Sunday December 11th 2016

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Inservice training for addiction and recovery professionals: The basics and beyond

Inservice training for recovery professionals

What can you expect (and what should you look for) from an inservice training provider? Where is the industry going? Today, we speak with Dr. Allen Berger, Ph.D. about his experiences with inservice addiction and recovery training for professionals in the field of substance abuse.

Dr. Allen is a Clinical Director, Psychologist and Author of 12 Stupid Things that Mess Up Recovery (2008) and 12 Smart Things to do When the Booze and Drugs are Gone (2010). He teaches Basic Counseling and Family Counseling courses for the certification program in alcohol and addiction counseling at Loyola Marymount University Extension. And, in addition to decades of experience working clinically, Dr. Berger has spoken extensively and worked as an inservice professional development expert for  decades.

Read on for a review of the importance of continued personal and professional development, as well as some of the common barriers to growth among our industry’s leaders. At the end, we invite your thoughts and questions on this topic in the comments section below. Enjoy this interview.

ADDICTION BLOG: How long have you been facilitating inservice staff training?

DR. ALLEN BERGER, PH.D.: I have been conducting inservice staff training since 1980 all over the world. I have been hired as a consultant in many of the major treatment centers in the United States but have also worked in Europe and Asia.

Most recently, I was a member of a four person delegation to Vietnam in 2012 called “The Gift of Recovery.” Our mission was to introduce the healthcare professionals in Vietnam to spiritual and psychological alternatives to drug replacement therapy. This was an amazing experience for me given that I am a Vietnam Veteran. It was great to return to that country and bring something of value to them. It was making amends for me.

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ADDICTION BLOG: What qualities do you think such a role requires? In other words, what makes a good “teacher of teachers” and how do treatment centers go about identifying such a person?

DR. ALLEN BERGER, PH.D.: Let’s divide inservice training into two categories. One category is “content driven”. Meaning that a program wants the staff to learn the latest rules or regulations regarding HIPAA or reporting laws or something like that. I rarely do this kind of inservice training.

I am more interested in the second category, what I would refer to as “process driven clinical training”. This kind of inservice is focused on helping the clinical staff either develop new clinical skills or to sharpen the skills they already possess.

I love this kind of work because I enjoy inspiring clinicians to discover new possibilities within themselves and within the therapeutic relationship, and to help them become more effective in their work.

I train staff in what I refer to as Process Focused Recovery Counseling. In fact, last year I spent nine (9) months with the clinical staff at the Betty Ford Center helping them learn this powerful approach to counseling alcoholics, addicts and their families. It had an amazing impact on the clinical process in their program.

In terms of what a program needs to look for in hiring a person for this kind of inservice training, I believe the following considerations should be made:

  1. Find a trainer who can inspire the staff and meet them where they are at in their skill set and help them take the next step in their professional development.
  2. Find a trainer who is able to do and not just teach. An important part of the inservice training that I do which is incredibly effective is the clinical demonstrations. I believe that doing is at least as important as talking about conceptual issues.
  3. Find a trainer who is practical and gives the staff specific things to try out. One of the things I train staff in is the addict self vs. recovery self dialogue. This has an immediate benefit because the staff ends up eager to apply this intervention to their work in groups or with individual clients.
  4. Find a trainer who inspires the staff to practice what they teach. I believe that we need to be committed to the kind of help we offer our clients … meaning that I don’t want to eat a chef’s cooking who is not willing to eat his own meals. Therefore, it’s important to integrate our clinical philosophy into our own lives. If not, then it becomes a “do what I say not what I do” situation. For instance, if I believe in authenticity as a path to healing then I need to be authentic with my clients as well as in my own life.
  5. Find a trainer who encourages your clinical staff to experiment with their clients and who helps the clinician learn how to quickly move from talking about to experiencing or doing with their clients.
  6. Find a trainer who can help the clinician learn how follow the moment-to-moment unfolding of the client’s experience and identify what is missing from what the client is saying. I teach clinicians to listen to what a client is NOT saying because this identifies what is needed.
  7. Finally, find a trainer who integrates psychotherapy with a recovery philosophy.

