Monday, September 7, 2015

What Stigma?????





I can remember growing up in the sixties in an extremely affluent town in Connecticut. There were no alcoholics - only problem drinkers or those who could not hold their liquor. A sign of the times I guess, the country club attitude, or perhaps a combination of both. If you had a loved one with a mental health issue they were just “eccentric” Un-huh, that’s why every spring when they would go off their meds then run through the streets naked. Just eccentric.

No alcoholics, No mental health issues – therefore, no stigma.

God forbid, if you had a loved one that died of cirrhosis from alcoholism in those days. You begged the doctor to put anything down on the death certificate but that! Maybe call it a heart attack or some incurable disease.

As if your neighbors and friends did not know the truth. It was just not discussed. Well openly anyway.

Zoom ahead to now. Addiction is more openly discussed in families and social settings than ever before. Yet at times one can see that stigma is still prevalent and often ignored or downplayed. How else can one explain that up until a few years ago if a person was civilly committed in Massachusetts (Section 35) for mandated addiction treatment they would be sent to a correctional facility? That’s right a correctional facility, not a treatment facility.

I am glad to see that this ‘stigma’ piece has changed.

There are still those in our society that mumble, ‘you know those people want to be that way.’ I always find it interesting when these people change that attitude when it is a member of ‘their’ family is suddenly having an addiction issue. I guess it is just not the same thing.

Those people want to be that way? You know, I have yet to see it on a resume, ‘Professional Addict/Alcoholic.’ Yea I’m sure when they were growing up they were thinking, ‘you know, someday I want to become an addict/alcoholic; homeless, jobless, walking the streets, drinking a half-gallon of vodka a day.’ Yup, that’s what I want to do.

People who make those types of statements show their ignorance, they are part of the problem – not the solution.

There are other areas of mental health often times shrouded in stigma and secrecy. Why else would a family not talk about ‘Uncle Tony’ who has not worked in two years due to his depression, or, no one talks about the times when Grandma would make everyone a Sunday morning breakfast clothed only in an apron because she was in a full-blown episode of mania.

In the case of depression, one might hear encouraging words from family such as: ‘what do you have to be depressed about, just pick yourself up by the bootstraps, you know if you only had a job...

Gee, those motivating statements should do the trick. I do not understand how ‘putdowns’ of that type can be considered motivating. Yet I will hear family members say these statements during a meeting with their loved one.. Can someone explain to me how that works?

Yet these are statements that patients/clients tell me they can go through on a daily basis. There are support groups for the friends and families of those with addiction and/or other mental health issues.

Often times the patients/clients I work with tell me their families are not willing to attend such groups to learn about their illnesses due to the beliefs I stated previously.

The suggestion I make to them in that case is, look directly at them and say something to the effect, ‘you say you love me, and that you care about me, yet you won’t attend a group to learn about my illness…’ Some fellow therapists have told me this is unethical for me to suggest – so be it. I advocate for my patients/clients, bottom line.

We need to continue to have dialogue and education on addiction and mental health issues; we need to do away with ‘blanket’ statements that allow us to turn our heads away from those that are in need. We “all” need to be part of the ongoing solutions.

There is no place for ignorance and stigma if we truly care about our fellow human beings.

Tuesday, September 1, 2015

Therapist? Then You Need A Therapist…


Counter-transference, secondary trauma, boundary issues, etc. Issues such as these can build up and ‘burn out’ a clinician if not addressed over a period of time. When I am teaching a new group of addiction counseling students at UMASS-Boston this is one of the first topics I discuss with them.

The need to obtain a therapist for themselves.

Why, what is the big deal if I am already getting supervision? While supervision can be beneficial it will not necessarily address the underlying issues in depth. Time constraints, vulnerability, and the issue of not wanting to appear ‘unable’ to perform one’s duties can play into the limitations of supervision only.

I can recall instances over my years in field when I was extremely grateful to have my own therapist.

One time I was performing an intake with a 26 year old female recently to the U.S. from a Latin American country. When I got to the section of the intake asking about family and after asking her a question about her father her face became expressionless, her voice dropped an octave and she stared straight ahead and said ‘When I was seven years old men banged down the front door of our house and started beating my father up…I was hiding in a closet, the type that has slants in the door and I could see everything they were doing…they knocked him to the ground before they killed him…’ In the back of my mind I was screaming ‘are you f@#king kidding me!’ Toward the client I expressed appropriate empathy and spoke of wanting to line up clinicians that specialize in trauma issues.

For the rest of the day I was useless. I could not get her story out of my mind. When the day was over I was still thinking about it…walking to my truck, still thinking about, start my truck up, still thinking about. I turned my truck off, grabbed my cell phone and called my therapist. ‘Hey, do you have some time to see me this afternoon? I really need to talk about a situation that happened today. What, you have a full schedule? Well, I’m coming by anyway.’ (He found time for me).

Without dialogue with my therapist I probably would have taken this ‘situation’ home where directly or indirectly it would have affected my family – not to mention increasing distress to myself.

I always try to leave work at work.

Another time I had picked up a new client that had recently been released from prison after serving a term for vehicular manslaughter. I asked him how it felt to be out and he said he didn’t care if he had ever gotten out. He had been drunk driving and the passenger in his car had been killed in the accident. After more dialogue I learned that the passenger had been his twelve year old son he had been driving to a hockey game.


Another phone call to my therapist…




Willy is an educator at UMASS-Boston & Cambridge College where he teaches Substance Abuse & Co-Occurring Disorders as his principle course. He presents from a clinical, academic, and personal perspective. Recently he has started guest lecturing nationally at Universities, Colleges, and to Professional Organizations. His style is high energy, entertaining, and informative due in part to his previous life as a comedian and comedy writer.