What kind of counselor should I seek out?
November 23, 2020 9:10 PM Subscribe
I'm looking for a therapist/counselor in my town (Columbia, SC just in case anyone has any local knowledge) that can help me with alcohol use disorder, resentment, and distrust (probably/obviously all tied up together). I know that's vague but can you suggest something specific I can search on or a certain focus area or specialty that I can google on that might be most effective? Thanks in advance.
Depends what’s important to you. Addiction can be understood as a moral problem, a disease, a behavior, or the product of social/cultural conditions. By deciding what kind of therapist you want, you get to choose which framework your therapist will use to contextualize your substance use. It will shape what language they use and how they support you to problem solve about it.
CBT sees addiction as behavior. CBT has a strong evidence base for treating substance use. It can feel a bit cold and mechanical. Some people find it hard to build rapport with someone doing really doctrinal CBT. Some CBT therapists emphasize the “B” and will be successful in supporting you to change habits but may not be able to address the mistrust and resentment. A CBT therapist who pulls more from cognitive therapies will do better with that, but it’s not touchy feely, and you’ll do less talking about feelings than you would in other modalities (although it can be pretty powerful and raw when a CBT therapist uncovers an unknown core belief).
12 step sees addiction as a disease. 12 step has less of an evidence base, but it comes with a built in sense of community and some... social retraining, if your mistrust and resentment have been a barrier to reciprocal social relationships.
There is some evidence that the therapeutic relationship itself, particularly from someone working from a humanist/Rogerian/eclectic/feminist approach is quite healing, especially with relational stuff like mistrust. There is also some evidence that women, queer people, racialized people, and very religious people have much better outcomes in therapy with someone who has intimate knowledge of those experiences. There’s a lot of research about how women are not consistently well served by 12 step communities. Feminist counselor or MSW counselors with a social justice lens often see substance use as the result of social, family, and cultural conditions. If you have experienced abuse or social marginalization and use alcohol to cope, these ideas may resonate with you.
There is a lot of moralizing pop psychology nonsense out there about “addictive personalities” and how “addicts are toxic people.” I think these ideas can do a lot of harm. Ask a potential therapist about the evidence base for their modality and then take note of how it sits with you. You deserve to feel heard and understood and respected no matter what kind of counseling you choose.
posted by unstrungharp at 10:33 PM on November 23, 2020 [13 favorites]
CBT sees addiction as behavior. CBT has a strong evidence base for treating substance use. It can feel a bit cold and mechanical. Some people find it hard to build rapport with someone doing really doctrinal CBT. Some CBT therapists emphasize the “B” and will be successful in supporting you to change habits but may not be able to address the mistrust and resentment. A CBT therapist who pulls more from cognitive therapies will do better with that, but it’s not touchy feely, and you’ll do less talking about feelings than you would in other modalities (although it can be pretty powerful and raw when a CBT therapist uncovers an unknown core belief).
12 step sees addiction as a disease. 12 step has less of an evidence base, but it comes with a built in sense of community and some... social retraining, if your mistrust and resentment have been a barrier to reciprocal social relationships.
There is some evidence that the therapeutic relationship itself, particularly from someone working from a humanist/Rogerian/eclectic/feminist approach is quite healing, especially with relational stuff like mistrust. There is also some evidence that women, queer people, racialized people, and very religious people have much better outcomes in therapy with someone who has intimate knowledge of those experiences. There’s a lot of research about how women are not consistently well served by 12 step communities. Feminist counselor or MSW counselors with a social justice lens often see substance use as the result of social, family, and cultural conditions. If you have experienced abuse or social marginalization and use alcohol to cope, these ideas may resonate with you.
There is a lot of moralizing pop psychology nonsense out there about “addictive personalities” and how “addicts are toxic people.” I think these ideas can do a lot of harm. Ask a potential therapist about the evidence base for their modality and then take note of how it sits with you. You deserve to feel heard and understood and respected no matter what kind of counseling you choose.
posted by unstrungharp at 10:33 PM on November 23, 2020 [13 favorites]
One therapist in my area (who I wanted to work with but alas, he didn't have any openings at the time) has this description of his practice on his website, which I think might be useful to you as a guide of what to look for:
My scope of practice encompasses adults and adolescents facing trauma and post-traumatic stress disorder along with the panoply of secondary reactions and comorbid diagnoses that can occur along with or as a result of traumatic exposures. These include relationship conflict, divorce, addiction, depression, anxiety, bipolar disorder, grief, and loss. I am versed in clinical and scholarly work on persons of diverse gender identities, sexual orientations, and socioeconomic, racial, and cultural backgrounds.posted by MiraK at 5:12 AM on November 24, 2020 [2 favorites]
I have a particular interest in the co-occurrence of post-traumatic stress and addiction. Research on this phenomenon suggests that post-traumatic stress disorder and addiction (substance use disorders) are closely associated. Persons struggling with addiction recovery and post-traumatic stress often have difficulty finding providers with experience in both areas. I welcome people at any stage of addiction recovery into my practice, as long as they are willing and able to participate fully and voluntarily in the treatment process. If you are curious to know whether you might be able to benefit from psychotherapy for co-occurring post-traumatic stress and substance use disorder, I encourage you to contact me.