So, to summarize, I think a good teacher is one who can demonstrate what they are teaching, inspire, encourage experimentation and taking risks, and support the staff in trying on new ways of being with their clients.

ADDICTION BLOG: What have you found as the most common skills that require strengthening among clinical psychologists?

DR. ALLEN BERGER, PH.D.: If this question is focusing on psychologists then I believe the most important issue in their addiction training becomes understanding the therapeutic value and psychological process operating in the 12 Steps.

There are many misconceptions and myths that abound in the mental health field about the 12 Steps and their philosophy. Many mistakenly view the 12 Steps as promoting passivity and a victim mentality. It is mistakenly believed that the Steps keep the alcoholic or addict from taking full responsibility for their problem.

For example, this idea is perpetuated by misunderstanding the therapeutic value of Step 1 which reads, “We admitted we were powerless over alcohol and that our lives had become unmanageable.” It seems like this step is telling the person that they are powerless, which would disempower them from taking full responsibility for their addiction. Well this couldn’t be farther from the truth.  Step 1 is a paradoxical intervention and is based on the Paradoxical Theory of Change which states that we change when we own what we are doing rather than try to be someone we are not.

Psychologists need to understand the therapeutic forces inherent in the 12 Steps so they can compliment the work that a client is doing in A.A. or N.A. or C.A. This knowledge will help heal the split between the 12 Step Recovery Community and the Mental Health Profession.

ADDICTION BLOG: How open are many psychologists to skill development? Is there much resistance? If so, how do you address it?

DR. ALLEN BERGER, PH.D.: I think that most psychologists are quite open in several areas but not in terms of addiction and 12 Step Recovery. I think one of the major problems is that God is mentioned in the 12 Steps.

There was a split between psychology and theology a long time ago because psychology wanted to be considered a science. I think we threw the baby out with the bath water on this one. This is beginning to change in the profession but quite slowly.

The other issue that I see creating resistance to embracing recovery is that it forces the psychologist to examine their relationship with alcohol and other drugs. The psychologist is susceptible to the typical defenses against seeing they have a problem but this is also complicated by the fact that we are one of the few professions that doesn’t have a well-being committee. The impaired psychologist gets very little support from their profession which adds to the problem.

ADDICTION BLOG: What core principles of effective group, family and individual counseling should addiction professionals master?

DR. ALLEN BERGER, PH.D.: There are several core principles that an addiction counselor needs to master:

  • Learn to attend to the moment-to-moment unfolding of the client’s process in the here and now.
  • Learn to identify what the client is not saying and how to use this information to construct an intervention.
  • Be able to develop interventions that increase a client’s awareness of what they are doing.
  • Help the client find the words that most accurately express their personal desires or pain.
  • Help clients loosen up and enjoy themselves. This means that a counselor needs to loosen up themselves, promote experimentation and have fun.
  • Understand the psychological imperative and how to use it as an ally in their work. For example, if I say one, two, three, four – what comes to mind next? This is the psychological imperative that operates in our lives if we don’t interfere with it.
  • Learn to provide a client with as much support as they need but as little as possible so that the client learns to support themselves and self-regulate.
  • Understand the importance of emotional sobriety and interventions that will help a client discover better ways of holding on to themselves and keeping their psychological balance.
  • Learn to confront a client without damaging or injuring a client’s dignity.
  • Know that clients are not nearly as fragile as we have made them out to be.
  • Learn how to use your personality to establish a strong therapeutic alliance.
  • Learn how to get feedback from clients or groups to see if they are in fact getting what they need from the counselor and their relationship with you or the group.
  • Admit when you make a mistake with a client.
  • Become comfortable with your own ignorance, incompetence and stupidity.

I am certain there are more but these are the ones that come to mind.

ADDICTION BLOG: How many years does it usually take to accomplish mastery?

DR. ALLEN BERGER, PH.D.: A lifetime, but you can get a good start in 5 – 10 years.

