My name is Fiona Reynolds, and I'm using the wiki to write about my Clinical Psychology Practicum. I am a senior, I plan to graduate in December of 2007 with a major in Psychology and minors in English and Clinical/Counseling psychology. I am enrolled in the Clinical Psychology practicum for Fall 2007 and am completing my hours during the summer at Nexus Recovery Center in Dallas, Texas. It is a drug and alcohol rehabilitation center designed specifically for women. There are three sections: Adult Women, Adolescents, and Adult women with children (they bring their young children with them to live with them during their rehab). I am working with the adolescents, and there are about between 15-19 girls there at any given time. Many of these girls have had extensive problems with violating probation and most of them have been in juvenile detention centers and have been given the choice between jail or rehab and have chosen rehab. While this is probably a more helpful place for them, the girls that aren't really there by choice tend to have slower progress with their treatment than the ones who have recognized an addiction and have entered voluntarily.
I have actually been at this internship for about two weeks, but I have only started the Wiki today. For the first week I was just observing and learning the rules, and gradually am getting a little more responsibility and am getting to do a little more.
I was there yesterday from 12 AM- 8:00 PM.
I stay long on Thursdays because it is a pretty busy day and they can use extra help supervising and there is plenty for me to learn. Yesterday was especially busy; two girls were successfully discharged and we had one intake. When someone first arrives there is a lot of work to do, and the center is pretty strict. A staff member observes the girl giving a urine sample to test for drugs, and then we search every item they have for drugs, and any sharp, glass, or item containing alcohol (hairspray, etc) is stored in a locked locker which is assigned to her. We also have to do a search of the girl herself. I usually help with that and then I take a background of her situation, such as who she lives with, whether she is in school, and what drugs she has been using.
Yesterday some of the girls went on a field trip and I stayed with the five who stayed. It is actually harder than it seems to be one person in charge of five teenage girls. I took them outside and they are never supposed to be unsupervised, so i had to keep them all in one group, which is difficult, especially if someone needs to go to the bathroom or something. Some of the staff are very firm and unsympathetic, it seems. A girl who has been running around in the sun for an hour asks if she can get some water from the main building or go to the bathroom and the staff will say "no". Most of the "staff" that are really with the girls most of the time are not counselors but "techs." I agree that the clients need discipline but I do think that that kind of treatment gives them a very negative feeling about rehab, as if they are in jail. I
think that if they hate rehab, they won't use it.
June 18th, 2007~
I worked at Nexus from 12 until 5 today. It seemed like it was a really slow day, but I was glad to see that the other staff had planned some exercise activities. One of the biggest issues at this rehab is that the girls gain weight very rapidly while they are there. I've seen that they gain anywhere between 15 and 45 pounds, depending on how long they are in there. Some of this weight gain can be explained by the simple facts that the girls are no longer on drugs. Some of them have admitted that when they were using crystal meth or coke or "cheese" (popular drug in in Texas; heroin mixed with Tylenol PM. A lot of kids die from it) that they would go days without really eating. Of course atNexus, they are eating three meals a day, and interestingly, they always seem ravenous. They always eat their entire meal plus a peanu butter sandwich. The food could be healthier in my opinion (they eat corn dogs and fries and things like that a lot) but it is a stretch to feed this many people on so tight a budget. The problem really is that they don't seem to ever get any exercise. Several of the girls have told me that they feel fat, and none of their clothes fit, and they feel lazy- they get a lot of down time between group sessions and life skills. It is frustrating for me because being in rehab appears to be a difficult experience- especially for someone fourteen or fifteen years old. They are away from their families, trying to come off of some hard drugs, they are on probation- and their clothes dont' fit. It is a very well known fact that physical exercise is an important aspect of overall mental health, so I think that a fitness program for the girls would do nothing but good.
