Safety First! The Client's Treatment Comes Second

The primary goal of addiction counseling is to assist clients in finding a healthy road to recovery. This mission is important, but is secondary. The first mission is safety.

Three clear examples support this assertion: 1) client safety (e.g., safe from abuse); 2) community safety (e.g., not a danger to family or others); and, 3) counselor's safety (both physical and psychological). All three are of equal importance.

A blind spot for new professionals is focusing on the bull's eye and being blind to the rings. Counselors who lack experience and intuition and rely on book smarts are at risk of hyper-focusing on the obvious.

Counselors must pay attention to their clients' safety. One behavior that can mislead a counselor's perception regarding a client's safety is client confabulation (e.g., leaving out information or adding false information). It is an accepted fact that in addiction assessments some clients compensate for their current circumstances by exaggerating, and they have a propensity to shade the truth and/or underscore at-risk behavior.

Counselors who know this keep this in mind and evaluate not only what the client is saying but also what they are not saying. For example, a 29-year-old female told me that her living situation was challenging but tolerable. She was a cocaine addict, so my gut told me to keep digging.

Upon further investigation I learned that she was living with a 58-year-old man who provided her with food and shelter, and who did not mind that she was a drug addict. As long as the client continued to engage in his sadistic sexual fantasies, such as allowing him to burn her with cigarettes, she was welcome. Do you think this client is in a safe situation? What needs to happen before treatment can begin for this client?

Community safety is another important factor. I recall working with a 49 year-old alcoholic who happened to live in a rural setting and was a self-employed farmer. In our first session it was clear that he was in the contemplation stage of motivation, and was struggling to make up his mind if he wanted treatment.

During this meeting it was obvious that he was drinking. He was not falling down drunk; he was still functioning. Like most 15-year-plus drinkers, this client was able somehow to present early in the day as if he were still in control. This illusion of control fools many alcoholics who happen to like to drive each day to get their daily supply of alcohol.

When I asked him how he was going to get home – since it was clear he was not ready for treatment, let alone to go through a detoxification process – he told me not to worry; he just lived down the road a few miles and he was going to drive himself home. Do you think the community is safe in this situation? What needs to happen?

Counselor safety is one topic that I promote in all of my training. Counselors do not need to take any kind of abuse or feel in danger psychologically or physically at any time. There is no level of fear that is acceptable. When a counselor does not feel safe, they should ask for support from a supervisor, a peer, or even the police.

One day I was working with a 19 year-old male who was involved in street gang activity, whom I had seen several times before, and was a person with whom I felt I had good rapport. During the counseling session he bent over to tie his shoe, and to my shock, I noticed he had a gun in his coat. Do you think the counselor was safe in this situation? What needs to happen?

A counselor who faces situations such as these, has a safety issue that needs to be resolved so treatment can continue. In this counselor's opinion, the top priority in these types of cases is always safety. One could argue that this is part of treatment.

I will not split hairs. The point is that counselors need to have clear boundaries; pay attention at all times; never assume; have no tolerance for danger; and must not turn another cheek when there is a potential safety issue. We, as professional counselors, are expected to make difficult decisions and take action to protect our clients, our community, and ourselves.

William A. Howatt, Ph.D, Ed.D., ICADC, serves on the faculty of Nova Scotia Community College and is co-editor of the Wiley Book series on Treating Addictions.