ADDICTION BLOG: Should addiction professionals be seeking psychotherapy themselves from time to time throughout their careers? How often? Or is inner work done as needed?

DR. ALLEN BERGER, PH.D.: This is an extremely important question. My answer is an emphatic YES.

Let’s go back to the idea that a counselor needs to be willing to do what they are asking a client to do. So, if for no other reason – and there are plenty of other good reasons – then go to therapy and see what the experience is like. What comes up for you as a client? What works and what doesn’t work in terms of how the counselor or therapist approaches you?

Also, there are going to be times when each of us are confronted with a dilemma or are facing our own personal crisis. Get help, don’t wait. Once again, if we believe that this is what our clients need to do to take care of themselves, then we need to do it as well.

ADDICTION BLOG: What kinds of tools/modalities do you use to help counselors examine their own professional development?

DR. ALLEN BERGER, PH.D.: The same things I do with clients. I make the counselors aware of what they are doing and what they are not doing and help them explore new possibilities in interacting with their clients through experimentation. My trainings consist of helping clinicians develop a conceptual foundation for Process Focused Recovery Counseling and then quickly move to clinical demonstrations and hands on work.

I work within a Gestalt Experiential framework. Dr. Walter Kempler was my mentor and is considered by many to be one of the first relationally based Gestalt therapists. Walt was a genius. I try to pass on his ideas and ways of working along with the ideas that I have developed over my forty years of clinical experience in working in the addiction field.

ADDICTION BLOG: In your opinion, do you think that continuing education requirements adequately keep the industry moving forward? What changes might be made to make the system more effective?

DR. ALLEN BERGER, PH.D.: Yes, in many ways. But I do think that too many of the CE Programs are driven by the need to get sponsors for their program and, therefore, have a sponsor driven faculty and topics rather than assembling a faculty or content based on an assessment of the needs of our profession.

Andrew Martin and I have tried to create a CE program based on the needs of the profession. Our conference is called The Evolution of Addiction Treatment and is held every two years. The next conference is scheduled to adjourn in 2017.

ADDICTION BLOG: What topics are currently trending in the world of addiction and recovery training? What topics would you like to see the industry move toward, and why?

DR. ALLEN BERGER, PH.D.: Drug replacement therapy is a hot topic right now. So is mindfulness and self-regulation.

I am personally glad to say that emotional sobriety is also beginning to get its rightful recognition. My Institute for Optimal Recovery and Emotional Sobriety will be offering the first certification program in emotional sobriety counseling. We hope to launch the program in 2016.

I hope the industry will move towards increasing the clinical skills of the alcohol and drug counselor and help them become more flexible in meeting their clients’ needs. If you read Anne Fletcher’s book, Inside Rehab, you will realize that we have a lot of work to do in increasing the skill level of the counselors in the trenches who are trying to help individuals and families recover from addiction. She gives many anecdotes of harmful interactions between clients and their counselors. This needs to be cleaned up and cleaned up fast if we are ever going to earn professional credibility.

ADDICTION BLOG: Is there anything else you would like to share with our readers?

DR. ALLEN BERGER, PH.D.: I would like to encourage the owners and CEOs of treatment programs to invest in their clinical staff. Increasing their staff’s clinical skills will have many wonderful benefits for their programs and even for the bottom line financially. Skilful counselors know how to maintain a strong therapeutic alliance which improves outcome, decreases AMAs, and creates a great team spirit.

—–

Are you seeking wisdom or things?
“Our focus on seeking things instead of wisdom is a kind of illness. This illness manifests in the feeling that we are unacceptable the way we are; that we are unlovable. So, to make ourselves “marketable” and acceptable we try to live up to an idealized image of who we think we are supposed to be. This idealized image is our false self. We cling to this false self.”  – Dr. Allen Berger, Ph.D.
Deep down, we see it as the solution to a basic fear or anxiety that we won’t be loved or accepted. But because our solution to this basic anxiety rests on a rejection of who we really are – a rejection of our true self – it never works.” – DR. ALLEN BERGER, Ph.D.

Photo credit: geralt

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