Compatibility With Other Treatments As noted in the description of the program

detailed previously, other therapeutic modalities, such as pharmacotherapy, family therapy, and expressive arts therapy, are considered to be not only compatible with but also essential to the success of treatment.

3.5 Role of Self-Help Programs

As previously discussed, special emphasis is placed on participation in AA/NA or CA for drug- abusing clients. Adolescent clients are informed before beginning treatment that they will be expected to attend at least three 12-step meetings a week outside of program hours. Again, their participation is encouraged through peer feedback and the behavioral techniques described earlier. Adolescent clients who have a drug-abusing parent are educated about Alateen groups, and parents of adolescent clients in the dual-diagnosis program are themselves referred to Al-Anon for additional support and education regarding self- care, boundary setting, and help in ending enabling behaviors. Essentially, adolescents readily attend 12-step meetings and use the groups on a variety of levels, including social support and normal ego- supportive socializing; for identifying positive mentors, role models, and parental figures; for educational help, support, and advice in remaining sober; and for enjoyment and stimulation. Adolescent clients are encouraged to obtain an AA/NA or CA sponsor, that is, a person with long-term sobriety who acts as a guide and who in general will be available for support 24 hours a day during the adolescent client’s active treatment and after discharge, thus providing continuity and direction.

For many adolescent clients, the 12-step programs serve as a surrogate family, where their original family system may be chaotic, devaluing, or nonexistent. The authors have witnessed many adolescent clients who were removed from their families and in various stages of foster care or surrogate care were able to use the 12-step programs as an effective means of obtaining nurture and structure.

Within the context of CCATS’ emphasis on the use of 12-step meetings, each adolescent client is encouraged to embrace a conceptualization of these groups and the spiritual focus of the 12-step philosophy that reflects his or her own personal values, spiritual orientation, and individual preferences. The adolescent client is continually

encouraged to examine and to express his or her ambivalence toward the 12-step programs without fear of consequence or reflection in privileges or status in the program. It is of clinical interest to note that in this environment, one that allows and acknowledges the importance of ambivalent feelings and their expression, there is very little behavioral resistance to 12-step attendance.

4. COUNSELOR CHARACTERISTICS AND TRAINING

4.1 Educational Requirements

The general educational requirements of the staff include an advanced degree in social work, expressive arts therapy, psychology, nursing, or counseling and specific continuing education and inservice training in chemical addiction and drug abuse treatment. A minimum of 3 years of clinical experience with adolescents is required, as is ongoing clinical supervision.

The clinical coordinator of the Adolescent Dual- Diagnosis Service is a certified alcohol and other drug abuse counselor with 8 years of psychiatric clinical experience.

4.2 Training, Credentials, and Experience Required

Particular emphasis on the use of dynamic examination of the therapist’s own

countertransferential experiences and reactions to clients’ transference is an important aspect of clinical supervision, which occurs both individually between the counselor and a senior clinical

supervisor and in the context of the coleader relationship in group therapy.

Counselors within this model are required to have a high level of understanding and acceptance of the validity and importance of psychodynamic techniques, along with a willingness to be introspective and to a certain degree able to acknowledge unresolved personal conflicts, which may be found to block clinical sensitivities within

the present. Because of the eclectic nature of the various treatment modalities employed within this model, counselors must be skilled and cross- trained in various modalities and techniques and must have the personal characteristics of flexibility and intellectual fluidity to function in multiple roles. 4.3 Counselor’s Recovery Status

The status of a counselor as being in recovery from alcoholism or addiction or having firsthand knowledge of Al-Anon recovery is not essential to being effective. However, the intricacies of experience awarded through an individual’s participation in his or her own recovery program can probably not be equal to a solely intellectual pursuit of the same knowledge. Counselors within this treatment program who are in recovery from addiction or coaddiction do not participate in free self-disclosure of their status and most specifically refrain from the disclosure of significant information regarding their history of drug use or other significant personal history. Inevitable direct questions from adolescent clients regarding both the counselor’s recovery status and specific details of the counselor’s history of drug abuse or previous treatment experience are usually answered interpretively, although the individual counselor is free to disclose his or her status as a recovering person. It appears that adolescent clients react favorably to recovery- oriented feedback from nonrecovering staff members; however, the level of knowledge, comfort, and conviction a counselor has regarding the content of educational material or directive or interpretive feedback may be the key indicator of the effectiveness of the counselor’s impact. In short, for a counselor to impart effectively the philosophy of a world view that holds central the belief in using a power greater than one’s self, either socially or through spiritual means, he or she must have a similar personal investment in the value of this world view. Similar to the means through which self-esteem is subtly and

consistently imparted to a child through the actions and words of a healthy, caring parent, the

step philosophy through the individual relationship and teaching of a counselor who lives by his or her espoused beliefs.

4.4 Ideal Personal Characteristics