Helping Clients Feel Safe to Share Their Drug and Alcohol Problems

Feb 13, 2017

“This I know. That the only way to live is like the rose, which lives without a why . . .”

Meister Eckhart (1260-1327)
Medieval Christian Mystic

Helping Clients Feel Safe to Share Their Drug and Alcohol Problems

TISA Description of the Problem: As we all know, clients are naturally hesitant to share drug and alcohol histories, and they frequently minimize significantly, for fear that they will be viewed as “bad people”. Coupled with genuine unconscious denial, such a state of affairs can result in gross underestimates of both the severity of drug and alcohol consumption and the resulting problems.

Tip: In order to decrease the atmosphere of shame and guilt, the clinician can emphasize that the material is being gathered solely for the purpose of helping like this:

Clinician: I want you to know that I?m not asking you these questions to pry into your private life, but in order for me to figure out what is the best way to help you. To do this I need some detailed information. For instance, try to give me a good idea of how many bags of heroin you are going through, during a typical day, when you are using heavily?”

I also tell people that I don?t have a personal opinion about their drug use, and I don?t mind hearing all the “gory details”. In this light I might simply add, “That all these difficult things, that you are telling me, help me to do my job better.”

Sometimes I tell clients that they can talk to me like they would talk to their doctors. Their drug use can be thought of as symptoms and that by describing them, I can better know how to treat them. Just as they would share the details of their “chest pain” with a doctor, by describing the extent of their drug use they help me to know what treatment might help them best.

Result: Such approaches often help clients to feel more safe. As they feel more safe they provide both more extensive and more valid data. The initial encounter has become a true therapeutic exchange as opposed to a potentially disengaging “interrogation”.

TISA Follow-up:

Tip provided by: Dianne Kuzia Hills, My Brother?s Table, Lyme, Massachusetts

TISA is a site dedicated to advancing the science and art
Of preventing suicide and teaching clinical interviewing