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Frozen in Denial - How to Help

a Substance Dependent Client


Enter the Grieving Process
while Decreasing the
Possibility of Relapse

Instructor: Don Cleveland


Course Description: b. Dealing with other stages of grief that can trigger
denial behaviors of using substances such as
This course will provide substance abuse counselors with anger, bargaining, and depression.
information on how to assist clients enter the grieving
process, without using substances and while taking the III. Preparing the client for the funeral
necessary steps to avoid relapse. a. Accountability partners before, during and after
the funeral
Course Objectives b. Talking through feelings and the funeral event
itself by projecting conversations, people, places,
Demonstrate: and things
a. How to apply the Five Stages of Grief (Kbler-Ross,
1969) as an outline for the helping scenario III. Helping the client face the death anniversary

b. How to help a client face the current death of a loved a. Preparing for the date
one while reducing the risk of relapse b. Writing letters
c. How to help a client face the death anniversary of a c. Using the Empty Chair Technique
significant other while reducing the risk of relapse d. Avoiding secrets
Course Outline IV. Helping a Client Face their Own Death
I. Applying the Five Stages of Grief (Kbler-Ross, 1969)
as an outline for the helping scenario The Case of Sammy Smooth
a. Dealing with denial to help the client avoid a
tendency to freeze or numb emotions before, during,
or after the crucial time frame surrounding the funeral

Frozen in Denial: How a substance dependent client is in Also, another critical reason to push
recovery may be one of these times in the issue is that its likely that the
to Help a Substance order to push the client toward healthy client will not simply avoid the funeral;
Dependent Client Enter behaviors and especially when facing they may get high, compounding their
a funeral they are fearful of attending. existing guilt and sending them into a
the Grieving Process prolonged stage of drug dependence.
Skipping the funeral can result in years
while Decreasing the of regret and added guilt; this could
Possibility of Relapse also keep a client from recovery for
Understanding Denial
years to come. A comment like, Mary, within the Five Stages of
The goal of this course is to prepare I realize it may sound reasonable to
the counselor to assist the substance- avoid the grief of a funeral at this stage
Grief
abusing client by helping them to in your recovery. However, I have By reviewing the Kbler-Ross (1969)
avoid denial and to survive grief worked with many clients who found model of grief, we will have a starting
associated with the loss of a loved one it almost impossible to work through point for what normal grief looks like
without succumbing to a relapse. To the guilt of missing this chance to say and for consideration in helping a
accomplish this task we will consider goodbye. If you dont push past the substance dependent client overcome
the Five Stages of Grief (Kbler-Ross, temptation to face this situation now, the temptation to relapse.
1969) and how to help a client face you may very well add years to the
either an upcoming funeral or a death time it will take you to recover. Lets The stages are presented as steps;
anniversary. discuss some ways to manage this however, Kbler-Ross (1969) makes
situation. it clear that they are not necessarily
When dealing with any client, one
in chronological order. Each stage
of the overriding considerations is When the client is beside themselves is referenced below with comments
when to move beyond the counselor with fear and guilt, its much more particular to the substance abuse.
role into that of an advocate for a difficult to lead them into discovering
particular action to take place. While this type of revelation on their own.
Stage 1: Denial Kbler-Ross defines denial much the same way helpers in the substance abuse field do. It is
a defense mechanism that can be conscious or unconscious, and arises to help an individual
ignore reality to protect them from pain. For the substance dependent client, this is an ingrained
way of living daily life.

Stage 2: Anger Anger is an emotion that rises as a suffering person lashes out at others to help stave off painful
emotions of grief. The substance dependent client would rather be angry with you than face this
pain sober. Its critical that as the counselor, you refuse to express any form of anger back to the
client. Otherwise, the client can transfer anger from him or herself unto you and remain in denial.

Often the client is angry about pulling a no-show at the funeral. Another common emotion is the
guilt of letting down the deceased by continuing to use right up to the point of their death, and
then using rather than attending the funeral.

Stage 3: Making deals with God is popular during this stage. However, beware of the deal a substance
Bargaining dependent client is tempted to make with a drug dealer. Oftentimes, this sets them up for
relapse.

Stage 4: Rather than a temporary period of sadness while working through grief, a substance dependent
Depression client may have been using substances to avoid depression long before this crisis.

