Counselling Young Binge Drinkers

Person-Centred Dialogues

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781846190599
• eBook ISBN: 9781315343204
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Young binge drinkers are becoming more and more common in society today. By using case studies with fictitious clients, this timely and much needed book offers the reflective thoughts and feelings of both client and counselor in a user-friendly format. Counselors and psychotherapists who practice, or are interested in, the person-centered approach, will find this book invaluable - particularly those who work with young people. It also provides vital information for youth leaders, teachers and parents of young people, and counselors and therapists in training.

PART 1

Gary’s story

‘So, after a few beers in that environment, you begin to feel kind of different in some way?’

Gary nodded. ‘Yeah, it’s like, I don’t know, different, yeah.’

‘Different, and it’s kind of hard to sort of describe what that “different” is like, yeah?’

Gary had lifted his arms by his sides, his fists clenched slightly.

Rick reflected his arm and hand movements. It felt to him like the kind of movement you might make before punching someone. He wondered how much the body movements were capturing the flavour of what the ‘difference’ was.

CHAPTER 1

Friday evening

Gary was getting himself dressed, looking forward to the evening (and weekend) ahead of him. Friday night, and he was going to have some fun. Get pissed, definitely, go clubbing, definitely, have a good time, for sure. Yeah, he was looking forward to enjoying himself. He worked hard and he liked his weekends, they were what he worked for. Have a good time, get out of his head, maybe a few pills, he didn’t always do that, but sometimes, yeah, kept him going and made him feel good. He’d already spent a good half an hour, maybe a little more, getting himself ready. Well, that’s what he liked to do. You had to look the part, yeah, and he was a man on a mission. He was going to pull, he didn’t care who she was, he wasn’t interested in any idea of a regular girlfriend. He had another look in the mirror. Yeah, he looked good. He was going to get really pissed and if anyone upset him, well, he wasn’t looking for trouble, but if they started it, he’d sort it and tough shit on them. He didn’t go out looking for trouble, but it happened sometimes, and he dealt with it. It was Friday night and, yeah, he lived for Friday night, and Saturday night, and, well, any other night if he went out with his mates.

He was planning a trip into town with Mai and Luke. They’d been mates for a while now. Known each other since school. Now they were all 18 and up for anything. Been on a couple of holidays together overseas as well. Yeah, had a lot of good times, and a lot of good shags as well. He was up for it, up for anything, especially after a few drinks. Been that way for a few years, particularly since leaving school.

The phone rang. It was Luke. ‘You ready yet?’

‘Nearly. You spoken to Mai?’

‘Yeah, he’s here. We’ll be over in about 20 minutes.’

‘OK, see you.’ Gary hung up the phone and returned to the mirror, bit more time to just be sure he was looking his best. Made him feel good. He didn’t know why, but he often felt like he wasn’t at ease with himself, on edge, but he would push it aside. He knew he’d had a crap time in childhood, but he didn’t think too much about that now.

Time passed, and it was soon approaching the time when Mai and Luke were due to arrive. They were planning to head down to the station – he only lived a five minute walk away. He looked around his room, at the posters on the walls, and the tumble of clothes on the chair. It was still light outside but he knew by the time they got into town it would be getting dark. The bar they went to was fairly near the station, and then they’d go on to a club that was only a few minutes’ walk away as well. It was good, the bars and clubs so close to the station like that. Everyone went there. OK, yeah, could get a bit crazy later sometimes, but, well, you looked after yourself, get in first, that was his motto. Someone looks at you, go and sort it. Always made him feel good.

He sat down on the bed to tie up his shoes. Yeah, he felt good, he was going to have a good time. He stood up, and walked over to the window, he could see Mai and Luke heading towards his parents’ house. He had another quick look in the mirror as he walked past, checked he’d got everything in his pocket, plenty of dosh and his card, and headed out the bedroom door and down the stairs. ‘Mum, I’m out. Be back later. Don’t wait up.’ Not that you ever do, he thought to himself.

‘You take care, don’t go getting into any trouble, and get a taxi back if you’re late.’

‘Yeah, OK, I’ll be fine.’ The doorbell rang. ‘That’ll be Mai and Luke. Gotta go. Bye.’

‘Bye.’

Gary opened the door. OK?’

‘Yeah, course I am. So, come on, let’s go and enjoy ourselves. I’ve been needing this all week. My boss has been a real pain in the arse. Fuck him!’

