Optimistic, Consistent, Non-Judgmental, Positive Attitude

There are ingredients that are essential to any treatment relationship – whether it is medical treatment or mental health therapy. These fundamental components fit together to create a treatment atmosphere where hope and change can take place. Just as with the ingredients of making a cake – if any of these ingredients are left out…the foundation of a therapeutic alliance may not be built between the treatment provider and the treatment participant.

An optimistic approach is so helpful in any group setting and contributes to the development of a therapeutic alliance. In addition, the three most important counselor qualities include maintaining a consistent, non-judgmental, and positive attitude (Daley & Montrose, 1995).

An optimist is defined as a person who has a disposition to expect the best possible outcome, to emphasize the most positive aspects of a situation, and to generally believe that good triumphs over evil. A pessimist is defined as a person who has a tendency to take the least hopeful view of a situation, focus on the worst aspects of a situation, and generally believe that evil in the world outweighs the good. (Excerpt from THE BASICS)

Yet how can a person just click their fingers and become optimistic when so many of the actual symptoms, daily challenges, perhaps life-long family issues…and the list goes on…create negative thinking patterns?

The curriculum in THE BASICS, Second Edition contains so many sections of “Changing Negative Thinking to Positive Thinking” that there is no way to possibly mention them all. Each is designed to give specific ways to practice positive thinking. Thinking patterns are developed and practiced over time. Positive thinking patterns can be learned and practiced in the same way… which paves the way to optimism. Just a few include:

1. Negative Thoughts Adversely Affect Physical and Mental Health
2. Positive Thoughts Contribute to Good Physical and Mental Health
3. Negative Thinking – Defenses and Habits
4. Changing Negative Self-Talk Habits Into Positive Self-Talk Messages
5. Steps to Positive Thinking
6. Changing Thinking Can Change Attitudes

We must look through the behavior, while providing consistent support for
the fragile human within (Ken Hickey, Professional conversation, September, 28, 2002).

Consistency is important in all areas from the person-centered therapeutic approach – with an emphasis on empathy and hope – to the science and evidence-based psychoeducational content, and to the treatment focus. It assures that no person or family member receives less than the most accurate and most helpful information.

Synonyms or other words used to describe consistency are evenness, steadiness, reliability, uniformity, stability, and regularity. This means being consistent in your treatment of people who present for services is the opposite of becoming upset, moody, annoyed, or inconsistent in any way.

Being consistent doesn’t mean just being calm or steady when people are not symptomatic or when they are not displaying unpredictable or erratic behaviors, thinking, or emotions. It means being consistent especially when they are symptomatic or acting out, which are a part of the symptoms and defenses of these disorders.

Yes, Consistency Can Be Challenging…

Treatment providers are, of course, people too. We all have bad days and experience crisis or loss. In any profession where we work with people, putting on a happy face is part of the job. Providing consistency can be challenging when we are dealing with people who often don’t want to be in treatment on any given day, or may appear demanding in groups, or may even blatantly say they don’t want any of the services we have to offer. It is, however, a challenge we must and can meet.

The very nature of the symptoms of co-occurring psychiatric and substance disorders creates inconsistency in peoples’ lives. These disorders are more prevalent in families with histories of the same disorders because of the inherited genetic connection. If these disorders are not treated, that means people typically grow up in families where psychiatric and substance disorders make reliability, evenness, and stability uncommon luxuries. However, clients and consumers – of course – have every right to receive these qualities from us as their counselors and therapists. It is part of our job, our duty, our ethical code of conduct, and our respect toward them as human beings.

We have all – at one time or another – received inconsistent or even completely different information from our care providers or other people providing services to us. We may have become confused, lost confidence in the service provider, or ended up irritated, anxious, or depressed. For the person who may already be experiencing confusion, uncertainty, or emotional instability, the end result of inconsistency can be much worse.

We’ve also – at one time or another – experienced inconsistent attitudes from care providers where it appeared we actually irritated a person who was supposed to be trained in the compassionate treatment of a specific disorder. It doesn’t feel very good. We may have been left with the thought that they were in the wrong profession. If we were captive at a hospital and couldn’t respond to their irritation by walking out, it might have added emotional insult to physical injury.

We simply can’t on one hand say psychiatric and substance disorders are medical disorders of the brain and then, on the other hand, treat people as if they are purposefully being difficult – or many other labels used for a person when they are simply doing what people do when they are experiencing symptoms related to their illness. The next true recovery story makes this point best (M. Brownlow, personal communication, August 30, 2003): 

We awaken in others the same attitude of mind we hold in them. Elbert Hubbard

Being nonjudgmental means exactly that. It means accepting each and every individual in treatment unconditionally without criticism, condemnation, disapproval, ridicule, or even disappointment.

All people are sensitive to the judgment of others. They can see it in a look, hear it in a tone, read it in body language, and certainly sense it in an attitude. This is especially true for specific populations.

People who were raised in dysfunctional families, or those who did not get their physical or emotional needs met, or people who were abused as children are typically hyper-vigilant (sensitive) about the reactions and behaviors of others. It was a survival skill when they were growing up. They could tell by the way the key went in the door or the sounds of footsteps in the house what kind of night it was going to be. It’s as if they have a keenly developed way of reading others and their surroundings.

