Table Of ContentLIVING THERAPY SERIES
Counselling a Recovering
Drug User
A Person-Centred Dialogue
Richard Bryant-Jefferies
Radcliffe Medical Press
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© 2003 Richard Bryant-Jefferies
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN 1 85775 850 1
Typeset by Aarontype Limited, Easton, Bristol
Printed and bound by TJ International Ltd, Padstow, Cornwall
Contents
Forewords v
Preface ix
About the author xi
Acknowledgements xi
Introduction 1
The person-centred aproach 2
Drug use 6
Seting the scene 9
Chapter 1 A new begining 1
Sesion 1 1
Sesion 2 20
Chapter 2 Painful memories and the struggle to identify feelings 2 7
Sesion 3 27
Sesion 4 32
Chapter 3 Supervision 1 43
Chapter 4 Panic atack and using on top 49
Sesion 5 49
Sesion 6 5
Chapters Making sense of the lapse 61
Sesion 7 61
Sesion 8 67
iv Contents
Chapter 6 Supervision 2 7
Chapter 7 'Parts' of Dan begin to emerge as he connects with his past 85
Sesion 9 85
Sesion 10 92
Chapter 8 Further 'parts' emerge and the metaphor of a jigsaw of self arises 99
Sesion 1 9
Sesion 12 107
The Jigsaw of Self by Richard Bryant-Jeferies 119
Chapter 9 Supervisions 125
Chapter 10 A month later 131
Sesion 16 131
Sesion 17 136
Chapter 11 The past relived; attempting to stop the methadone 139
Sesion 18 139
Sesion 19 146
Chapter 12 Supervision 4 15
Chapter 13 Dan reflects on his goals for the future 161
Sesion 20 161
Author's comments 171
References 173
Further reading 175
Useful contacts 17
Drugs 17
Person-centred 178
Index 179
Foreword
The first thing that strikes me about this book is how readable it is. Usually when
I read a book about a factual subject, in particular about medicine or other subjects
related to my work, I tend to dip in and out over several weeks, as many textbooks
I frankly find hard going. Not so with this book. I was riveted from the start as if I
was reading a good novel.
Counselling a Recovering Drug User: a person-centred dialogue has a story line
which gripped me like a magnet from cover to cover. By the time I had read the
book not only had I gained an insight into a drug user's life and the complicated
issues that can affect them, but I also felt that I had had a damned good read. I had
also learned about the principles behind Rogerian person-centred counselling
and some of the issues which may confront both the client and the therapist
within this type of encounter. Throughout the book Richard Bryant-Jefferies
manages to put across these issues, whilst at the same time gripping the reader
in the story line.
Another important part of the process is that of supervision of the therapist.
The reader will not only see that supervision is a desirable facility for a health
worker but is an essential element in supporting the worker and encouraging cri-
tical analysis and thus deeper understanding of the relationship and dynamics of
the encounter. Having worked as a doctor for 22 years without ever receiving
any formal supervision, after reading this book I feel slightly lacking and quite
let down as the benefits are shown so eloquently in this book, not only for the
therapist, but also for the therapeutic process itself.
Aside from certainly enjoying this book, the reader will come away with a
heightened awareness and increased knowledge of the complexities of dealing
with people who have a drug-related problem. Richard Bryant-Jefferies evidently
has a deep understanding himself and is able to communicate these issues in an
easy-to-understand way, at the same time stimulating but not taxing the reader's
mind. Within the story line are inset boxes in which the author provides the
reader with a commentary on the counselling process and explains some of the
practicalities of drug using, thereby giving a greater depth to the reading experi-
ence. At the end of each chapter there is a useful summary and a list of points for
discussion which encourage the reader to become involved in the counselling
process and the issues which both the client and counsellor encounter.
Many people will benefit from this book. The lay reader will find the book an
engaging read whilst gaining some insight into the world of drug users and the
vi Foreword
counselling process. Actual and potential clients may read this and gain encour-
agement about the benefits of person-centred counselling. Health professionals
will find this book provides an easy-to-follow explanation of Carl Rogers' counsel-
ling model and a unique view on how the counselling relationship allows a
troubled client to grow and heal.
Anyone reading this book will not fail to notice Richard Bryant-Jefferies' non-
judgemental approach to the drug user, which is essential if any therapeutic rela-
tionship is to work. They will also not fail to question their own judgement of
other human beings in light of the author's humbling respect for others.
I enjoyed this book immensely. If other textbooks were as easy to read I would
have a much greater knowledge and a deeper understanding of many subject
areas. As with his earlier book, Problem Drinking: a person-centred approach,
Richard Bryant-Jefferies has a winner. I highly recommend this book to anyone
who has an interest in drug users' problems and the therapeutic relationship.
Dr Peter C Robinson MB, BS, DRCOG
General Practitioner, Farnham, Surrey
GP with a Special Interest in Substance Misuse, Guildford, Surrey
Hospital Practitioner in Genito-Urinary Medicine, Guildford, Surrey
GP Tutor, St George's Hospital Medical School, London
August 2003
Foreword
In the past decade, research has overwhelmingly established that drug abuse and
drug dependence is a disorder with symptoms that manifest themselves in all
aspects of life. It is no longer acceptable for anyone to view a person who has a
drug abuse problem as a matter of a person being morally deficient and lacking
sufficient amounts of willpower to change behavior. Persons with drug abuse
disorders are also on the rise according to recent reports from the Global Burden
of Disease and the World Health Organization. It is estimated 141 million people
worldwide are drug abusers. Recent data from the UK Department of Health
estimate the social and economic costs of drug use in the UK at £4 billion a
year. Drug-related deaths have continued to rise in England, Wales, Scotland
and Northern Ireland. These numbers have a significant impact on individuals,
families and communities at local, national and international levels in relation
to public health problems associated with drug abuse.
