Linda Magnelli

I have been thinking about the subject of continuity of care a lot lately. When we become counselors, we are charged with the responsibility of caring for our clients without causing them harm. However, I have witnessed many agencies that seem to disregard this very basic tenet when it comes to group counseling dynamics. When a counselor is shifted from one location to another suddenly without the ability to provide closure on the relationships they have established with the individuals in one group, is that not essentially or potentially causing the client harm? People don’t like change. Addicts seem to dislike change more than normal. When a substance abuse group is forced to deal with changes in counselors every few weeks, continuity of care is lost. It is not just a matter of the person remaining in the same group, it is also about remaining with the same counselor as long as possible.

I was recently on a well-deserved, and well-needed, vacation. During my trip, I found that I could not stop thinking about my clients. I kept wondering if they were still staying sober or even getting sober. I remembered a couple of funny quirks some of my clients have and how different ones act in group. I wondered if the substitute counselor was taking care of them and looking after their needs. I also thought of the stressful group night prior to my departure in which a supervisor had chosen that time to sit in on a group. Needless to say, there was some drama within the group that resulted in a tense feeling session that lasted the evening. Because it was a short group, there wasn’t time to fully process the events that occurred.

The winter holidays are over and most of my clients came through without relapse, but many of them didn’t come out unscathed. This is a hard time of year for most people, and going through it without one’s usual coping mechanisms is even harder. Although we aim for complete abstinence off all substances, many of my clients who are opiate addicts feel that drinking is okay for them, and many of them got drunk over New Year’s Eve especially because they wanted to have “fun”.

Christmas has come and gone and New Year’s Eve rapidly approaches. Most of my clients came through last weekend virtually unscathed. Still, many of them with several weeks, months, even a year or more of sobriety still feel “funny”. The question I get all the time is “If I am sober, how come I still feel like this?” When asked what “this” feels like, I get a variety of responses from not being able to think clearly, not being able to sleep, being unable to do the simplest of tasks, unable to remember where they put things, unable to walk straight, to not being able to put a coherent sentence together and more. What is up with that?

I am constantly amazed at the number of new clients that have been joining my groups these past few weeks. After all, wouldn’t it be more like an addict to wait until the New Year to make such an important life change? Isn’t that what resolutions are all about? The truth is, some people actually want to be sober before Christmas, and before New Year’s Day. Amazing! I am not being sarcastic either. I welcome such determination into the groups but I always ask “Why now and not in a month or two? What happened that was significant enough to propel you into recovery at this very moment?” Of course the reasons vary and can be attributed to appeasing the legal system, being under the threat of losing family and friends, but the most compelling reason I have heard is “being sick and tired of being sick and tired”.