I was pleased to see the brief discussion about trying to treat an addict who lies. This is common. Many addicts lie. They lie to themselves, so it is easy for them to lie to others.
In my last post I was not saying that I was angry at this patient for lying to me, nor was I totally surprised. I was disappointed, both in him, for promising to try to to be honest, and with myself, for allowing it to happen again.
It is not very difficult to determine why he lied. He needed letters for his probation officer. He didn't know if I would cover for him, and he probably didn't want to put me in that position.
I probably would not have told his probation officer, at least not before making several other attempts at getting him to change. Then what? I can't be sure. Drinking alcohol, even getting wildly, obnoxiously drunk, is not against the law. But if it is a condition of your probation that you can't drink, then it becomes against the law for you.
We all joined in the cover-up, especially over the last month. Everyone kind of likes this guy. The people who run the alcohol monitoring program liked him, and were also probably sick of him. So was probation. He didn't break any other rules: he showed up to every appointment, he did his community service, he paid his fines, he stayed out of trouble. I think everyone involved (except his wife) decided not to push too much and let it go.
Now he is out of the system. He doesn't need me for letters, nad probation doesn't need me to cover their ass.
Now the qustions are completely different. Does he need treatment? Who determines that? Does he want treatment? That's up to him. Can he benefit from treatment? That depends upon why he thinks he would be coming. Am I the best one to treat him? How can I believe anything he says? How much does that matter?
We still have an appointment set up from before his wife called and told me what she has been living with. If she shows-up for that appointment we will try to answer all of those questions before proceeding.
I'd like to be able to believe his answers. But then, Obama thought he could believe BP.
7 comments:
I have an idea if he shows up for his appointment or if he ever wanders your way again. You could cut right to the chase and ask him what he is really running from. What is it in his reality that he needs to render unconscious? Go in for the kill and ask him about his childhood, but only if you can commit to staying present with him should the you-know-what hit the fan in his head afterward. Normally I would worry about such an aggressive approach, but it sounds to me like this guy needs something different to show him another path besides denying himself all the way to an early grave. Take it from one who knows: the alcohol is NOT what is driving this trainwreck, it's only the explosive he is using to blast himself off the tracks after the fact. It sounds to me like this guy might have an awful lot of pain to process.
You think that in two years of treatment we have not attempted to examine every aspect of his history, is perceptions of the world, his relationships, his family, is success as well as is failures?
How honest has he been, with me or with himself, remains unclear.
I felt a little pang when I read your response. It is obvious that you care about this man. And yes, it is true that many therapists do not ask about trauma. They don't ask and/ or people don't tell and some traumatized clients slip through the cracks undetected. You would not believe the disaster my brothers, sister and I were raised in, but my brothers insist it was not abusive. I don't know what can be done in the instance where a therapist catches on that there may be something under the surface and the person says there is not. The only thing I can think of is the client having a heavy need to believe what they believe. Unless he has buried the stuff or is dissociative. Sometimes people go for the drugs and the drink when the dissociation begins to crumble. Sadly, he may not understand what is happening to him if that's what it is. I wonder if there is some way other than the DES to try to figure out if he is somewhere on the PTSD spectrum. The DES might be misleading because his history of being impaired could cause a false positive result. If I think of anything, I will come back and leave it in comments for you to consider. I did not understand that you had addresed the possibility of a trauma history.
When you asked him about his father/mother/siblings/family did he tighten up and look uncomfortable at the mention of any one of them?
Alcoholism is a disease.
People without traumatic childhood experiences and ptsd suffer from alcoholism. They're genetically prone to addiction. I'd be willing to bet that everytime this guy has been in trouble, alcohol was part of the picture.
Alcohol MAY BE what is driving this "Trainwreck"................get him a copy of "the big book"......send him to AA.......and QUIT covering for him!
Trying to find out if someone is drugging themselves with alcohol to cover the distress of traumatic material is not 'covering for them'. It is a reasonable avenue of inquiry. AA does not treat trauma, it merely advocates for abstinence and there are a lot of relapses for substance using trauma survivors who simply address symptoms instead of also trying to heal the underlying cause of the distress that creates them. Many people don't think there is sufficient proof that alcoholism is hereditary in a genetic sense. Sure, it 'runs in families'. As does bad parenting, chaotic living situations, child abuse, etc. It sounds like this guy has exhausted the 'just stop doing that' method of recovery and that is why I brought up the issue of trauma.
Another thing is... he's got to wanna. Any way he chooses to help him with his addiction, whether it's AA, Carr or smart will work if he wants to work it.
The willingness comes at different stages for everyone. He might need to fall much lower than that before he can listen - and for some there is no return.
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