Today, there was a group about nutrition, which was helpful: it was informative about how to eat right, and what to believe when it comes to weight loss. Afterward, one of the other staff took eight girls across the street to run on a college track. There was another staff that was supposed to do a work out video with them, but she ended up having to do an intake of a new client, so I took the girls downstairs to do the video. There were about nine of them, and they didn't all have sneakers, and for some reason some of them refused to wear anything but jeans. It looked like a pretty challenging kickboxing video, and some of the girls really didn't want to be doing it, it seemed. I think because I'm much younger than the rest of the staff, they think they can get away with more with me, which I have to stop. I can be easygoing about some things with them, but I felt that they all needed to be working out, so I didn't let them take breaks except for water. I'm getting better at telling them no. I think it turned out well and I hope they keep this for at least three times a week.
There was free time after that, during which I caught up with the other staff about what had been going on. Apparently two of the girls who claim to be bisexual had been "inappropriately" touching earlier that day, so we needed to keep an eye on that. I also did some of the intake with the new client and helped with her search. Her drug of choice is marijuana, which is a lot more hopeful than some of the other drugs the clients have used. After the free time, there was a 12 step group led by one of the counselors, Miss Patricia. (They call of the counselors and staff "Miss" so and so. They call me Miss Fiona. I guess they do that sort of thing in the South!) For the twelve step group, it is run a lot like an AA meeting- everyone goes around and says their name, age and drug of choice, and everyone has to recite one of the twelve steps of recovery. If they dont' know it, they get a "level drop." The levels represent the system of discipline that Nexus uses for the adolescents. All of the girls start the day off with a 4, but if they break the rules, it will be dropped to a 3, 2 or 1, depending on the offense. Each client has a graph posted on the wall of the common room that shows their levels for each day of that week. Unfortunately, it is rare that a day goes by without someone having a level drop.
If a client forgets one of their 12 steps, their level goes to a 1. I think that Miss Patricia is a good counselor because she is consistently emphasizing the positive aspects of each client and looking at them as individuals, which is not an easy task with 17 girls. I thought it was a beneficial group. After that, the girls went to dinner, and I went home. I will be there today from 12- 9- a long shift!
June 21st, 2007.- Thursday
Today I worked at Nexus Recovery Center from 12 until 8. Today was a crazy kind of day for behavior. There are also 17 girls there right now, which is two or so more than usual. It was good though because I got to spend some one- on- one time with a few of the girls to get a better idea of their situations. The first girl I talked to was a meth addict. Through my neuroscience course at Canisius, and my training at both of my volunteer sites, I was able to have a pretty good conversation with her about the effects of meth on the body, and what goes into it. She strikes me as one of the girls that has a good shot at staying clean once they get out, simply because of her attitude. Sometimes I see a sort of cockiness or attitude that unfortunately, makes me doubt their sincerity when they express a desire to stay clean. Another girl I spoke to is one that has a very interesting but unfortunate story. She actually completed a month at Nexus in February and relapsed, and came back about two weeks ago. Her drug of choice is Xanax, or any kind of pills, and she overdosed on Xanax, Sudafed and Ambien (she took about 110 pills altogether) and was sent here. What is really noticeable is her right arm which is covered in cuts of various size and also various states of healing. SHe also pulled up her sleeve to show a few cigarette and lighter burns which she had inflicted on herself. We had a lot of free time today, so I spent a lot of time with her, getting an idea of her history and what she hoped to accomplish in rehab. I actually think that her problems go much farther than drug addiction- it seems like the addiction is just a symptom ofher problems. Despite the efforts of Nexus to stop the girls from having sharp objects, this girl last week found a light bulb, broke it, and cut herself. She claims the feeling after she cuts is better than the feeling she has when she takes pills. She also claims she had been diagnosed with Bipolar Disorder and takes many pills for it but doesn't feel better. She told me that her biggest problem in rehab is a lack of people to talk to. She doesn't relate well to the rest of the staff, who are much older and have no experience with depression, and she doesn't like her counselor. They might just have a bad clinician/client rapport or something. She expressed a desire just to be able to talk and have someone listen, without judgement or instructions. From what she said, it sounds like her counselor uses a very behavioral method- which works very well for most of these girls. Somehow I feel that this particular client would benefit from psychiatric care before simply drug addiction rehab. I let her talk for about two hours though, so I hope that she has decided that she trusts me and will feel comfortable talking to me in the future, and i can encourage her to cooperate with her counselor and try to "use" rehab as much as she can until she gets out and can start seeing a psychiatrist.