Two additions.
One is that withdrawal from extreme alcohol addiction can be life-threatening and requires medical and sometimes even inpatient support. Do you wake up and shake until you've had a drink? Then I would seek medical help to detox.
Two is that I've had some experience as an addict getting counseling (In Columbia, SC, as it happens, but this was years ago.) and I was very weak willed, wanted to be better whatever it took, willing to listen to any advice and was referred to a man (not a Dr.) whose beliefs were, to put it in shorthand, Jungian. Not for me at all. And it took some months and a relapse to give him up. In sum, my advice is if the first counselor/therapist is wrong for you, seek out other help. I know this is hard to do when you're feeling lost, but it's really essential.
posted by tmdonahue at 5:34 AM on November 24, 2020 [1 favorite]
One is that withdrawal from extreme alcohol addiction can be life-threatening and requires medical and sometimes even inpatient support. Do you wake up and shake until you've had a drink? Then I would seek medical help to detox.
Two is that I've had some experience as an addict getting counseling (In Columbia, SC, as it happens, but this was years ago.) and I was very weak willed, wanted to be better whatever it took, willing to listen to any advice and was referred to a man (not a Dr.) whose beliefs were, to put it in shorthand, Jungian. Not for me at all. And it took some months and a relapse to give him up. In sum, my advice is if the first counselor/therapist is wrong for you, seek out other help. I know this is hard to do when you're feeling lost, but it's really essential.
posted by tmdonahue at 5:34 AM on November 24, 2020 [1 favorite]
Motivational Interviewing is a frontline approach for addiction, but I'm not sure how often therapists advertise to the public that they use it. This is a model for change management and it works with a variety of health behaviors.
You may also want to consider where the alcohol use comes from. Dysfunctional upbringing? Boredom that morphed into something more problematic? I have heard that the rates of alcohol use are way up during Covid-19.
Were you raised by an alcoholic? Adult children of alcoholics is a specialty that some providers will mention that they work with on their marketing materials. Alternatively as stated above, trauma underlies a majority of substance use disorders. Trauma doesn't have to be someone dying in front of you. It can be bullying as a kid, growing up with an emotionally or physically absent parent, being a person of color in America, having to parent your own parent growing up, etc. If you have trauma then looking for someone who works with trauma will be imperative since reducing substance use sometimes increases trauma related discomfort until the trauma is addressed.
posted by crunchy potato at 6:50 AM on November 24, 2020
You may also want to consider where the alcohol use comes from. Dysfunctional upbringing? Boredom that morphed into something more problematic? I have heard that the rates of alcohol use are way up during Covid-19.
Were you raised by an alcoholic? Adult children of alcoholics is a specialty that some providers will mention that they work with on their marketing materials. Alternatively as stated above, trauma underlies a majority of substance use disorders. Trauma doesn't have to be someone dying in front of you. It can be bullying as a kid, growing up with an emotionally or physically absent parent, being a person of color in America, having to parent your own parent growing up, etc. If you have trauma then looking for someone who works with trauma will be imperative since reducing substance use sometimes increases trauma related discomfort until the trauma is addressed.
posted by crunchy potato at 6:50 AM on November 24, 2020
Maybe google “the sober school” while you are looking for the therapist in your town. I’ve been observing a cultural shift (in Europe at least) where women (I don’t know your gender!) are exploring alcohol free living and embracing sober lifestyles where they want to empower themselves and feel feel better. It’s really nice to see regular people having a conversation about alcohol and making different choices. The blogger above does a great job exploring the myths of alcohol and WOW I find it refreshing! I do t know about you but a lot of the guilt in alcohol misuse really sucks and makes it hard to actually make changes. Up until now a lot of the literature I’ve read hadn’t felt so empowering.
posted by pairofshades at 8:38 AM on November 24, 2020
posted by pairofshades at 8:38 AM on November 24, 2020
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Questions to help narrow down your choices:
What do you want in a substance abuse counselor approach? Do you want an abstinence based counselor? Do you want someone who helps you decrease use on an outpatient basis(harm reduction is the term)? Do you need detox for withdrawl symptoms first before any of that (detox programs)? Do you want someone who is very much a believer in the 12 step approach, or someone whose more focused on relational approaches, or someone to do more concrete emotional work like CBT or DBT? Is anger management something you are looking to learn?
Answering those things will help you to find someone whose approach matches up. You don't have to know the answer to all of them, but even being able to say something like "I want a counselor who is flexible in how they treat alcohol use disorder and will give me concrete excercises to work on my feelings at home" is enough to help you narrow down your choices. Or even identifying things like that 12 step isn't for you. It's also just okay to call a few people of the psychology today probobly under substance abuse or alcohol abuse search term list and do an initial session with a few of them and see who you like best.
posted by AlexiaSky at 10:12 PM on November 23, 2020 [2 favorites]