Richard Bryant-Jefferies' book is well timed and critically needed because it
is a unique focus specifically working with the individual drug abuser which is
written within the framework of Carl Rogers' person-centered approach. Why
is this important? It is important because for far too long it has been a belief in
the drug treatment field that persons having drug problems are in denial due to
personality deficits, and are immoral. A mainstay of treatment has been aggres-
sive confrontation treatments which may demoralize a person and attempt to
coerce positive behavioral changes. Counseling behaviors, however, using such
approaches have been shown to predict treatment failure. An almost exact oppo-
site approach, use of empathy, has been associated with successful outcomes
of treatment. Humanistic approaches have been utilized for other psychological
problems for a number of years but very few times have these approaches been
used when treating a person for drug abuse.
In a classic paper in 1936, Rosenzwiez introduced the concept of common fac-
tors. Common factors are not specifically unique interventions or approaches
used but are factors, such as warmth, attention, understanding, and encourage-
ment, which are central to, and play an active role in, client improvement. Pro-
ject Match, a study in the USA, supported evidence of the importance of these
types of common factors as criteria for success for persons treated for addiction
problems. Project Match studied outcomes of persons who were substance depen-
dent and found that all patients who participated in the study showed sustained,
significant improvement with positive outcomes. The improved outcomes were
viii Foreword
found to be related to the high quality of care each person perceived they were
receiving, not one of the three different behavioral approaches used in the study.
Other recent studies support the effectiveness of a therapist's style using empathy
with successful client outcomes. Furthermore, regardless of the treatment tech-
nique used by a counselor, the counselors who create a strong therapeutic alli-
ance and relationship with their client have better improvement outcomes for
the client.
Bryant-Jefferies' book, Counselling a Recovering Drug User: a person-centred di-
alogue, does exactly this. This book is matchless and deeply insightful. It brings
alive the work formulated by Carl Rogers in defining and utilizing the necessary
and sufficient conditions, which Bryant-Jefferies demonstrates, to bring positive
behavioral life-style changes for a person experiencing a drug problem. Bryant-
Jefferies offers critical wisdom from his many years of counseling persons with
substance abuse problems and brings into the text the guidance and skill of
an experienced supervisor. This in turn offers counseling suggestions, which are
within reach for all who read this book. The therapeutic alliance at work within
the pages of this book describes brilliantly the relationship of three people work-
ing together, the client, the counselor and the counselor's supervisor, to actively
improve the life of one person struggling with a drug problem.
No doubt Bryant-Jefferies' book will remain a reference for a long time to come
for all of us working in the field of counseling persons with drug abuse problems.
Dana Murphy-Parker RN, MS, CNS
Professor of Nursing, Arizona Western College
Board of Directors, The International Nurses Society on Addictions
Chair, Education Committee
The International Network of Nurses (TINN) Interested in Alcohol
Co-Founder, Tobacco and Drug Misuse
August 2003
Preface
Few general counselling training courses include a great deal on the subject of
working with people with drug problems. Yet counsellors and other health and
social care professionals are being faced with clients who, for one reason or
another, have developed a drug-using habit, or may have had one in the past and
may still be carrying the effects of drug use. The counsellor in the GP surgery, the
nurse in the accident and emergency department, the social worker concerned
with a family, the housing support worker in a city centre hostel can all expect to
encounter people with drug problems. In fact, the list is endless: drug use is so wide-
spread these days that you are likely to encounter it anywhere and everywhere.
I am aware of the growing need for a wider understanding of the issues to be
addressed and ways of working with this client group if we are to ensure that
damage is minimised, both to the user and to others. There is so much prejudicial
and judgemental thought around in relation to this group of people, and I hope
that this book will help to emphasise that the drug user is more, much more, than
their drug use. The client in this book is not a stereotype; recovering drug users
are individual with their own set of experiences and meanings that they attribute
to their drug use.
This book sets out to provide material to inform the training process of counsel-
lors and many others who seek to work with this client group. It is intended as
much for experienced counsellors as it is for trainees. It provides real insight into
what can occur during counselling sessions where the client is seeking to resolve
issues related to their drug use, reflection on the process, and helpful summaries
and points for discussion in the wide range of training courses for which it
is intended.
Counselling a Recovering Drug User: a person-centred dialogue will also be of value
to the many healthcare and social care professionals who are likely to encounter
patients or clients, or relatives of these, with this kind of problem. For all these
professionals, the text demystifies what can occur in therapy, and at the same
time provides useful approaches and frameworks that may be used by profes-
sionals other than counsellors.
Importantly, I have also written this book for the person who has thought of
seeking help for issues underlying their drug use, offering them insight into the
process that they might expect in order to resolve their difficulty. However, one
book can only convey part of the story. There may be common factors, but essen-
tially each person is unique, using substances for their own reasons. These need