After dinner I went to an "AA" meeting with the girls. They are actually all drug users, but a couple of ladies from an AA group came to lead it. Because Nexus uses the same 12 step approach, it was easy for them to relate to each other. I really liked this meeting, because all of the other groups are led by counselors, and some of the girls opened up to the fellow addicts so much more than they open up to the counselors. They spoke so freely that I found out things about them I never knew. I got some more insight into the life of a successfully recovering alcoholic; most of my experiences are with people who have been sober for no more than about 2 months. I am supposed to go tomorrow as well, but I have to go to a training session for my other volunteer position at St. Joseph's Adolescent Services (outpatient drug counseling).
Monday, June 25th
I worked from 12-5 on Monday. It is usually pretty uneventful- the girls go to "life skills" for about two hours and I usually just talk to the other staff for a while about what has been going on.
When they got back, the girl I had talked to last time showed me new cuts she had done on her arm- a lot of them- with a razor she had found in the bathroom. This was a little upsetting because the girls have to usually go to the staff office, sign out their razor, have a staff member get it out of their locker for them, and then return it promptly. Apparently whatever member gave her the razor did not keep track of getting it back. Quite a few of the girls in rehab are known to cut and it is important to take care of that. I do keep in mind that this is a drug rehabilitation center, not a psychiatric ward. I actually think that someone who has problems with drugs should be trusted with a razor, and someone that can't be trusted with one has problems that extend much deeper than drugs. I discussed this with some of the staff members and they told me that she was probably here because most psychiatric centers only keep people for a certain amount of time, and at least in rehab we could "keep an eye on her." Unfortunately, that isn't even helping.
After that was a 12- step program group. Most of the girls had memorized the 12th step- but it is hard to tell if they "internalized" it or not. Next week the counselor that leads that group is taking a different approach.
Wenesday June 27th
I worked from 12-8 today. It has been raining a lot in Dallas these past two weeks and there have been a few new girls who seem to be the source of a lot of conflict in the adolescent dorm. The two newest ones have a pretty negative attitude and can be pretty disrespectful of the staff. In turn, the other girls are becoming less respectful. Sometimes I see the other staff become kind of grumpy with the clients and wonder why, but not today. I offered to take a few of them outside (it was wet, but there was a breeze and it was drying pretty nicely). The other staff person, Miss Loyce, decided that ALL of the girls would go outside with me whether they wanted to or not. About 14 out of 18 girls did not want to go. They whined the entire time. They begged to go inside. THe newest girl is very cocky and is disrespectful in such a way where I tend to actually disregard her when she comes up to me and starts to try to show off or mess with me. The other girls seem very impressed with her and want to be around her all the time, but I want to make sure she realizes that it takes a lot more than that to get respect from adults.
I sat in on an interesting group that used meditation. The counselor asked everyone to rate their negative feelings on a scale of 1-10. They ranged from about 3-8. THen she asked everyone to put their negative feelings in a box or container and then put some kind of barrier between themselves and the box. Then she asked everyone to think of different cities, and then different television shows, and different sports. And then she told them to start counting backwards from 100. (Eyes closed during all of this). After a while she asked everyone to rate their negative feelings again, and most of them had gone down a few points. She was trying to show the clients different ways in which to deal with negative feelings which dont' necessarily take more than ten minutes out of their day. I liked this group, because some groups involve work sheets or demand participation that is pretty passive and the clients dont' always get so involved as they did in this one.
