Spotlight Series: Maybe It’s Not A Problem.

Other versions we hear beside “Is it really a problem?” include, “Am I really that bad?” “It’s not running my life.” “I can stop whenever I want.” Have you heard these phrases from your clients? 

It is really important that we truly hear our clients as they ask these questions in our counseling sessions with them. They’re not asking for our clinical impressions or judgment in these moments; they’re asking far deeper questions: “Am I acceptable?” “What happened to me?” “Can I show you/talk about these parts of me?” 

So what happens if you, and I, have the same questions as our client?! What if we really do wonder if ________ is really a problem or a higher level of care is needed? 

At IMF Counseling, we often hear these questions in response to behaviors clients find shameful, or have been told are shameful, and/or are impacting their life in an undesirable way. Some of those behaviors include: 

• Shopping and spending money 
• Time spent using technological devices (phones, gaming systems, even online research)
• Drinking alcohol and/or using drugs, including prescribed medication 
• Sexual behaviors, including pornography, engaging with sex workers, the frequency and intensity of sexual behaviors within consensual relationships
• Gambling (be aware of the increasing popularity of the trading card hobby and business)
• Working, whether it be longer or shorter hours than what is “typical,” and/or the compulsion to engage in work to relieve unwanted emotions

How do we assess the level of care and treatment planning around these behaviors?  

1. Change in routine: any change in daily functioning in conjunction with a behavior or substance raises a yellow flag. Is your client utilizing this behavior at work, whereas last week, it was just at home? Do they report they’re unable to move through tasks without thinking about ______ and then acting on it before resuming daily activities? 
2. Level of impairment: the amount of time spent either thinking about and/or acting on a behavior increases agitation, anxiety, and changes in mood and thoughts. Consider emotional dysregulation around these thoughts and actions as an indicator for appropriate level of care. 
3. Client willingness and motivation: are you hearing more change-talk in your conversations with your client? This sounds like an expressed desire to change a pattern, yet an unclear (or no) action plan, yet. Sometimes levels of willingness and motivation go hand-in-hand, but oftentimes, one is higher than the other. This is normal and to be expected. As your client explores this, it is best practice to give plenty of options for treatment, as they are interested in what comes next. 

Whether we are working with an individual on a biweekly basis, a group on a weekly basis, a family on a monthly basis, or an Intensive client who is with us nine hours per week, we are continually assessing for appropriate levels of care. If you’d like more information on how to incorporate this into your practice or to consult with one of our team members on what to do next, let us know! We’re happy to help.