Only under direst circumstances should a substance dependent person begin a new prescription
during this time. It is very difficult to decipher whether the client is using meds in accordance
with their history of abusing substances, or if this is a necessary action to avoid some sort of
psychosis. If the client survives the ordeal without relapse, their prognosis for recovery improves
considerably.

Stage 5: Acceptance is the last stage of healing. Whether facing ones own death, or the death of a loved
Acceptance one, resolution takes the form of detachment and objectivity.

Its unlikely for a counselor to witness acceptance during the acute situation they are involved with.
However, acceptance is a critical goal to teach and model; it is found in every step towards recovery.

Consider the case below as Richard works with a client who has experienced an exceptional amount of loss due
to his familys drug use

The Case of Sammy Smooth Sammy: I dont need to be around Sammy: Whoa Cowboy! I tell you
all those church people. I dont know all this stuff and you use it
Samuel goes by Sammy among them and they dont know me. Theyll against me? Screw this and
his network of helpers but is known try to get me to come on Sundays. screw you.
as Sammy Smooth on the street.
Everyone is drawn to him and enjoys Richard: Go to the funeral Sammy. Richard: Youre angry but whats
his easy going and charismatic style. Say goodbye to mom. under that anger?
Only his counselor, Richard, has seen
Sammy: My mother died after having Sammy: You want me to cry?
the real face behind the mask. Two
me.
months ago, Sammy opened up about Richard: No you want to cry. You want
his actual emotional state due to his Richard: And her mother raised you. to face the pain and youre
AIDS diagnosis. He also discussed ready. Youre ready to face
how his entire family (mom, dad, Sammy: What do you care? Mister, I this funeral and face it sober.
three brothers and two sisters) has wont tell you what to do?
died due to drug overdose or violence Later in the session, Sammy first
associated with dealing drugs. Richard: You said youre tempted admits his fear of not living up to his
to use. You fear this funeral street name by showing, weakness
The reason for todays emergency because youre reminded at the funeral. Richard goes on to help
visit is to discuss his grandmothers of the services you missed, Sammy explore the guilt and hurt over
death. Sammy has been sober for the people you havent said missing the funeral of each family
three months and is tempted to begin goodbye to yet. member.
using again. Richard and Sammy are
discussing his grandmothers funeral.
Richard affirms Sammy. He also If youre new to substance abusing One of the goals of these exercises is
helps Sammy see that keeping his clients you may cringe at this provide an atmosphere for the client
street credit will cost him freedom controlling situation. However, most to come clean with their secrets. First
from cocaine and healing from his clients set themselves up for relapse and foremost are the secrets they
hurts. Neither of them mentions long before they realize what theyre keep from themselves. By practicing
Sammys own imminent death within up against. The written plan acts as being open and honest within the
the next few years from AIDS. First, a safeguard against a seemingly safe environment you provide, the
they will need to get through his harmless diversion, when the client is client is able to experience the
grandmothers funeral and then build in an already vulnerable position. release of these hidden emotions.
on that victory. This in turn frees them up to speak
Preparing Clients for the honestly rather than practicing the
Preparing Clients for the Funeral Anniversary
long running script of lying to procure
substances to abuse.
Funeral
Whether or not the client missed
When the client agrees to attend the original funeral or is still having Helping a Client Face
the funeral he has almost as much trouble coping, its best to prepare their Own Death
preparation to finish before the event them for this time of the year, the
as the funeral director. Consider the funeral anniversary. This will also Counseling those who are facing
following tasks and how you can assist them in continuing the journey death can be compared to taking a
incorporate these strategies into of processing what was lost to them journey to some mysterious place.
your practice: long before they were ready. Consider You have no idea where you are
the strategies below to assist your going, how the both of you will get
Accountability Partners Your client with unresolved grief. there or what will happen along the
client will need to list the names of way. The client is the guide yet he or
people close to them who they are Letter Writing One of the most she has no clue either and is fearful
willing to be accountable to and who successful and easy tactics to of what will be found along the way.
can remain close by before, during, employ is to have the client write a
and after the funeral. Its important letter to the deceased. The only real This type of counseling requires
that these folks be well aware of challenge here is convincing the client authenticity because the client
the tendency this person has to of the value of this approach and will look to you as a foundation
relapse and be willing to aggressively motivating them to begin the task. of stability and trust to help them
intervene if the client begins taking move forward in the process. Like a
steps toward using. Once completed, the next hurdle is defense attorney before a trial or a
having them read it out loud. This is pastor before a service, everything
Projecting Problems The client awkward for them and clients often you have learned from your research
should verbalize everything that resist. However, everyone I have and bought with experience is on
could possibly go wrong at the ever convinced to follow through has call pending the clients clues as the
funeral so they can begin dealing released an incredible amount of direction he needs to take.
with potential issues immediately. emotion and was grateful for
You can coach them though this by the experience. While we cant fake authenticity,
role-playing the more serious and this value can be practiced in our
likely problems or the ones they most Empty Chair Technique This daily life. When I was a pastor, I
fear. By rehearsing effective ways to technique is a tactic borrowed from committed to applying the message
deal with difficult issues, the client will the school of Gestalt Therapy. It is a I was going to bring on Sunday to
be able to use the funeral to grieve great way for your client to experience myself throughout the week first;
instead of relapse skyrocketing. his or her emotions by pretending I then brought it to the flock for
The work they put into preparation to speak to a lost loved one. They consideration. If I felt my clients
beforehand will equip them to resist should be free to express anything could benefit from the empty chair
temptation and focus on the task they would like to say; whether it technique, I recruited a friend who
at hand. involves apologizing, expressing witnessed my experience with it,
anger, explaining their actions, hurts, and invited them to provide input.
Make a Plan Have them write out a or anything else that needs to be Though Im far from perfect, I believe
plan of events and commit to sticking said. This technique can also be used practicing authenticity is a key factor
to it. Make an agreement with them to help clients practice addressing which has allowed clients to learn
to keep the plan exactly as written family members whom they anticipate something about themselves while
and to speak with their accountability seeing at the funeral and foresee finding an inner strength they never
partner before they consider being a problem for them. knew existed.
changing it.
Practically speaking, you can take 2. The empty chair can speak to Once you become comfortable
all these ideas about helping a different ages or periods of life and are success in employing
substance dependent client make that were difficult or positive. these strategies, you will find this
peace with a loved ones passing, 3. The client can plan his own part of your work a challenging
and help them apply these same funeral with loved ones by giving and rewarding process that may
principles with just a few changes in away items of significance and not always work out the way you
viewpoint. Here are a few examples explaining the meaning attached envision. Yet whatever distance you
from this course: to each, and make amends when can move the client forward to, they
possible. are that much closer the next time
1. The letters are can be written to around.
address various emotions being 4. Purposely deal work through the
experienced such as anger, Five Stages of Grief.
regret and thankfulness.