The group after dinner was with an outside counselor that comes once a week or every two weeks. She did a self esteem workshop with them, writing letters to themselves and to people they love. Writing a positive letter to themselves turned out to be really difficult for some of the clients. One girl asked me for help because she couldn't only come up with negative adjectives! It wouldn't be that easy for anyone, but very difficult for them. THe counselor was really entertaining and funny, which i found helped the girls attitude and their willingness to participate immensely. They were very comfortable with her. I think some people are better at individual counseling and others are better at groups, depending on their personal style.
Thursday
I worked from 12- 8.June 28th
One of the biggest issues in working with the adolescent girls is the fact that there are between 14-19 of them at any given time, they spend every second together, and share rooms. Combine that with a lot of down time and there are definately issues with their interactions.
Today one we had nicotine awareness group, in which the counselor just basically educated the girls on what smoking does. Most of the girls desire a cigarette more than they do a blunt, probably because for them smoking was a habit more than the drug use was. Being under 18, Nexus does not allow smoking and discourages it. I myself smoke on occasion, so I actually learned the actual affects of nicotine on the brain. I am certainly discouraged from even the occasional cigarette now!
After that was a staff meeting, which I did not attend because i offered to supervise the girls in the dorms so that all of the staff could attend it. That in itself was quite a task. Anytime they want a hair straightener, hair dryer, makeup, anything, I had to unlock lockers and sign things out, and they all suddenly seemed very needy when I was there by myself. Also, being young, they assume I can't discipline them. (I actually often am confused with a client at Nexus because of my age). For instance, i could hear a few of them swearing from the office. Since this isn't allowed, I reminded them that they couldnt' do that. Because I know that they have always used that language most likely, I didn't want to come down too hard on something like that. But a few minutes later, I heard it again. I told them I would write down names from then on. Of course, I did have to start writing down names, but I didn't tell them i was doing it, because I knew they would just argue and beg for me not to tell anyone, and I needed them to realize that they could not negotiate the rules with me. Also, I caught six of them in the bathroom when the limit is four people at a time. I wrote all their names down. They seemed pretty disappointed that I would "tell" on them, but they were trying to manipulate the situation. After the meeting, the tech assigned appropriate punishments. That couple of hours showed me that in order for real supervision and care, two staff members should be with the girls. it is too easy for a few to distract while the rest are doing any number of things that they shouldnt' be doing.
After the meeting all of the clients and staff had a meeting, called "client staffing." One of the techs held up a notebook at the beginning of the meeting, saying she had found it in one of the girl's rooms. It was what appeared to be a "slam book"- basically, written in by most of the clients saying pretty horrible things about each other. It turns out the girl who started it was a girl who actually has a two year old daughter who is staying with her grandmother. I was shocked that someone's mother would be doing something so immature!
The issues I saw with the punishment of this was that 13 out of 18 girls were found to be guilty. There are 3 counselors in the adolescent dorms, and each girl is assigned to one counselor. Whenever a situation like this arises, the counselor of that girl is the one who decides the consequences. One counselor (in my opinion, the most consistent and fair) decided that her clients would be denied their weekend passes and priveleges for that week. The other two counselors deliberated and came up with a level drop from a 2 to a 4- which really didnt' affect the girls hugely. They were also supposed to write a paragraph about why it was wrong. I found this to be a pretty serious issue and if I was the counselor, I would have more serious consequences. I believe it is hugely important in therapy to not judge ourselves or judge others- judgemental thoughts increase negativity so much in these girls, and this book was perpetuating those thoughts and making them recreational, somehow. It was very, very disappointing to me.
One July 2nd i worked from 12-5- Monday.
