Internship Horizon Health
Stephanie Comer
Week One
I got an internship at Horizon Health Services were they specialized in chemical dependency and mental health. The clinic in Niagara Falls is an outpatient clinic with mostly a working class population. Many patients are at the clinic through drug court or federal probation; however, some patients are there on their own terms. My first day they allowed me to look through the patient files and become familiar with some of the paperwork required for each patient. When initially coming into the clinic they conduct a PSII which is a behavior health assessment. If the patient is demonstrating mental health associated with chemical dependency then they have to see the CD counselor and the MH counselor. Although, they have said that it is difficult to detect MH when dealing with a CD patient due to withdrawal symptoms and deceptiveness associated with CD. They also have them conduct a Global Assessment of Functioning Scale is a 100-point scale that measures a patients overall level of psychological, social, and occupational functioning-which to be discharged the patients GAF must increase.
After completing the initial PSII the patients create a treatment plan with their counselor that is very specific and outlines exactly what needs to be done to overcome their CD. Some patients also need to fill out a intent to harm sheet which says they won’t harm anyone or themselves and if they think about it, they have a list of numbers they have to call.
I sat through a relapse prevention group which discussed a lot of cognitive behavioral therapy. The people in the group were very friendly, ranging from 20-50in age and seemed pretty stable. Upon arrival the patients are breathalyzed and urine tox’s are given at random, not every week. Relapse prevention talks a lot about thought stopping- cut off your thought before it even starts. The counselor talked about thoughts and urges as being the number one reason drug addicts relapse…because they think about the drugs too much. The number one thing was to avoid thinking about how good a drug was because if you can change thoughts=actions will change! Counselor talked about how recovery starts in your head with your thoughts. You could definitely tell which people were in a difficult stage of withdrawal because they were most quiet. However, most people were willing to talk about their experiences because they had been through treatment several times. One patient in particular was talking about how difficult withdrawal is and he could relate to each stage the counselor was talking about. In recovery there are several stages: withdrawal, honeymoon, and the wall. All of these stages are associated with different levels of chemicals and hormones in the body fluctuating due to lack of drugs which causes changes in moods. After group, I sat down with the counselor and we wrote group notes which is just an overview of what we talked about in group and if any of the patients participated and if they said anything significant.
Internship week 2
This week in group there was a woman that had a positive tox for hydro’s which the counselor questioned her about. The woman said that he roommate was trying to sabotage her and make her get into trouble with drug court. She had no idea that she would test positive and blamed it on some “pain medication” her roommate gave her. Counselor was pretty sure she was lying, because drug addicts can be very good at being deceptive.
There was a lot of positive reinforcement from the group and counselor today. Some of the patients were having tough days and everyone was very sympathetic. Today’s discussion was about avoiding triggers; such as going to a bar or watching a sports game. One man’s trigger was 10am because that’s when the liquor store opened. One patient started talking about her kids and how they are her biggest trigger for wanting to use, even though she only gets to see them on the weekends because she doesn’t have custody. She also said that her kids know when she is on drugs which was very disconcerting for me and made me feel judgmental towards this person. If you’re going to do drugs at least wait until your kids leave.
Counselor focused on rational emotive imagery in which she had the patients imagine they were in a “trigger environment” and having them tell themselves “No!” and turing away from the triggering thought. Also, they worked on telling themselves that they have said no before and that they can do it again- positive affirmation.
Relapse prevention group focuses on learning about the new person you’ve become and having structure in your life. Once you lose the structure in your life you are more likely to use again. Counselor talked about signs that you/someone close to you is going to relapse; signs such as missing NA/AA meeting, not getting out of bed, hanging out with old/bad friends. Many patients could relate to noticing signs and that it is very important to maintain structure in your life to avoid relapse. Counselor talked about withdrawal and when you are having a super down, terrible day that it is simply your brain healing and that it means you are coming along in your recovery.
