A week in my . . . addiction counselling practice

Frank Harkin sees clients across a spectrum of addictions, writes Arlene Harris

Addiction counsellor Frank Harkin, in the grounds of Belvedere House, Mullingar, Co Westmeath. Photograph: James Flynn/APX

Addiction counsellor Frank Harkin, in the grounds of Belvedere House, Mullingar, Co Westmeath. Photograph: James Flynn/APX

 

I am a self-employed counsellor who specialises in addictions. As a member of the Addiction Counsellors of Ireland and also of the British Association for Counselling and Psychotherapy, I deal with other issues such as stress, bullying, low self-esteem and depression.

I worked for a semi-State body from 1969 to 2009. I started a degree in applied addiction studies at night school in Athlone Institute of Technology in 2007 and got my BA in 2010. I then had to attain 500 hours’ counselling training with clients in order to get my accreditation. This I did by working as a voluntary counsellor in a centre in Bray, where I was under close supervision.

I also attended many additional training seminars, such as in the area of gambling, sexual addictions, 12-step groups and harm reduction. It was also very important for me to attend conferences and seminars and read journals to keep up with new developments.

Training

Many people with addictions have other issues in their lives, so it is important for addiction counsellors to have training in these areas also. Because I am self-employed, my working hours can be very irregular and I have to arrange appointments to fit in with clients’ own work schedules.

I also work Saturdays and evenings, but where possible I try to schedule daytime appointments.

Because of the nature of counselling, it can be stressful, and self-care is very important. It can be difficult, but it is also essential not to take on clients’ problems. For that reason all trainee counsellors are made very aware of the importance of self-care and of not overloading with work.

The “therapeutic hour” I have with clients lasts for 50 minutes. I try not to see more than four clients in any given day, but sometimes sessions can run over the allotted time.

The techniques I use are mostly what we call “person-centred”, based on the work of Carl Rogers mainly but also of Gerald Egan. The basis of this is that each of us has the ability to overcome or deal with whatever issues we may have, but that people often need counselling to help them find clarity around these issues and what avenues may be open to them. Person-centred counselling requires three essentials to be present: congruence (genuineness), empathy and unconditional positive regard.

I also use other techniques such as cognitive behavioural therapy (CBT) and motivational interviewing (MI).

Addictions

I mostly see people who have addictions to alcohol and or other drugs. Some could have gambling addictions and occasionally I get clients with sexual addictions (this could be an addiction to internet porn sites), or internet games (some people become totally infatuated with them).

Client and counsellor sit face to face in a comfortable environment, and on the first session I complete an assessment to find out as much information as possible. However, some vital information may not emerge until later sessions when the client is more trusting.

I try to let them talk as uninterruptedly as possible, but sometimes they need prompting and this may be where MI comes into play. Some addiction clients may be in denial, so MI could also be used.

Many addiction clients have other issues such as depression, anxiety or low self-esteem. If these issues are present, they need to be identified, as they could have contributed to the person becoming addicted to something.

The whole area can be rather complex, as there can be other mental health issues, so there is no simple all-encompassing solution. Some clients may be referred by employers, some may need long-term support and some who are in recovery may continue in counselling for an extended period to prevent relapse. Each case is completely different, but the client’s goals are always more relevant than those of the counsellor.

Sometimes very traumatic issues can be revealed and occasionally a client can set out to shock. Counsellors are precluded from getting personally or romantically involved with clients, so it is very important to maintain clear boundaries in these areas.

We also have to be very discreet about self-revelation, especially in an area with a small population and, of course, all dealings with clients have to be totally confidential. So again I would have to be discreet if I happened to meet a client on the street or in a shop.

Counsellors have to attain a certain number of hours of continuous professional development annually and also have to attend supervision as laid down by their professional accrediting body, and this all adds to the workload.

Although it can be hard work, the best part of my job is seeing a client making positive progress and I also really enjoy being self-employed. The worst part of the job can be when you appear not to be able to make progress or where you feel overpowered by a client’s problems. This is where your supervisor is very important. If you have a good relationship with your supervisor, you can occasionally seek advice when a difficult case presents.

Office hours

I work fairly regular “office hours” where possible, which means I get up at about 8.30am. I rarely see my first client before 10am, but I could have four appointments in one day and see the last client at 8pm. I don’t mind this as I am very flexible and I also facilitate an aftercare group every Wednesday night on a voluntary basis.

Overall, I would say that counselling can be very absorbing and emotionally draining, but it’s also very rewarding, especially when there is a positive outcome for the client.