A reader asked Dr. Mee-Lee for some suggestions/recommendations in providing treatment and relief for the treatment team of a client residing in a rehabilitation home who is diagnosed with an Axis II disorder and is repeatedly violating the rules of the home. The reader explained that the client also tells staff the program is “stupid”. In response, the staff are asking for permission to place the client on a behavior contract in which further non-compliance will result in discharge. Dr. Mee-Lee first suggested that staff begin to look at the rule violations as “treatment opportunities”. He encouraged the staff to look at what is not going well and work WITH the client to make changes to improve the treatment plan. He explained that one would not expect for a patient to make changes to their medical treatment all on their own, and encouraged staff not to make similar demands of clients to make changes to their mental health needs all on their own. Dr. Mee-Lee uses the six ASAM Criteria dimensions to re-assess:
Dimension 1 - Acute Intoxication and/or Withdrawal Potential
Is some behavioral issue/mental health symptom resulting from drug use or withdrawal?
Dimension 2 - Biomedical Conditions and Complications
Is there a medical problem creating more irritability due to physical pain?
Dimension 3 - Emotional, Behavioral or Cognitive Conditions and Complications
Is there something gone unasked that is creating stress or worry?
Dimension 4 - Readiness to Change
Is it possible that the client is in Precontemplation in an area that the staff is in Action? Or visa versa?
Dimension 5 - Relapse, Continued Use or Continued Problem Potential
Is the client experiencing ongoing urges to use and doesn’t know what to do with those cravings? Is the client experiencing mental health symptoms like depression or aggression and unsure how to handle that?
Dimension 6 - Recovery Environment
Are there barriers at home that are contributing to the difficulties that the client is experiencing in the program?
Dr. Mee-Lee encouraged staff to consider how the treatment team can relate to the client in an “Adult-Adult interaction” instead of a parent-child relationship. He explained this is more realistic to real life interactions in which both the client and staff will participate outside of the rehabilitation center.
Dr. Mee-Lee gave recommendations in his TIPS:
Assist clients to develop emotional intelligence, remembering many have never been taught how to cultivate interpersonal effectiveness skills. Staff may take for granted that a client would know that a statement or behavior is rude or disrespectful when in fact they do not. He states, “What they don’t need is a “school” where the focus is on behavior control, rule-breaking and “punishments.” He reminds us that the skills are teachable and that the client probably has very little insight to what they are feeling. He encourages us to help them explore their feelings and increase their awareness. He states, “We must create a therapeutic environment to promote learning, not compliance.” He also stated, “Help people name their emotions to tame their emotions.”
Tips & Topics September 30, 2013, The Change Companies