This can also be true for people of different racial groups or sexual orientation who were raised or currently live in areas where prejudice is prevalent. They too developed survival skills of reading body language and attitudes of others instead of relying on what is verbally said.

People who judge themselves harshly, such as people with Psychiatric and Substance Disorders, are particularly sensitive to the judgments of others. Individuals in treatment for co-occurring disorders have often internalized society’s stigma of the mentally ill, or of alcoholics or addicts. They often judge themselves harshly and compare themselves to others. They typically overestimate the qualities of others, while underestimating their own. This is often called, “Judging our insides compared to the outsides of others.”

People with these disorders often view others as being the epitome of the “Norman Rockwell family portrait” or as the perfect family – physically, mentally, emotionally, and behaviorally. Individuals also typically judge themselves negatively for not being able to drink in the “American” way. They see images everywhere in movies and commercials of people drinking and using other drugs in a positive way of being “cool” and not experiencing problems.

Mental health problems are also typically shown in negative ways which can lead to the individual being critical of themselves for not being able to consistently manage their thoughts, emotions, or behaviors. People have often been beating themselves up for so many things for so long they are usually emotionally black and blue when they enter treatment. The scars can be seen in protective defensive behaviors developed over the years to protect themselves from feeling inadequate or “less than.”

In our eagerness to help and perhaps try to eliminate the problems caused by alcohol and other drug use…we must be aware of any overt or covert messages we may give of judgment or disapproval. We should always be aware that frustration over an individual’s progress – which may be slower than our agenda or hopes for them – is a type of judgment too.

Judgment of any kind is usually acutely felt by a person who is struggling with mental health, withdrawing from substances, or coping with toxicity and many more scenarios. They are often facing these challenges at the same time they are bombarded with problems of finances, health, or relationships…along with the mountain of legal or family issues that brought them to treatment in the first place. Not meeting a person at their level of readiness for change can feel to them like, “Great, I’m not doing recovery right either.” Just showing up for treatment is an accomplishment…a big one!

It helps to remember that psychiatric and substance dependence are disorders of the organ of the body the brain – just like someone having a disorder of the heart. Yet these disorders affect how a person feels, behaves, and thinks. What we are seeing in individuals are symptoms…not purposeful acting out. Remembering that co-occurring disorders are based on the brain over-or-under production of specific chemicals helps leave judgment out of the treatment setting.

Yet, we want the best for them. Our emotions can emerge which is especially true with drugs, such as methamphetamines, which can quickly cause serious brain damage or cognitive impairment while exacerbating the symptoms of a mental illness (T. Shamseldin, personal communication, May 15, 2002).

Such treatment efforts are complicated by not knowing when, or if, the consumer will “see the light” and consider an alternative to ongoing substance use. During these times consumers are best served simply by our continued expressions of support, hope, and empathy, as well as education to develop tools and skills to support their recovery and information to help them understand and make sense of their experiences with their illnesses (T. Shamseldin, personal communication, May 15, 2002).

Messages of encouragement should be given, at every opportunity, whenever the individual encounters the “system,” be it at the emergency room, crisis triage, respite, a shelter, detox, jail, a mental health or chemical dependency service, or on the streets. Providing support and non-judgmental validation of the individual’s situation may well be the anchors needed as they navigate the myriad of difficulties on the road to recovery (T. Shamseldin, personal communication, May 15, 2002). 

Clients and consumers live in a life of fear, self-loathing, depression, anxiety, and confusion. Their job is to be toxic, apprehensive, frightened, defensive, and ambivalent. Our job is to be positive, optimistic, helpful, encouraging, affirmative, and constructive.

Each one of us has probably received services at least once from people who didn’t have a positive attitude. We may have found ourselves thinking, well that’s the last time I’m ever going to bring my business here. That’s easy enough when there are comparable places to switch to. After all, getting a routine physical, dental checkup, haircut, or a new pair of shoes isn’t a life-or-death decision. It’s kind of empowering to be able to just walk out when we’re met with a negative attitude from someone, especially if they act like helping us is too big of a chore.

Now let’s imagine we can’t walk out. We really need to receive the services from a specific treatment provider. Perhaps these services will make the difference in whether or not we regain custody of our children or whether or not we go back to jail. The feeling is quite different. We might feel trapped, defensive, or even victimized.

Of course, it can be challenging to stay positive toward individuals in treatment when deficits in the areas of thinking, feeling, and behaving persist in spite of intervention. However, treatment providers may wrongly focus on their clients’ attitudes rather than on adapting strategies to help their clients cope. It might help to keep in mind that what is viewed as “unwillingness” to follow treatment plans, complete assignments, and actively participate in their own recovery is typically due to cerebral dysfunction rather than conscious or unconscious psychodynamic processes (Kugler, 1997).

Again, we can’t know that people have medical disorders of the brain and then treat them as if they don’t have a brain disorder. If they were thinking logically, experiencing emotions in a balanced way, and behaving in their best interests, they would not be in treatment in the first place.

A positive atmosphere is also one that is free of shame. It is important that group discussion of substance abuse be encouraged. It is through this process that group members develop the necessary trust that it is safe for them to begin to discuss their own use of substances openly in the group. Candid statements about continuing use in an atmosphere that fosters self-disclosure – without shame – are extremely therapeutic. The value of the group process depends on discussing what is really happening for people, not what they think others would like to hear (Siacca, 1991, p.77).