‘Any arse in particular?’ They all sniggered as they headed towards the railway station.

Counselling session 1: ‘I don’t have a problem with my drinking’

Monday 7 April

Gary walked across the car park at the doctor’s surgery, thoughtlessly kicking a stone that was in his path. He heard it rattle off the hub cap of the green Fiat to his left. It made a nice sound. He didn’t give it much more thought, he was more concerned with what the hell he was doing going to see a counsellor. It hadn’t been his idea and he didn’t see any point. Why did he need to talk to someone? What had he got to talk about? Just because the doctor thought he had a problem. Well, he didn’t. Yeah, so he got into trouble sometimes, but that was no trouble, not really. Just how it was. Not a problem. He sorted his problems out, and this wasn’t a problem. Waste of time, but the doctor had been insistent. So here he was, Monday morning, nine o’clock, to see some shrink about a problem he didn’t have. Bloody marvellous.

He went into the surgery and stood in the queue at the reception desk. He didn’t like queues, never liked waiting. He stood, hands in his pockets, staring at the back of the woman in front of him, wishing she wasn’t there, in his way. Still, he then thought, if it makes the doctor happy, might get him off his back.

In this instance the client has been referred for counselling for his binge drinking by his general practitioner (GP). There may not always be positive responses from the young person to such a referral, but some will engage in treatment via this route. It often depends on the way it is presented by the GP, and the relationship the young person has with their GP. It may also depend upon where the counsellor is located. My own experience of working in a GP surgery was that it offered scope for young people who were already familiar with the environment to attend. That seemed to help.

Eventually he got to the desk. The receptionist took his name and told him to wait and she’d call the counsellor to let him know that he had arrived. Gary went and sat down. He stared across the waiting area. What was he doing there? What was the doctor thinking about, telling him he had a problem with his drinking and he needed to talk to someone? He didn’t have a problem, he didn’t drink more than anyone else, and so what if he did get in fights, why was that a problem? Maybe for the other guy, he grinned at the thought of his last fight. Yeah, he’d sorted him out. So, he’d ended up in accident and emergency (A&E), but so what. It’d been worth it. What was the problem? He sat with his thoughts, feeling increasingly pissed off with being there and wondering how long the counsellor was going to be. He’d only been waiting two minutes.

‘Hi, Gary?’ He heard his name and looked up. A guy was looking his way.

‘Yeah, that’s me.’

‘Hi, I’m Rick, the doctor asked you to see me?’

‘Yeah.’

‘OK, so, follow me, the room’s along here.’

Gary followed Rick along the corridor, past the leaflet display and assorted posters warning of the dire consequences of various diseases. It wasn’t how he wanted to spend his Monday morning. He followed Rick into a room on the right.

‘Take a seat, whichever.’

Rick went to the seat nearest to him, which happened to be closest to the door.

‘So, Doctor James has referred you, and I assume he gave you the information leaflet about the counselling service, what we offer, how it’s confidential and what that means?’

Gary was looking out the window. ‘Yeah, yeah, he did.’

‘Any questions, anything you weren’t clear about?’

‘Nah.’

Rick nodded, very aware of the tension that was present in the room. His instant sense was that Gary didn’t want to be there. Not all his clients did, and certainly not everyone who was referred to him with an alcohol problem. Although he was a general counsellor, the surgery knew of his experience of working with people with alcohol problems, so they tended to refer people to him.

‘OK, so, what I know from the referral letter is that you’d been in a fight recently, alcohol related, and the doctor felt you might benefit from seeing me. Whether that’s your view, I don’t know. But I’m happy to listen and give you some time and you can decide whether it’s helpful, whether you want to continue coming, it’s up to you.’

Gary was still looking out of the window. He snorted. He didn’t want to say much. He didn’t have a problem. It was the doctor who had the problem. He shook his head as he thought about it, still looking out of the window. He didn’t say anything.

‘You don’t want to be here, do you?’

The counsellor is being transparent in what he senses to be the situation and experience for his client. It’s not that the client has directly said this, but his manner, his demeanour, is communicating this to the counsellor. It can be a powerful response, it brings reality into the room, into the relationship, into what is passing between client and counsellor. It is not voiced as a judgement, a criticism. It is an attitude that the counsellor will accept. The person-centred approach requires that the counsellor accepts how the client feels, warmly and unconditionally, and that they do not bring into the relationship an intent to seek to change the client in any specific way. The client is there, he doesn’t want to be, the counsellor senses this to be the client’s reality, and he voices it in an accepting manner.