Mondays, while I'm there, are generally devoted to fitness, free time for the clients to complete their treatment work, and an anger management and or drug education group. There were a shortage of staff today, so I ended up with the responsibility of taking them downstairs so they could do a kickboxing video. The clients complain about gaining weight in rehab, but still seem to resent any authority or regulated activity. They all have their own version of what exercize should be, and dont' want to be told what to do. It would have been a good work out if they had tried- but they are whiny! Also, many of them seem to just plain not be healthy. Since most of them have been heavy smokers (of cigarettes, crack, meth, heroin or pot) they have bronchial problems. Doing cardio with them is not terribly easy. In the frustrating position of not being a counselor or full time staff member, i could not assign rewards or punishments, but could only write the names down of those who didn't participate.
There was a group about anger management. The previous one we had gone to was very meditation- based, and this one was recognizing triggers. It is interesting to sit in on some of the anger management groups because drug addicts certainly aren't the only ones with issues in this area. Probably most people can benefit from some kind of anger management. It is interesting too, because the counselor that leads this group has been to anger management classes in her own youth, and is therefore very understanding. I can see that the clients definately tend to be more attentive to someone who can truly empathize with their situation. The counselor handed out a sheet that specified three broad areas of anger reactors- the ventor, the supressor, and the manager and director. She explained examples of what these are, and how to recognize different parts of these styles in themselves.
On July 5th, a Thursday, I worked from 12-8.
It was a pretty ordinary day for the most part, except for some drama in the dorm. Usually if I have been gone for a couple of days, the staff fills me in on any major events or behavior problems that have been going on. Apparently on Monday night, one of the girls had been caught in another girl's bed. This wasn't hugely surprising, because the girl who had jumped into the other girl's bed is constantly having trouble controlling her impulses as far as horseplay and physical contact. SHe is younger, just 14. The girls claimed that one had jumped into the other's bed randomly in the middle of the night just to tickle her and talk. Both of them recieved level drops after being found by the night staff, who does checks every hour. The staff and counselors discussed this in a meeting because it was difficult to say what kind of punishment is in order. Developing any kind of relationships in rehab is forbidden- as it is in most treatment centers, co-ed or single gender. However, today one of the girls tested positive for Herpes_ and the girl who had jumped in her bed ran to her counselor, terrified. She claimed she was scared she would have it because they share jeans. They are very different sizes, however, so it was concluded by the counselors that something inappropriate was going on. A few of the newer clients do happen to be homosexual or bisexual, and this creates an enormous problem with everyone sharing rooms and clothes and showers- and horseplay has become more of an issue than it was a few weeks ago. The staff has decided to start dropping levels for that behavior, which is a good thing.
After dinner there was a multi family group. It is interesting to see that while all of the girl's families are invited, it is mostly the parents who are recovering addicts that will come to this group. I know some girls have parents who continue to be addicts, yet do not show up to group after having promised. Some of the girls come from middle class families who are so concerned they show up early and leave late and are attentive- because they seem very worried about their child. It is an emotional time for everyone- either parents didn't show up, or they came and got into an argument, or the client sees their mother and decides she wants to go home that night. However, the parents who are recovering addicts themselves are very vocal and very helpful in facilitating discussion. I personally get a lot out of this, because the parents seem to support each other quite a bit in these groups, and they dont' know each other at all. It would be a very horrible situation to have your fifteen year old child addicted to meth, and even worse because of the stigma attatched, a parent would feel very alone. It is a great service that Nexus offers. There is usually some sort of education about a certain drug, such as huffing or cocaine, and then discussion. It lasts two hours.
On Monday, July 9th, I worked from 12-6 at Nexus.
Because the girls aren't scheduled for any group therapy until about 3 on Mondays, the staff and I tend to try to do more physical things, like volleyball or basketball outside. Today started off difficult because it was hot and muggy outside, and the staff there decided that everyone needed to be outside being active for a while, no exceptions. I always get there right after lunch, so everyone was full (They eat a lot at Nexus!) and trying to somehow get out of doing anything. One girl in particular is 16 and four months pregnant and is absolutely miserable in rehab, which is of course court ordered for her. Sheand another relatively new girl got into a fight eventually, because they both have such poor attitudes that they actually began yelling at each other about each other's attitudes and comments. They both received level drops. It does seem pretty impossible to get someone to really play a game of basketball if they don't want to, and after an hour of trying, we decided to take the girls back inside.