Internship Week 3
I was able to go into my internship for the entire day (during president’s weekend) so I got to see a lot more in the morning groups than I get to see at night. The clinic is very busy in the morning, there are several groups going on at the same time and lots of interesting people to observe. I was able to attend a wellness group which had a very different population that relapse prevention group. The wellness group was a lot more motivated and talkative. These people wanted to go through rehab on their own terms; no one forced them to go. Most of the patients seemed enlightened, almost like they had a big glowing bubble around them. They seemed to have a totally new outlook on life. They were definitely very positive and more opened to talking about the difficulties that they had overcome to get where they were. The counselor was very positive and reinforced all of their healthy choices.
There was one bad egg in group, he was rude and was swearing the entire time. One of the men made a group rule that there were no cell phones and this one difficult man’s cell phone constantly was going off and he was counting down the minutes until group was over. The other group members were trying to stay positive despite the negative outlook from the difficult patient. He did not want to admit that he had made mistakes to get where he was and would not admit that he was a drug addict. The entire time he was saying that he didn’t have a choice in how he had got there and nothing was in his control but the counselor was trying to re frame his mindset and get him to understand that is was his fault he was there. The patient was not ready to accept that his choices had got him in rehab.
Besides the difficult patient, the wellness group was very motivated to stay on track in their recovery. They filled out worksheets about something they wanted to improve upon in their life and they were all willing to talk about it and discuss it with the group. I feel that the worksheets help patients to open up and really think about what they could improve upon; some of their responses were that they wanted to lose weight or working on going back to school.
After the morning meeting I sat in on a meeting in which all of the mental health, and chemical dependency counselors attend to discuss current cases. In the meetings all of the counselors discuss what to do with certain patients that are: not showing up to meetings, having positive tox’s, where to refer people for more extensive treatment. This meeting occurs once a week and allows the opportunity to throw ideas around. One patient that was discussed was someone who had missed several meetings and had to be referred to a clinic in the middle of nowhere in PA because her boyfriend was abusing her causing her to use.
Horizon Sanborn-
I went to the village clinic and was able to sit in on group family meetings. Before the meetings started I was able to talk to the wellness counselor who instructs the patients about good eating habits and exerise. The patients are required to do some for of exercise everyday and the wellness counselor conducts group exercise progrmas such as a core workout, zumba, pilates, kick boxing ect. She told me that most of the patients have bad eating habits and part of it is because they eat alot more in recovery because they dont have the drugs to supress their hunger. The families arried with packages and mail that has to be opened in front of the counselors; some people were caught sneaking in tobacco and chew and they had to leave. In the family group the counselor talked about the real self and the addicted self. She had a board in which she was writing down characteristics of drug addicts: manipulative, cheat, lie, steal, mean etc...she then asked the family if the would want someone like that in their house. Everyone agreed that they would not want a manipulative, violent ect person in their house. The point of this was to let the families know that its ok to not allow a person on drugs in their house. It's ok to call the cops on them. She talked about how the family will act oblivious or overlook the signs that their family member is using drugs. The family will believe that they are good all the time and remember them when they were clean. If the family wants their family member to stop using drugs the need to "call them out" when they think they have been using.
The second family group worked off of the first one but talked about illusions. The counselor had a picture of what looked like a mans face. She was walking around with the picture asking everyone what they thought it looked like. Most poeple said the man looked sad, or showed no emotions. The counselor said to look very closely fr4om every angle and not to be fooled. Turned out that if you looked at the picture slanted just a little it said "Liar" in cursive. This was a lesson to the family that you cannot always look at your drug using family member from one angle because they may not be the person you thought they were. Another illusion was a bunch of what looked like triangles but they were not completely closed in lines. Everyone said that the picture was of triangles but when the counselor pulled out the definition of a triangle; these did not meet the criteria. "The brain just fills in things that aren't really there" the counselor related this back to the true self vs. addicted self in that the family may think that the perosn in all in one piece but they are really not.
Niagara Falls Clinic
I had to finish going through all of the patients charts and make sure they have all of the appropriate signatures. Went to a RET ( Rational Emotive Therapy) group in which the counselor talked about positive vs. negative self talk. One of the patients was proud of themselves for discontinuing an unhealthy relationship and was eliciting positive self talk to tell herself that this was a good thing and the friendship was hindering her ability to recover. Positive self talk was helping her because she was very emotionally attatched to this person. One person discussed that when he is with his friends he used negative self talk which generally causes him to relapse. I was able to write up group notes after all by myself.
