Empathetic and Hopeful Relationship

Universal Dual Diagnosis Capabilities identify
empathy and hope as evidence based practices (EBP) (Minkoff & Cline 2004, 2005).

Additional EBP studies state that the most significant predictor of treatment success is the presence of an empathetic, hopeful, continuous treatment relationship, in which integrated treatment and coordination of care can take place through multiple treatment episodes (Minkoff, 2000).

The importance of empathy and hope is also a foundation of Motivational Interviewing – founded by William Miller and Stephen Rollnick. Empathy is further described as Motivational Interviewing: Definition of Empathy (Ingersoll, Wagner & Gharib, 2002):

  1. Seeing the world through the client’s eyes.
  2. Thinking about things as the client thinks about them.
  3. Feeling things as the client feels them.
  4. Sharing in the client’s experiences.

Benefits of Accurate Counselor Empathy… (Ingersoll, Wagner & Gharib, 2002) (Excerpt From THE BASICS)

  1. When clients feel that they are understood, they are more able to open up to their own experiences and share those experiences with others.
  2. Having clients share their experiences with you, in depth, allows you to assess when and where they need support, and what potential pitfalls or difficulties may need to be focused on as part of the change planning process.
  3. When clients perceive empathy on a counselor’s part, they become more open to gentle challenges by the counselor about lifestyle issues and beliefs about substance use.
  4. Clients become more comfortable fully examining their ambivalence (“I want to” but “I don’t want to) about change and less likely to defend ideas like their denial of problems, reducing use vs. abstaining, etc.
  5. A counselor’s accurate understanding of the client’s experience facilitates change!

Developing An Empathetic Approach

Empathy is an essential ingredient in the therapeutic process. The dictionary’s definition of empathy is the “identification with and understanding of another’s feelings, situation, and motives.”

Treatment providers can gain an “understanding of” co-occurring disorders through training, literature, and working with clients, patients, or consumers – the person in treatment. It is the “identification with” or “seeing the world through the client’s eyes” that’s often more difficult. It can be a challenge for a therapist, counselor, or case manager to “see, think, feel, or share” the client’s experiences who are facing many of the following situations: (Excerpts from THE BASICS)

  1. Being told you are required to attend treatment when you don’t even think you need treatment.
  2. Having the emotional pain in your life bring you to your knees.
  3. Living with disorganized thoughts, voices, compulsive behaviors, delusions, hallucinations, and feeling completely out of control and terrified of sharing these experiences with others.
  4. Being caught between not wanting something called “recovery” and the fact that continuing without help may eventually kill you.
  5. Relying on “institutions” who have provided you with housing, treatment, or medications and the fear of being told you must now access all of these services on your own because funding is no longer available.
  6. Being raised in a family that values self-reliance – yet in treatment being told that asking others for help is an important step in “getting well.”
  7. Become so “sick and tired of being sick and tired,” yet having to negotiate the forms, assessments, and financial aid in order to get the treatment you are not sure you want in the first place.
  8. Having a person you have seen for only an hour give you a diagnosis of a Psychiatric or Substance Disorder or both.
  9. Being confused, toxic, physically and emotionally ill, and then walking into a room of strangers and being expected to do, say, or feel something…except you have no idea what that something will be.
  10. Realizing “recovery” means changing your thoughts, feelings, behaviors, attitudes, friends, lifestyle, and possibly housing, job, and relationships…actually realizing that life as you know it will never be the same.
  11. Trusting others – when you have never been able to trust anyone before – to know that all these changes are possible, worthwhile, attainable, and in your best interest.

If we are able to “identify with” the emotions of uncertainty, fear, confusion, ambivalence, anger, outrage, and helplessness, that any of these scenarios have the potential to produce, then empathy is possible.

Empathy is not feeling sorry for a person and allowing them to stay “stuck” because change is difficult. Nor is empathy doing everything for a person who is either capable of doing it or in need of learning how to do it for themselves.

Empathy is about relating to the struggles that bring people through the doors of treatment as well as the emotions and challenges they experience throughout recovery – while acknowledging the courage it takes to continue in spite of every cell of their body telling them it would be easier to just give up and get loaded.

Promoting Hope (Excerpts from THE BASICS)

Education and information are always essential components of any psychoeducational treatment group. Psychoeducational and skill-based programs are not intended to be emotional process groups. They are designed so a person can process and discuss the education and the skill being taught. It is always important, however, to take the necessary time throughout the group to create a hopeful and supportive atmosphere.

Hope is an essential ingredient in the treatment process. Lots of information does little for a group that feels hopeless. In fact, feeling hopeless combined with a mountain of information, will work against recovery and is counter-productive.

The combination of psychoeducation and hope will change your group from a school model to a recovery model. It is, however, important to remember that what actually provides the hope is the education of understanding, managing, and living with these disorders – the same process as with other chronic illnesses. While the lesson material is important, group interaction about the content offers a network of social support. If recovery was based solely on education – treatment would be offered in a correspondence course!

While it is necessary to discuss the costs and problems regarding substance abuse and/or untreated psychiatric disorders, it should always be done without judgment. Scare tactics rarely work to help a person move from ambivalence into recovery. Group members have usually heard all the cautions and lists of problems associated with alcohol and drugs. They have heard the “speech” many times (Minkoff, 2000). In other words, they could probably teach many sections of this curriculum.

There are several reasons to mention the hopeful benefits of treatment and recovery early in every subject as well as at the close:

  1. People with co-occurring disorders often feel a sense of hopelessness. Continually reinforcing the hope for recovery makes it easier to “hear” the information about disorders.
  2. The same approach works when presenting any serious information. When a physician begins reciting symptoms and problems, people begin to shut down or become filled with fear and apprehension. If the same physician begins and ends with something similar to, “There is a treatment that works and we’ll work with you,” it makes the middle part less unnerving and much easier to absorb.
  3. Group time can get away from you when you have enthusiastic group members interacting with the subject material and with each other. If you plan on touching on the “hope for recovery” only at the close of group, you may be rushed for time or worse yet, be out of time altogether.
  4. Purposefully interweaving hope and empathy throughout the group is a good approach and sets the tone of the group from beginning to end.
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