“In Your Face”

March 25th, 2011 | Posted by Michael Taleff in Addiction | Addiction Discussions

I recently read a post on a substance abuse listserve. The topic referred to past interventions used by our field. A Ph.D. expressed favor for the retention of “in your face” interventions because they might be “solutions” to certain clients, specifically those with Antisocial Personality Disorder. I assumed the “in your face” interventions are those harsh confrontations that our field used in the past, and still does in some programs. We remain infamously noted for “in your face.”

Retaining such interventions is problematic for several reasons.

First, I would expect Ph.Ds (or anyone) to offer at least a modicum of support for such claims. There was no trace of it in her post. In fact, I would be willing to bet there is no evidence that supports “in your face” interventions in the peer reviewed journals.

Certainly the antidotal tales abound, nevertheless they are just testimonials.

I would be especially interested in seeing the evidence that supports “in your face interventions” with the antisocial population to which the Ph.D. felt such interventions would be effective. On this account, I would again be willing to bet no such evidence exists.

Yet, I would be willing to also wager that this Ph.D. would respond to my criticism with a story or two of how she has personally seen or heard of the positive effects from such interventions. “It was a solution. It worked,” I would envision her to say. And, the problem would still be the testimonial realm.

Second, there is an ethical problem “with in your face” interventions. The problem is — on what footing does a professional addiction counselor stand that warrants calling clients names, yelling at them, or similar such actions, all of which generally comprise “in your face” interventions.

What is the ethical justification for such counselor behavior?

I suppose the standard response is often that clients have to get honest, and “in your face” is the way to do it. And my response is — so honesty is found at the end of a loud verbally abusive road? (Means justifies the ends.) Moreover, note the word abusive. If “in your face” entails abuse such interventions have no place in addiction counseling simply because they are abusive. We just don’t abuse our clients. Can that be made any clearer in ethical terms?

Third, if the logic is to retain such “in your face” interventions after I used all the standard empathic interventions and they failed, I am then justified to break out the harsh ones? The answer is still — No! If you failed then it means is you have come to the end of your skill sets, and that signals you have nothing else to offer. This, in turn, means it’s time to refer the case to someone else. Referral is the professional thing to do in such situations, not ratchet-up the intensity of your voice.

In tandem with this third criticism is that counselors may well opt for “in your face” techniques more often and more frequently than need be. Essentially, they may well turn to it as a matter of routine, as has been the problem in the past.

Fourth, and to make this as clear as possible, a counselor’s personal frustration with difficult clients does not merit that I take my revenge on them with “in your face” interventions. If I “lose it” due to my frustration the onus of losing it is on me not the client. As a professional addiction counselor I am the one who needs to be responsible, proficient, and in control of my frustration. That’s what it means to be professional.

Will we ever get away from the belief that “in your face” interventions have a place in modern addiction counseling?

I sometimes think not.

Sad.

Having said all that, suitable confrontation may well have its place in our field. With a little effort on your part, a literature search will reveal such sources and methods.

So, if you are of a mind that at times you need to be suitably confrontational seek the good literature on the subject.

Yet, suitable is a far cry from “in your face.”

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