Quiz

1. The Kbler-Ross (1969) Five Stages of Grief happen 3. When a client expresses fear or pain about attending
in the following order: the funeral by telling you they want to go but cant
a. Denial, Anger, Bargaining, Depression, and imagine themselves going through with it, the author
Acceptance believes the counselor should actively encourage and
press the client to prepare to attend.
b. Denial, Anger, Depression, Bargaining, and
Acceptance 4. For the substance dependent client, denial is:
c. Denial, Bargaining, Anger, Depression, and
Acceptance a. A way of life ingrained into their behavior

d. Denial, Depression, Anger, Bargaining, and b. No more or less important than the other Five
Acceptance Stages of Grief
c. A way for the client to deal successfully with some
2. According to the author, when a substance dependent problems
client misses the funeral of a loved one due to their
substance dependence they will usually: d. Is a way for the counselor to deal with a difficult client

a. Repress this event and claim they were at the 5. Richards challenging of Sammy to attend his
funeral by providing details from memory grandmothers funeral was presented as:
b. Refuse to attend another funeral for the rest of a. An unfair expectation given the fact that Sammys
their lives family had all died
c. Regret this act until it is successfully dealt with b. A necessary intervention to help Sammy face up to
(recovery will be more difficult until this task is lifes realities rather than cover them up by getting high
completed) c. An approach that was too aggressive given the
d. State that their disease of addiction kept them circumstances
from being able to attend d. A negative approach that could have pushed
Sammy to relapse before the funeral

References
Boag, S. (2010). Repression, suppression, and conscious awareness. Psychoanalytic Psychology, 27(2), 164-181. doi:10.1037/a0019416

Five Stages of Grief. (1969). Inspiring life, confronting death. Retrieved November 22, 2012, from Elizabeth Kbler-Ross website: http://www.
ekrfoundation.org/five-stages-of-grief/