What would you do with that money if treatment was affordable? Find out if your insurance covers treatment now!
Should Addiction Counselors Disclose Their Recovery?
More often than not, the answer is: no.
- “I’m in recovery too…so you can trust the suggestions I give you.”
- “I’ve been there, done that, so I ‘get’ where you are coming from.”
- “When I was in early recovery I wouldn’t trust normal people. But now it makes me better suited to helping you.”
Over the years I’ve trained many therapists and counselors, both students and more seasoned providers. It turns out, many people who decide they want to be addiction counselors are themselves in recovery. This makes sense. In fact, it’s very common for patients in rehab to announce that they are changing careers and intend to become addiction counselors.
There is no question that recovering counselors, therapists and doctors bring to the therapeutic relationship passion, energy and personal experience that can be a tremendous asset.-Omar ManejwalaGenerally their motives are good. They may want to give back as a way of showing gratitude for the help that was given to them. Or they may have had bad experiences with treatment and want to do things differently so others won’t have to suffer. Perhaps they are passionate about recovery, and want to focus on that. There is no question that recovering counselors, therapists and doctors bring to the therapeutic relationship passion, energy and personal experience that can be a tremendous asset.
Sometimes, however, the drive to become an addiction counselor can be less healthy. I’ve certainly seen many cases where counselors in recovery use their profession as a proxy for their own recovery. From a psychodynamic perspective they may be using the profession as a psychological defense against conscious awareness of irrational drives, or self-loathing. They may also use helping others to avoid their own intimacy, to avoid looking at their own issues.
From a cognitive perspective, some who pursue addiction counseling may struggle with the cognitive dissonance that arises when they are forced to reflect on the idea that there are many ways to get and stay in recovery. This many-paths view may be viewed as a threat to their own recovery. They then pursue counseling with a more heavy-handed, prescriptive approach, and sometimes come across as more reformed than in recovery. This sometimes shows up in treatment as the “12-steps or die” view, or any of a number of variants of this. In general, the drive to be expert as a proxy for self-care and healing leads to destructive behaviors. Dissolution of appropriate boundaries is a well-known consequence, for example.
I advise recovering addicts who wish to become counselors that their recovery, while in some respects a strength, can often be more of a hindrance to the successful delivery of therapy that is nuanced and dynamically informed.-Omar ManejwalaGenerally, the best counsel is usually to wait a few years and then decide. I advise recovering addicts who wish to become counselors that their recovery, while in some respects a strength, can often be more of a hindrance to the successful delivery of therapy that is nuanced and dynamically informed. I also tell them that relapse is an occupational hazard and that, in general, a much higher degree of self-care is required for those who work in the field.
When Does Therapist Self-Disclosure Work?
For those that are able to care for their own recovery at a very high level, a career working with addicts and alcoholics can be tremendously rewarding. One of the questions that comes up is whether to disclose their own recovery to their patients. Volumes (actual volumes!) have been written on the subject of therapist self-disclosure, so I won’t rehash the full debate here. By way of summary, the analysts generally believe in the idea that therapists should be a blank screen. They insist on minimal disclosure. Nevertheless, many other therapies rely heavily on limited, carefully determined disclosures.
Group therapy depends on some therapist disclosure (a la Yalom), and behavioral and cognitive-behavioral therapists use modeling and limited self-disclosure for therapeutic efficacy. More humanistic approaches (c.f. Jourard) depend even more heavily on therapist self-disclosure; the minimizing of fundamental differences between patient and therapist is itself a tool for effectiveness. In these cases, the informed view seems to be that disclosure depends in part on the type of therapy being offered.
Many argue that patients with alcoholism and addiction are similarly better able to relate to therapists in recovery, and that since therapeutic alliance is the primary correlate with successful therapy, that disclosure cements that alliance and drives superior outcomes.-Omar ManejwalaHowever, the efficacy (or harm) of disclosure doesn’t just vary by type of therapy but also by target. Some groups of patients simply seem to do better with some level of therapist self-disclosure – for example, veterans with PTSD. There are also some strong data that gay and lesbian clients may do better with certain types of therapist self-disclosure. And yes, many argue that patients with alcoholism and addiction are similarly better able to relate to therapists in recovery, and that since therapeutic alliance is the primary correlate with successful therapy, that disclosure cements that alliance and drives superior outcomes.
I take an opposing view, but not rigidly opposing. Of course, accidental and unavoidable disclosures will happen from time to time. And clients themselves can now learn much about therapists through Internet searches, which adds a new layer of complexity. But it is still generally possible to maintain some lack of transparency in most cases in the therapeutic relationship.
Self-Disclosure as Last Resort
My view is that…disclosure of personal recovery should usually be an act of last resort in addiction counseling.-Omar ManejwalaMy view is that, generally speaking – and there are exceptions, disclosures of various types to be more approachable in the therapy, and to avoid appearing aloof or cold is important – disclosure of personal recovery should usually be an act of last resort in addiction counseling. The reasons are multiple.
Most novice addiction counselors in recovery will use disclosure as a shortcut, to bypass the work necessary to establish and maintain a therapeutic alliance. This is a very natural (and very common) tendency, but can easily backfire, as clients can view the therapist as trapped in his approach or view. However, the hard-won therapeutic alliance is worth much more than the short-cut alliance, because the hard-won can withstand the vicissitudes of the therapeutic process. For example, with the disclosure approach, the patient may, when facing the question of how to proceed, think “you’re in recovery and you used __x___ method to achieve that, so you assume that any other approach I may try is doomed to fail, thus I don’t trust you.”
And there are many other pitfalls from self-disclosure besides dismissal of therapist based on recovery-orientation. Just a few of those are:
- Tendency to discount therapist as projection of shame.
- Development of collegiality that can produce an unconscious collusion to avoid the “real”, uncomfortable work of therapy.
- Various forms of transference development.
- Other boundary-related issues.
Even when therapists elect to disclose, there is value to delaying disclosure, even in time-limited and structured therapies. In addiction counseling, patients may often inquire about the therapist’s recovery-orientation. Exploring those questions without immediately answering them can yield fruitful material that can enhance the therapeutic process and alliance. Therapists who do eventually disclose should ask themselves why they are doing it. Is it for their own ego, or to help the client?
In many addiction treatment settings, avoiding self-disclosure of the therapist’s recovery status is essentially impossible. Counselors may go to recovery meetings where patients are present, and the community of patients in treatment settings may pass on this information to each other over many generations of admissions (and in my experience invariably do). However, even when disclosure is inevitable, care should be taken to avoid therapeutic approaches that rely on the therapist’s personal recovery experience rather than tried-and-true therapeutic techniques, as the effects on the therapy can be irreparable. In the 12-step parlance, “that’s what a sponsor is for.” Thus, even when disclosure is inevitable, steps should be taken to protect the therapeutic relationship from effects of emphasizing the therapist’s personal recovery.
However, even when disclosure is inevitable, care should be taken to avoid therapeutic approaches that rely on the therapist’s personal recovery experience rather than tried-and-true therapeutic techniques, as the effects on the therapy can be irreparable.-Omar Manejwala
Each case is unique, and there are circumstances where disclosure may enhance the relationship without significant risk. But even seasoned counselors should seek counsel with colleagues prior to disclosure, check their motives, and take steps to mitigate the risks to the therapeutic relationship.
Photo Source: istock