Counselling can be beneficial for clients at all stages of addiction and recovery, from the early work of helping clients to explore honestly their relationship with substances and / or behaviours, defining what recovery is for them,  through to the later work of maintaining changes in that relationship. 

Some clients need a more intensive approach to treatment such as rehabilitation services , medical detox,  dayhab, and daily support. These cannot be provided by one-to-one therapy and counselling. However many clients can and do achieve lasting recovery by utilising the services of counsellors, either in isolation or as part of a package of care.

My practice is rooted in an individualised pluralistic approach.  I feel that the one-to-one tailored approach that I can offer has a number of advantages, in particular that I can explore and help clients to engage with additional support where helpful.  I am entirely flexible and am not constrained by any particular approach, so I am happy to work with clients engaging in 12 Step Recovery, SMART recovery and/or other approaches, and I find this freedom to explore options enables clients to engage with and utilise whatever elements are helpful to them individually.    I have taken the time to understand as much about the many options available to clients as I possibly can, because I find that clients often present with blocks to particular services such as peer support, based on inaccurate myths and stigma.  Therefore some of the work we engage with might be exploring these beliefs and helping clients to make informed decisions rooted in accurate information.

The work with clients struggling with addiction is as varied as the clients seeking support are.  It can involve psychoeducation work, defining what recovery will look like for a particular client.  It might include abstinence, harm reduction, or a developing a blended way forward.  We then set to work in achieving a new relationship with the substance/behaviour and exploring and healing the pain and suffering that may have contributed to the addictive struggle.

Many clients I work with have experienced trauma or other difficult life experiences, so processing and healing is an important step, for which counselling is a powerful process.   Being pluralistic in approach, I call on a number of different theoretical models to inform my work, and for some clients having a number of options is very helpful.  My philosophy is rooted in collaboration from the beginning, from helping clients define what recovery needs to look like for them,  to how we might work in achieving that.  This collaborative tailored approach and the one-to-one relationship of counselling facilities clients in softening any defences and working together in finding out what works for them.

Counselling can also offer a helpful framework for aftercare, for example for clients who have attended rehab, offering ongoing support building on the work they have done in treatment and exploring their challenges in recovery.  It is often the case that when people have successfully stopped or reduced their harmful relationship with substances / behaviours, unaddressed pain becomes manifest.  Counselling at this point can meet the pain, work with it and help clients continue to heal.   For many clients I believe that this ongoing support can provide the essential “backend” support that is often the missing ingredient of people’s journeys. 

Counselling has its limits of course.  50 minutes a week (the therapeutic hour) leaves over 1,000 other minutes that week.  Counselling cannot meet the medical requirements of clients, and neither can it provide crisis support.  It is also not a substitute for a peer or sponsor.  As a practitioner, it is my job to know and to work with these limits, to be aware of what is available, to acknowledge with  clients when these limits are leaving gaps and to help clients find the resources and recovery capital to address the needs. 

One of my motivations for writing this piece is to share my conviction in the value that counselling and private practice can offer clients struggling with addiction, and the opportunities for recovery and support that if offers to those clients that do have the opportunity to access counselling and therapy.  I know from the referrals I receive from practitioners in other sectors of the addictions field that the private counselling sector is valued, but I am troubled when I see it viewed as a lesser option.   I believe that for some clients it is a very effective standalone option, and for others a valuable additional option.

As I close, my message to other sectors of the profession is – please keep us counsellors in mind!  We have much to offer each other and most importantly the people we seek to support.

Andrew Harvey, FD (Open), MBACP (Accred), AP APM is a Psychotherapeutic Counsellor working in private practice with clients seeking to make and maintain changes around substance or behavioural struggles.

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