SAMI TEAM
COUNSELOR-THERAPIST
Substance abuse counselors
and mental health therapists contribute their clinical skills to the SAMI team by helping
persons with dual disorders increase their self-awareness of the symptoms of mental
illness and substance abuse, as well as their awareness of the side effects of medication.
Clinicians help consumers develop healthier coping skills. As consumers develop higher
degrees of self-awareness and coping skills, they typically achieve higher levels of
self-determination, self-motivation, and self-control, which translate into a potential
for more independent living.
The New Hampshire-Dartmouth DDIT model stresses that therapeutic interactions take place in vivo, that is, in the homes of consumers and
in other community locations like coffee shops, hospitals, 12-Step meetings, and jails. In
the DDIT model, a counselor or therapist not only utilizes traditional cognitive
behavioral and motivational interviewing techniques but also techniques that help
consumers develop independent living skills. Clinicians typically help consumers develop
the awareness and skills necessary for shopping, managing money, and interacting socially
with peers, family, neighbors, co-workers, supervisors, and professional service providers
like doctors and nurses. This work may by accomplished in the community or in the agency
setting.
This section of our Web site was written by referencing a book by Carolyn Mercer-McFadden, et al, entitled Substance Abuse Treatment for People with Severe Mental Disorders: A program manager’s guide. Concord, New Hampshire: New Hampshire-Dartmouth Psychiatric Research Center. 1998, 211-217.
CONSUMER AS THERAPEUTIC PARTNER
Counselors and therapists in DDIT-based SAMI programs include consumers as partners in the treatment process. They acknowledge that each individual has a different view of his or her own disorders, has a different learning style, and a different preference for treatment. Counselors and therapists develop specialized skills to assess the severity of mental illness and addiction and to encourage consumer choice from a range of appropriate treatment possibilities, without imposing their own judgments. Clinicians must know when and how a consumer may best be served with information and persuasion. They must also understand how to communicate effectively with consumers about available alternatives for
- medication
- hospitalization
- rehabilitation services
- substance abuse treatment
- housing
By using their skills to help consumers increase their
self-determination, self-motivation, and self-control, counselors and therapists are more
likely to foster motivation for change among the consumers they serve. The New
Hampshire-Dartmouth DDIT model often challenges clinicians to rethink their methods and
develop creative strategies for interacting with clients. More specifically, DDIT
challenges clinicians to rethink the way they approach self-help groups and therapeutic
boundaries.
SELF-HELP GROUPS
Clinicians using the DDIT model have found that many consumers
with dual disorders can achieve sobriety without using self-help approaches or programs,
such as Alcoholics Anonymous (AA). They have found that some consumers like self-help
groups, and others do not. As stated above, clinicians must respect the consumer’s
preference.
To respond to those consumers who are interested in self-help groups, counselors and therapists must search for an array of meetings that are open to persons with dual
disorders. This enables the clinician to offer a consumer a choice. These groups include
the following:
- Alcoholic Anonymous (AA)
- Narcotics Anonymous (NA)
- Cocaine Anonymous (CA)
- Dual Recovery Anonymous (DRA) (The number of these groups is slowly growing acrossthe State of Ohio.)
- Double Trouble
The SAMI CCOE encourages counselors and therapists to support the
start-up of meetings in their communities. This can be accomplished by forming
partnerships with dual disorder consumers who are currently in active recovery. For more
information about how to start a meeting in your community, review the selections from the
CCOE Library and Links listed below and contact the SAMI CCOE.
DDIT encourages clinicians to integrate self-help material selectively into interventions,
as well as into the dual disorder program as a whole. DDIT also encourages clinicians to
present established self-help programs like AA, NA, and CA as a choice during the active
treatment stage and to utilize sponsors to assist consumers in the active treatment
process. Peer counselors and advisors can be a source of motivation for consumers.
THERAPEUTIC BOUNDARIES
Traditional therapeutic training teaches clinicians to maintain
emotional distance in order to prevent consumers from becoming dependent upon them. As a
result, clinicians may feel uncomfortable about helping consumers on a more intimate level
in community settings. DDIT stresses that as long as consumers are actively making
decisions and solving their own problems, a clinician will not produce unhealthy
dependency by helping consumers with day-to-day tasks.
Counselors and therapists should note that working with consumers in public settings and working in teams, where boundary issues are regularly discussed, can lower the potential
for the violation of therapeutic boundaries. They should note that some boundaries are
never changed. To avoid their abuse of the therapeutic relationship, clinicians must avoid
and refrain from
- making sexual contact with consumers
- taking or using the money or property from the consumer for personal gain
- employing a consumer for personal gain
- using a consumer for emotional support
TASKS
In addition to the tasks discussed above, counselors and
therapists typically
- assess consumers for the presence and severity of mental illness and substance abuse
- intervene to prevent a relapse to the use of alcohol and other drugs for actively recovering consumers
- respond effectively to psychiatric symptoms
- identify treatment goals with consumers and caregivers
- lead multiple family psychoeducational groups or programs
- monitor medication use
- support healthy activities of daily living (ADL)
- assist consumer's in managing their income
- maintain case records
- participate in team meetings
- consult with family caregivers regarding their needs
- consult with SAMI team leader
KNOWLEDGE
Clinicians typically need to have a working knowledge of
- mental health symptoms and progression of illness
- substance abuse symptoms and progression of illness
- recovery model philosophy
- stage-wise treatment
- basic psychopharmacology
- team development and dynamics
- insurance regulations
- confidentiality laws
- interventions that emphasize an integrated
biopsychosocial approach
SKILLS
Counselors and therapists must be able to demonstrate these
skills
- assess mental health and substance abuse
- recognize the signs and symptoms of a relapse to
substance abuse and/or psychiatric episode
- translate the specialized language (jargon) of medical
and social service professionals into a language that consumers and caregivers can
understand
- make effective use of motivational interviewing
techniques (including reflective listening)
- work as a member of a team
- interact and communicate with professionals from other
disciplines
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