I would be aware of mentioning the addiction before the client is ready to talk about it, I feel it is for the client to lead this disclosure and to focus on it when they are not ready, could adversely impact on the them, although if they are noticeably intoxicated, there may be a need to be congruent. Clients not turning up for sessions, due to withdrawal, or being intoxicated and so on, are possibilities to keep in mind, as is the possibility that they may suddenly stop coming to sessions.
Relapse and the possibility that at first being in therapy may lead to increase in the addictive behaviour is worth thinking about, as it could lead to mixed feelings for the counsellor. Number of sessions available in agencies is a consideration, as is the length and the setting or environment of the sessions. This client group may be involved in a framework of help or ‘treatment’ and it is important as a counsellor to be aware of different models that may be available or being used by the client.
For this purpose I am going to do a compare and contrast between Alcoholics Anonymous and the PCA. This is not going to involve me going through the whole AA model; I am making the big assumption that the readers are familiar with it. Alcoholics Anonymous, was conceived in the 1930’s in Akron, Ohio, and has since “… grown to be the most widely used organisation for the treatment of alcoholism and substance abuse. ” (www. unhooked. com 04/01/07)
It has more than 2 million members, in 134 countries, and has influenced the conception of a large number of other support groups, e. g. – eating disorders, drug addiction, and gambling, also having a great influence in the way that people think about alcohol problems. The heart of the program lies in their 12 step program. AA believes in abstinence, for me this feels like a condition and goal-setting, and may lead to feelings of failure and shame if relapse occurs. Although for some people this may work well, it can be seen as an extreme measure, and may not be necessary, as people have been known to drink safely after having a problem with alcohol.
Counselling has no specific targets or goals. “IT seems that AA largely caters for those who are or have been at the extreme end of the drinking continuum. ” (Bryant-Jefferies, 2001, pp17,e) . This is a criticism made by some people, and I feel it narrows the availability, in terms of preventative work and for those who alcohol may just be beginning to cause problems. The PCA, I feel is available whatever the situation, and can be worthwhile at any stage, there are no conditions on who can and cannot come to counselling.
AA states that “The only requirement for membership is a desire to stop drinking. ” (www. alcoholics-anonymous. org. uk 04/01/07) The wording of this, for me, is wrong, it would deter me from approaching AA, it feels like a condition, and in contrast is very different from the PCA, that has no such ‘membership requirements’ “AA meetings are accessible; there is no screening of members, and the free help can be as long term as the member desires. ” (www. unhooked. com 04/01/07) .
A major advantage, in my eyes, of AA is that even if I were abroad I could attend a meeting, if it was available in the country, so there may be less anxiety when travelling. Counselling, if private, can be seen as expensive, and may deter a lot of people from coming, especially, if they are ‘using’ and need the money, for drugs or alcohol. It may be free if through an agency, but then there may be a limited amount of sessions available, but with person-centred counselling there is also no screening.
“A particular strength of the AA is its ability to help members in times of crisis. ” (www. unhooked. com 04/01/07) . The sponsor idea, of one member being available for another, in times of distress or crisis, is a great advantage, and I’m sure it provides much needed support, especially as its from people who may have been in the same situation, so there may be less feelings of guilt, shame and humiliation, in asking for help.
Counselling has boundaries, and counsellors are not usually available out of sessions, this is an advantage in the sense that it doesn’t encourage dependence, and may be a part of the person being responsible for themselves, but also a disadvantage, if a person is isolated and has no one else, it could lead to desperate measures and a relapse. The group meetings are an advantage for some people, as it provides support, and sharing of experiences with people facing similar problems, it may help people feel understood.
“AA can provide the individual with an environment in which experiences can be shared and trust can be established” (www. unhooked. com 04/01/07) . This is similar to counselling, which is on a one to one basis, and highlights the importance of trust and safe environment, whether in a group or individual setting. There are people that would feel uncomfortable in a group, so it may not be correct for everyone, just as counselling may not be. AA believes that alcoholism is a ‘disease’, “… a progressive illness…
it cannot be cured in the ordinary sense of the term, but that it can be arrested through total abstinence from alcohol in any form. ” (www. alcoholics-anonymous. org. uk 04/01/07) . This would frighten me, and I think it may be a little misleading, this may shock people into wanting to stop, taking the responsibility away from the person, its not their fault, it’s a disease, this can work both ways, it may lessen feelings of guilt and shame, but also they could just give into it at some point and feel they have no control over it.
From the perspective of the PCA, it is empowering to take responsibility for oneself and this has been important in the work I have done in therapy, maybe taking responsibility for the problem and owning it would be a step towards the client taking back control. The twelve steps themselves, “… were originally adapted from a Christian organisation, The Oxford Group. ” (www. unhooked. com 04/01/07) , and their religious nature is one of the biggest criticisms of AA, and I agree it is not for me, I found them a little unnerving and apologetic, but some people may find comfort in them.
The notion of the ‘Higher Power’ is something some people may not appreciate, feeling alienated by the model. The PCA, is ‘each to their own’, you can hold any belief you like and there is no emphasis on outside power, it is about empowerment and responsibility from within. As models of care and change, both have their advantages and disadvantages, but that is my opinion. I feel there is too much emphasis on handing over power and being powerless, and the fact the steps are written as ‘we’, which feels impersonal. This may not be how other people see it; there are many people who have had success with AA, which is testament to its strengths.
I feel AA is directive and the relinquishing of responsibility for self and self-direction, may have adverse affects, I interpret some of it as saying, someone else will solve the problem. It is wise to remember that AA is not a counselling theory and may work well alongside other help options. Looking at culture and diversity, the first thing that comes to mind is that both models were developed in America by white men, both could be seen as westernised, which may make some people feel they will be of no use to them.
With the AA it is the religious nature or undertones, which could isolate people from different cultures and those with different religious beliefs, such as atheists, people could be fearful of trying to be converted by AA, and may feel it has a cult like presence. The group structure may be difficult for some cultures to understand, for example, for Asians, who believe in keeping things quiet and within the immediate community.