The day got even worse when group came at 3:00. I had been spending most of the afternoon with one girl who had abused marijuana daily for about two years and had an awful lot of trouble memorizing and repeating the 12 steps. (The clients have to memorize two of the twelve steps for every Monday group session). I was trying to quiz everyone on them, because it is really unfortunate if someone practices them and forgets it while they are saying it back to the counselor in group and receive punishment. Everyone felt pretty good about it until we went to the group room and the counselor, Miss Patricia, came in and told everyone that the dorm was on "shut down."
Apparently, some of the girls had figured out the long- distance codes for the phones, and had been sneaking into the office while the night staff was taking cigarette breaks. They were making calls to Austin, Lubbock, Arkadelphia- just about anywhere they came from, because the clients come from all over Texas. Nexus had just recieved the phone bill for this, and it obviously was a huge problem. One girl had confessed already, but the counselors knew that several more girls must have been guilty. The consequences were the most severe I've seen at Nexus.
The "shut down" procedure includes no talking between the clients- even to their roommates. They have to stay in their rooms at all times, and did not even hold group therapy sessions. I stayed an hour longer to help with dinner, because the clients were not allowed to go the cafeteria to eat, so we had to bring the food over, distribute it, and clean up in the dorm. Because the clients were not allowed to talk to each other all afternoon, it was very quiet. This made things easier except that I sort of had to police the hallways because I could hear whispering. Supposedly, this was supposed to last until the counselors were satisfied that everyone guilty had confessed and had received their punishments. I was surprised at the severity of this consequence, but it turns out they had had a client/staff meeting on Friday announcing that the next time rules were broken, a shut down would ensue. I only worried that the girls who had just gotten there days before, and were not guilty, were having an unecessariy difficult first few days in rehab, which are a big challenge anyway, for anyone.
On Wenesday, July 11th, I worked from 12-9.
I was relieved when I got to Nexus and saw that the shut down situation had been lifted. It turned out that quite a few girls had confessed, and things were more normal. A lot of girls were discharging, so where there had been 18 girls a few days before, there were now closer to 13 or 14, which seemed like a better number. Things seemed much more manageable.
They had a "Planned parenthood" group, which was really like a sexual education class. From what was said during this group, I found that a lot of the clients were very experienced for their age, which I supposed shouldn't be terribly surprising, but it was disappointing. What was surprising is how little they actually knew about pregnancy and STD's, and the different ways in which it could be contracted. I recall that when I was in high school in Jamestown, NY, sex education was basically shoved down your throat until you were an expert. Thinking back though, I realized that that wasn't how it was when I got to Texas and went to a public school. I remember going to a health class that warned about the dangers of cigarettes and alcohol, but not really anything about unprotected sex. I don't entirely blame the public school system in Texas for the fact that some of the clients had contracted STD's and gotten pregnant though; they all admitted that they had done these things under the influence of drugs, and probably never would have if they had been sober. It's just another huge risk they were taking, which is probably something that didn't occur to them at the time. This group included a lot of those very aversive pictures of STD's, and the woman leading the group reminded the girls they could all be tested in the Medication Room if they had any reason to believe they could have contracted AIDS. It seems to me that, during their stay in rehab, taking STD tests and having them come back negative would be very positive therpeutically. It might emphasize the fact that they do have a second change and have not yet condemned themselves to a life of drugs and crime, and unhealthiness.
On Wenesdays, there is also "client staffing", where the staff and counselors meet with the program director to discuss the progress of the clients, and any issues that have been raised. I go to the meetings when I can, but this week I stayed to supervise the girls, because they are not allowed to be alone in the unit. It went by very quickly, I let them watch television and helped them where I could with their treatment work, which consists of "Hazeldon packets" which are distributed by their counselors. Some of the girls go through them very quickly, so they can pass through the phases quickly. There are 3 phases in the program, with each phase allowing more priveleges than the one before it. For instance, a client on phase one is not allowed to get a drink from the coke machine at lunch, but they are allowed once they reach phase two.
