After agreeing to be a regular contributor to Counselor magazine and Counselor Connection, I designed a brief survey for readers to elicit their ideas on topics for these columns. The rationale was to get input from colleagues who provide direct services or are involved with behavioral health care in some capacity, and individuals in recovery (some of whom also work in a professional capacity). This survey asked readers questions about their backgrounds, current positions, work settings, length of time working in behavioral health care (BH), and degree of interest in topics related to oneself as a clinician or caregiver who provides services to clients or works in another professional capacity; individuals with substance use, psychiatric or co-occurring disorder; families or concerned others; and other topics of interest.
Following is a summary of 444 respondents who completed this survey. It should be noted that not all respondents answered every question. However, they provided valuable insights on issues concerning them, and for this I am grateful.
About the Respondents
Nearly 60 percent of respondents are therapists or counselors, social workers, psychologists, nurses or aids; 10.2 percent are managers or administrators; 7.7 percent are clinical supervisors; and the rest are prevention specialists, research staff or function in other capacities. One in ten respondents is in recovery from one of these disorders.
Time in Current Position
Nearly 60 percent have been in their positions for more than ten years (43 percent) or between six to ten years (15.3 percent); 28.8 percent for one to five years; and less than 10 percent less than one year. A little more than 3 percent of the total sample are individuals in recovery who do not work in BH.
Experience in Field Working with Clients
The majority of respondents (68.1 percent) have over ten years of experience in the field; 16.2 percent have six to ten years; 13.4 percent have one to five years; and 2.3 percent have less than one year of experience in BH.
The large majority have master’s degrees (59.6 percent) or PhDs (13.5 percent); 17.7 percent have bachelor’s degrees and 5.4 percent have associate degrees.
Current Work Settings
A little more than half (51.7 percent) work in an addiction setting; 30.4 percent in a mental health or psychiatric setting; 19.7 percent in private practice; 10.8 percent at a school, college or university; 10.5 percent in a criminal justice setting; and 6.3 percent in a medical hospital, HIV clinic or other medical setting.
Topics of Interest in Behavioral Health Care
Respondents were asked to rate their degree of interest in twelve topics related to themselves as professionals, twenty topics related to clients or individuals with behavioral health disorders, and four topics related to families or significant others affected by the disorder or disorders of a loved one. Respondents could rate their interest in each topic as very interested, somewhat interested, not very interested, not interested at all, or not sure. In addition, an open ended question allowed readers to provide their ideas on other topics of interest.
Topics Related to the Caregiver/Clinician
The topics readers were very interested in included
- Ideas to use in individual sessions with clients (66.7 percent)
- Providing integrated care to clients with both psychiatric and substance use disorders (64.7 percent)
- Ideas to use in group sessions (63.2 percent)
- How to grow as a professional in terms of knowledge and competencies (60.6 percent)
- Ideas to use with families (51.9 percent)
- Integrating positive psychology into clinical practice (44.22 percent)
Topics Related to Clients with Behavioral Health Disorders
The topics readers were very interested in included
- Motivation to change (77 percent)
- Reducing relapse risk (72.3 percent)
- Resilience (65.5 percent)
- Recovery from any of these disorders (61.7 percent)
- The role of medications with addiction (60.8 percent)
- Managing emotions or moods (59.1 percent) or gratitude and other positive emotions (55.5 percent)
- Co-occurring personality, anxiety or mood disorders combined with substance use disorders (<55.7 percent)
- Interpersonal issues (54 percent)
Topics Related to Families or Concerned Others
Readers were very interested in dealing with a family member who refuses help (58.3 percent); recovery for the family (56.2 percent); and the impact of disorders on the family (54.3 percent) and children (51.3 percent).
Other Topics That Readers Suggested
I was impressed that 141 respondents shared nearly two hundred responses to “other” ideas or issues to consider. Most suggestions related to clinical issues or populations with behavioral health problems or those affected by these problems, although some responses related to issues such as ethics, recovery-oriented systems of care or reimbursement for services. The most frequently identified issues fall into these categories:
- Non-Twelve Step mutual support programs (especially SMART Recovery)
- Trauma issues
- Co-occurring psychiatric disorders (especially PTSD and eating disorders) and nonsubstance addictions (compulsive gambling or sexual behaviors)
- Children and family issues
- Other clinical approaches or interventions (e.g., dialectal behavioral therapy, EMDR, mindfulness, etc)
- Counselor issues (e.g., preventing burnout, self-care, team building, professional development, boundaries, etc.)