No. I don’t see why I have to be. I haven’t got a problem.’ He shrugged, still looking out of the window.

‘Mhmm, no problems, everything’s fine, yeah?’

‘Nothing I can’t sort out.’

‘Yep, you’ve got it all under control, yeah?’

‘I mean, what’s ...’ He shook his head again. He turned to look at Rick, who was looking his way, and looked him in the eyes. ‘I mean, why do I have to see you, no disrespect, but, I mean, I don’t know. He thinks I’d find it helpful to talk to you.’ He shook his head. ‘I told him, “I’m OK, I don’t have a problem”. But he didn’t take much notice, told me I should see you, said you’d be able to, I don’t know, give me time to talk about things. But what have I got to talk about? I haven’t got a problem.’

‘OK, so it’s like he thinks you have a problem, but you don’t, he thinks it would be helpful for you to come and talk to me, and you’re wondering what the hell you’re doing here.’ Rick was intentionally direct in his response, seeking to be upfront. His experience told him that this was the best way to be. Say it as it was, or as he was experiencing it. Don’t get into ‘counsellor-speak’, just level with the client. At least that way the relationship could begin to be established and that, as far as Rick was concerned, was what really mattered. He accepted, more than accepted, he knew that to the degree that he could form a relationship, and for that relationship to develop therapeutically, then there would be the possibility for something constructive to occur for the client. He accepted Rogers’ ‘necessary and sufficient conditions for constructive personality change’, and his role was to offer the therapeutic qualities as a contribution to ensuring those conditions were present in the room, in the relationship. He had deliberately spoken not loudly, but not quietly, again seeking to convey a sense of his presence. He sought to match the tone in his client’s voice.

‘Yeah, yeah, you’ve got it. That’s how it is.’ Gary nodded. Yeah, at least this guy seemed to hear how it was. Pity his GP hadn’t heard him like that, he probably wouldn’t have had to be here now, wasting his time.

Note that the counsellor has not launched into a formal assessment. The focus is being placed on establishing contact and relationship with the client, on offering the therapeutic conditions. From a person-centred perspective, therapy starts where there is contact. To formally assess will bring a directive element into the therapeutic process, setting a tone for the relationship that will be built. The client will then experience the counsellor as someone who probes, asking questions about areas of his life and awareness that the client may not want or feel ready to disclose. The person-centred therapist will be wanting to let the client communicate what they want to disclose, when they want to. So, the emphasis is on listening, on communicating empathy and warm acceptance, on being non-directive, and on letting the client communicate whatever it is that they wish the counsellor to hear. This is a significant difference between person-centred therapy and most other forms of counselling.

There are, of course, settings in which there is a requirement for an assessment, for a history. Where this is the case, then it should either be undertaken by someone else other than the therapist, or it should be made clear by the therapist that some basic information is required by the agency. The person-centred counsellor will not want to invade the client’s inner (and outer) world. The best way is for information to build up over time. Many clients don’t immediately want to tell you their family history, it may contain experiences they are uncomfortable with, or do not wish to share with someone they have only just met. Why should they? The person-centred therapist is more concerned with communicating to the client that they, the client, have the power to choose what they wish to say, and when they want to say it. This is fundamental, setting an important tone for the building of the therapeutic relationship.

‘OK, and he was saying he thought you specifically had a problem with your drinking, and that’s what you’re pretty clear you don’t have.’

‘Mhmm, and that’s what’s important, yeah, feeling, yeah, you can handle it.’

‘Yeah, your drinking isn’t causing you a problem.’

‘Nan.’ He pulled face. No, it wasn’t a problem, it was how it was. He didn’t have a problem. So what the hell was he doing there? Why didn’t people let him be? At least this guy, Rick, wasn’t pushing him. In fact, Rick seemed to quite accept what he was saying. That was actually a bit of a relief, not that he would have agreed with anyone who said he’d got a problem. The doctor had pissed him off insisting that he came and saw this guy. Oh well, time was passing, he wouldn’t have to hang around for too long now.

‘Ok, so, th...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Forewords
• Preface
• About the author
• Acknowledgements
• Introduction
• Part 1 Gary’s story
• Part 2 Carrie’s story
• Author’s epilogue
• References
• Useful contacts
• Index