I think the counselor/staff meetings are important because there seems to be some separation between the staff and the counselors on issues such as discipline. In general, the staff spends more time with the girls as a group, while they are doing activities or are in their free time and meals, and so on. They actually observe more of their behavior and how they interact with each other more than the counselors do. However, the clients have group therapy and, more importantly, individual sessions with the clients in which they get to know the clients probably an a much more personal level than everyone else. The staff is mostly comprised of people who are in school part time, pursuing a human services type degree, mostly drug counseling degrees, and the counselors of course all have an LPC. I find that the trend is for the counselors to be much more lenient than the staff on things like piveleges and discipline. It is difficult to be lenient and lax to a floor of 15 clients than it is for one client at a time. I do believe that for the program to work, all of the counselors and staff need to work together to create a therapeutic, nurturing yet very structured environment, because the clients are very young.
During the client staff meeting, where all of the staff, director, counselors and clients meet, phase requests and pass requests were denied or approved.
July 12th, 2007- Thursday
I worked from 12- 8.
When the clients leave rehab, I have noticed that during the last three or so days of their treatment, they become very anxious. I think most of the clients actually have become addicts because of their environments more than anything else. From what I have heard in groups, many of them have been abused, have addicts in their families, and live in exremelydangerous areas of bigger cities. Other than withdrawals, it is very easy to stay clean in rehab, with tight security, rules, structure, and trained counselors and staff available at al times. One of the good things that Nexus does is hold a "goodbye group." I don't always go to these, because sometimes intakes are going on when they are held. Today though, a couple of girls from Austin had one and i was able to go to it. What happens is everyone sits in the group circle, and the client who is leaving moves around the circle, putting their chair in front of each of the clients/counselors and saying whatever they want or need to say. I was glad I got to go to this one, largely because I really like the style of the counselor who was leading this group. She is a new counselor, and is very structured but also extremely positive and sincere, which to me seem to be the two most important attributes of a good counselor, and not all counselors possess these qualities.
When it was my turn to say "goodbye" to the clients, I basically tried to remind them of their strengths and tell them that I really thought they had to ability to change their lives. I actually did believe what I was saying- I do not necessarily believe that to be true of all of the clients at Nexus. They were both clients from Austin who had made a lot of progress with their own situations- one was pregnant and the other had recently come out as a lesbian to her mother. They both were very smart and capable of recovery. I was glad to see that their counselor said the same specific things to each of them that i did- I am hoping that meant that I was able to perceive their strengths and weaknesses as her counselor did.
Thursdays are multi- family group from 6 until 8. Today was a small group. There was one girl who was very excited about her mother coming all day, and her mother never showed up to it, so she spent the entire time almost crying in her chair. It is difficult not to get frustrated with parents. This seemed pretty detrimental to this client's whole day and her attitude. It is especially awkward because some girls' entire families show up every Thursday evening, and some of the girls who have been there three months and haven't seen their parents in that long seem to get even more depressed and homesick. On top of therapy- some of the girls are just 14 years old and have to be away from home for a long time. It isn't even easy to be a college freshman away from home, and for them it is a very challenging time.
July 25th, 2007- Wenesday
I worked from 12-9.
It was an eventful day! There have been a lot of intakes lately. It is an adjustment for everyone to have a lot of comings and goings and dorm changes.
I try to help a lot with the intakes. There were two today, and when i got there the regular staff had taken the girls on a field trip, leaving about four clients who were ineligible for trips and a fill in Chemical Dependency tech who had never done an intake. There is a lot involved- a body search. a urine analysis, a thorough search and inventory of their belongings, etc. Something I always try to do is a sort of informal assessment, so I can find out things like the girls' education, living situation, drug of choice, and whether or not their stay in rehab was court- mandated or not. This is not only a helpful thing to do for the busy staff, but it is helpful to the counselor, and I like to know a little bit about a girls' background when she comes in. Otherwise I usually look at their files, which are kept in a locked filing cabinet.
