Bert Klavens wrote this article which was featured in the Times Argus on May 16, 2016. It's a great summary of youth treatment for substance abuse and working with youth in general.
Demystifying Teen Substance Abuse Treatment:
Strategies for Successful Youth Counseling
Editor’s note: Current PrEvents is produced by the Central Vermont New Directions Coalition in collaboration with the Washington County Youth Service Bureau, as part of the Partnership for Success grant from the Vermont Department of Health.
BY BERT KLAVENS with Jeremy Vermilyea
Effective counseling is a collaboration between counselor and client. The counselor is not an enforcer, or a convincer. The counselor is a problem-solving partner. Treatment provides an opportunity to communicate confidence in the young person’s ability to make their own choices while also helping them to understand the consequences that go along with those choices.
When young people begin substance use treatment there is often an assumption that they are strongly motivated to make changes in their substance using behaviors. Counselors who press teens to make quick decisions to quit right away are often unsuccessful, as many youth entering substance use treatment believe they have a drug solution not a drug problem. They might experience substances as helping with problems like sleep, fitting in socially, or feelings of boredom, sadness and anxiety; therefore, at least in the short-term, they are often not very motivated to make changes. Youth who are mandated by parents, schools, or courts to attend counseling, sometimes simply want to “get it over with.” Developmental issues connected to autonomy can easily create additional barriers when talking to adults. The perception that adults are trying to take away their autonomy or control them can often lead young people to lie, disengage, or increase resistant behaviors.
The foundation of any good counseling intervention starts with the development of a strong therapeutic relationship. From a clinical point of view, the most valuable and pertinent information about a young person's substance use habit, and what he or she thinks about it, is going to come from that young person. What most effectively encourages honest communication between the counselor and the young person is the safety fostered by a therapeutic relationship based on trust and respect. For these reasons, therapists will often proceed slowly early in treatment, taking the time to develop the strong relationship and feeling of safety that will support the therapeutic change process going forward. At the same time, counselors use the opportunity provided by this “getting to know you” period to learn more about other areas of a young person’s life.
Substance use often presents as a secondary reaction to chronic stressors, such as depression, trauma, educational issues or family conflict. Gathering information about these areas allows the counselor to better understand co-occurring psychological and situational issues, as the context within which the behavior is occurring.
As mentioned earlier, external pressures to change substance use habits are also an important factor in treatment. Whether they are legal, academic or family-based, these pressures may be helpful in motivating youth to enter treatment, but are rarely enough on their own to motivate lasting behavioral change. Lasting change becomes more likely when it is connected to a person’s internally generated motivations and goals. As Dr. Robert Schwebel puts it, "From a holistic perspective, it is evident that drugs are used to satisfy or attempt to satisfy personal needs. They also cause personal problems. For individuals to make informed decisions about their drug use they must engage in a thoughtful and often complex decision-making process that involves comparing the benefits and harm." Counselors, therefore, while working with clients to address external pressures to change, bring even stronger focus to creating an opportunity for the youth to reflect on their substance using behavior and its impact on their lives.
Engaging clients about things in their lives that they are struggling with or might want to change allows treatment to focus on the person, not just the drug use. It demonstrates the counselor’s investment and commitment to helping the youth improve their lives in ways that make sense to them and can facilitate a discussion about alternative ways to satisfy needs and solve problems in ways that do not involve substances.
To sum up, here is another quote from Dr Schwebel:
“In other words, counselors create a safe accepting climate in which they listen to clients with empathy in order to understand them fully. After careful listening, they provide personal feedback, accurately reflecting back what they have heard to help youth gain clarity about their lives; offer encouragement and their own advice; and discuss a menu of options looking forward. Within this framework, clients find their own motivation to change. Instead of taking over and trying to control clients, counselors make it clear that youth are responsible for making their own choices and are capable of doing so. Counselors implicitly and sometimes explicitly deliver a message of confidence in their clients’ own ability to succeed.”
The two quotes in this article are from The Seven Challenges – Brief Manual – a brief intervention format developed by Robert Schwebel Ph.D. based on his Seven Challenges model.
Bert Klavens, M.A. LADC is the Director of the Healthy Youth Program (HYP) a service of the Washington County Youth Service Bureau in Montpelier, Vermont.HYP serves youth 12-26 with co-occurring substance abuse and mental health issues and utilizes a Positive Youth Development, strength based treatment approach. Bert is a licensed addictions counselor, who has worked with youth, adults and families in Central Vermont for over 20 years.
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