expedition through the mine field of human need, pain, and tragedy. If we step on one of these emotional mines, the symbolic explosion can generate severe soul searching; “Did I handle this correctly?“, “Where did I go wrong?“, or “I shouldn’t have terminated so soon (or so late)“. As the therapist struggles to define the limits of involvement there often is an ongoing recognition that involvement is what makes therapy work. So, we are “back to one” . . . knowing that the essence of the therapeutic relationship is a combination of skill, knowledge, intuitive sensitivity, and the desire to serve another person . . . but not too much. 79
80 ment (purposeful redundancy!) to engage in self-care behavior. As the therapist cares for the self, there is less need to fulfill needs via needy clients! Again, the need to be needed is valid, appropriate, and “right”. When, however, the therapist has difficulty answering the classic assessment question “Whose needs are being met in this therapy hour?“, it is time to step back and self-monitor the need/involvement issue. There is no “recipe” attached to this brief statement. It is offered as a form of recognition for a powerful, non-measurable qualitative component of the helping role. It emanates from a firm belief that the drive to be of help to someone in need does make a difference. We often aren’t aware of how we made
Pamela K.S. Patrick
a difference, phenomenon
but must affirm to ourselves that the does exist. Pamela K.S. Patrick, Ph.D Halifax Hospital Medical Center Daytona Beach, FL
REFERENCE Patrick, P.K.S. (1984) Self-preservation: A non-negotiable requirement for the substance abuse clinician. Journal of
Substance Abuse Treatment 1, 85.