Today I actually found a cigarette in a Q- tips box, which i was almost excited about because I never usually find anything the clients aren't allowed to have. The searches are kind of arduous and it is somewhat nice to know there is at least a reason for them.
I took a lot of care trying to get the information, especially knowing that the staff there was inexperienced in the process. What has happened a couple of times recently is I have spent hours admitting someone, and then they either run away or decide to leave the second day. Most clients decide they want to leave the second day, regardless of the consequences. It just becomes overwhelming.
That was basically all that happened today- there were no group meetings, just supervision. My main task was to keep one of the girls out of the day room, where there was a television. She was "on a contract" for swearing at staff members and being disrespectful. Being on a contract basically involves a punishment that lasts one to two weeks, of having no privileges like TV, radio, soft drinks at dinner, weekend passes to see families, or anything like that. This one girl, assuming I didn't know about her contract, tried to watch TV during the day and actually tried to convince me to let her. I come across that a lot- clients who want to try to make it like i am their friend instead of any kind of authority. I was glad I was able to enforce the rules, though.
July 26th, 2007- Thursday
I worked from 12-8.
Thursdays are good days because there is usually at least one group during the afternoon, and then a two hour multi family group right after dinner. It is a pretty full day, usually. Today during the day there was a 12 step group, which was led by a different counselor than usual. The one who usually leads it is very dedicated to the philosophy of twelve steps, which the Nexus center is really based on. The one who led it today has the more educational approach and simply asked the girls what they thought of the steps they were supposed to memorize (5 and 6). The different techniques work in different ways. Group counseling can be a challenge at times, because sometimes the morale of the clients is low for whatever reason, or tension within the group causes the girls to be either too vocal or not vocal enough. This group was laid back enough for the girls to be more vocal. The usual counselor actually makes them memorize two steps each week and recite them at group, or they get pretty severe punishment. I find this tends to be more distressing for the girls than educational or therapeutic at times.
The multi family was interesting, because since one of the usual counselors was out, the remaining counselor asked me to lead. We usually do "life stories" at these groups, where we take a true life story from the internet and then reflect on it. The group was big tonight, involving both clients and their families, so I had to try to think of things without a lot of planning, since they asked me to lead kind of last- minute. I didn't do anything structured, just pointed out parts of the story (which was about ecstasy) and asked the girls how they could relate to their story. I was trying to think of information that i knew about ecstasy that I had learned in neuroscience, but I realized there were a lot of things that I should know, if i were to be a drug counselor. I thought of enough general facts about the drug to facilitate some discussion, though. That specific profession actually involves a lot of drug- related information, which I actually don't have. The tricky thing is to try to get the parents to participate, but in general I don't think it is a good idea to really call them out or ask them specific questions. They probably feel awkward there, and a lot of them seem more concerned with why their kids use drugs, and more relieved that they aren't alone, than actually interested in discussion.
On July 30th, I worked from 12-6
On August 1st, I worked from 12-9
On August 2nd, I worked from 12-8
On my last week at Nexus, I continued to attend group meetings and observe the different styles of all of the counselors. I was able to distinguish one counselor as being very educational in her style, and also left the real work of treatment up to her clients. I believe this showed respect for the clients on her part, although some of the clients did not feel they were benefiting too much from her help. The second counselor was very rigorous with the twelve steps, and very eager to help the girls internalize them, if nothing else. The third counselor was faily new, but very dedicated and emotionally attatched to her work. She was very educational as well in her style. I could see all of their strengths and weaknesses. The whole experience was educational for me both in the sense of behavior modification and drug counseling. I gained experience working with substance abusers, and the whole environment, with rewards and consequences, provided for a kind of behavior modification program in itself.