- Specialty populations or settings such as LGBT, adolescents, Native Americans and patients in primary care with substance problems
Observations and Conclusions Based on this Survey
Respondents represent a diverse group of individuals in terms of positions and work settings although the majority provides clinical care in addiction or mental health settings. Given that only 6.3 percent work in medical settings, there is clearly a need to expand dissemination (e.g., information and training) to these settings. My colleagues from the National Institute on Drug Abuse’s Center for Clinical Trials Network (CTN) recently published a paper stating that now is the time for making “transformative changes in the provision of SUD care” by expanding research efforts into general medical settings (Tai, Sparenborg, Ghitza, & Liu, 2014). The CTN has already conducted studies in medical settings and will continue efforts to study interventions in these settings to reach a broader population of substance users and those with problems. Dr. Thomas McLellan, one of the leaders in our field, also strongly recommends providing integrated care in medical settings to individuals with a broad range of substance problems and disorders (2014).
Respondents represent a stable, experienced, and educated workforce. The large majority has over ten years of experience in BH and nearly 75 percent have advanced degrees. Studies show that many clinicians leave the field of addiction treatment so it would help to know what motivates our respondents to sustain their commitment to the field of BH for so long. More stability in the clinical workforce can only help the clients and families we serve.
Despite being highly experienced and educated, respondents were very interested in improving their knowledge and competencies by learning more ideas on clinical tools to use in individual, group or family sessions. The highest clinical categories of interest were motivation to change, reducing relapse risk, and resilience. Readers also want to learn more about “integrated” treatment of substance use and psychiatric disorders, probably because comorbidity is common in addiction, mental health, and criminal justice systems. There is strong interest in many psychiatric conditions especially mood, anxiety, personality, eating, and psychotic disorders as well as PTSD. I also believe that an increased focus on integrated care in medical settings is of high importance since only a small portion of those with substance disorders receive care in an addiction setting.
A significant majority of respondents were interested in learning about the role of medication in addiction treatment. I believe clinicians are generally good in facilitating the use of medications for opioid dependence, but less so with alcohol dependence, an addiction associated with numerous medical co-morbidities and increased rates of early mortality due to the adverse effects of alcohol, accidents, suicides or being victims of violence. Medication options for alcohol dependence should be routinely provided to clients with alcohol dependence, especially multiple relapsers.
I was pleased to learn that there is strong interest in resilience, gratitude, and other positive emotions. There is much we can learn from the field of positive psychology in our work with clients and families affected by BH disorders. I have worked with many clients whose lives have been devastated by their disorders, yet they bounced back and engaged in recovery, making significant life changes and showing an impressive ability to be resilient.
Over half of respondents were very interested in all four topics related to the family. While I am pleased with this, I am less pleased with the reality that many programs and clinicians do not include families or significant others in treatment or facilitate their engagement in recovery. Conferences and training programs often do not include any or much focus on family issues. Additionally, the major textbooks on treatment of psychiatric disorders or addiction devote limited pages (less than 4 percent) to family related issues. Clearly more educational and clinical focus is needed on issues pertinent to families as well as members, including children who are often adversely affected by a parent or sibling’s disorders.
Finally, we as counselors, clinicians or caregivers clearly believe it is important to focus on professional and personal growth. This helps us increase our knowledge and skills, and reduce burnout. One of the comments that stuck out to me by one of the respondents was the need to focus less on group treatments and more on individual therapies. Group is the main form of treatment provided in many treatment programs. I have conducted numerous focus groups with patients in multiple psychiatric and addiction treatment settings. The one consistent complaint is that many receive limited or no individual sessions. In a major multisite clinical trial I was involved in that studied individual and group treatments, we found that clients receiving both individual and group addiction counseling did better than those receiving group alone combined with brief case management sessions. While private practitioners often provide individual therapies, treatment programs need to offer this service as well. Not all problems or issues can be addressed in groups, and not all clients will want or benefit from groups.
Go to the “Resources” section for a free PDF file of “Online Resources” that includes information on twenty-six mutual support organizations, including SMART Recovery.
This is the website for the University of California at Berkeley Greater Good Science Center. It provides information, book reviews, PowerPoint slides, lectures, and other information on these core themes of positive psychology: gratitude, altruism, compassion, empathy, forgiveness, happiness, and mindfulness.
McLellan, T. (2014). Moving toward integrated care for substance use disorders: Lessons from history and the rest of health care. In D. A. Fiellin, S. C. Miller, R. Saitz, & R. K. Ries (Eds.), The ASAM Principles of Addiction Medicine (5th ed.) (pp. 403–17). New York, NY: Wolters Kluwer.
Tai, B., Sparenborg, S., Ghitza, U. E., & Liu, D. (2014). Expanding the National Institute Drug Abuse Treatment Clinical Trials Network to address the management of substance use disorders in general medical settings. Substance Abuse and Rehabilitation, 5, 75–80.