Counselor training should include self-awareness

Addiction counselors today see patients with increasingly complex problems in healthcare systems of similarly growing complexity. Often, they are required to see more patients with fewer resources. If their academic training does not address the real threat of burnout and potential turnover out of the profession, one can expect a worsening of a problem that currently plagues all of healthcare.

“From day one of orientation, we're talking self-care,” Stephen Delisi, MD, assistant dean at the Hazelden Graduate School of Addiction Studies, tells Addiction Professional.

“When we hear back from our students, they'll say, 'We didn't necessarily fully appreciate at first how important self-care was, but we kept hearing about self-care. By the end of the program, we were fully aware,'” Delisi says.

The topic of self-care hits home for Delisi, a longtime addiction psychiatrist who maintains a clinical practice in addition to his administrative duties. His medical training certainly did not focus much on physician self-care, and one byproduct of that is seen in present-day doctor surveys in which half of respondents report feelings of burnout.

Students at the Hazelden graduate school see self-care topics embedded throughout the academic curriculum, from introductory courses in the first semester to professional development training in the final semester. Delisi says the school's ties with a working treatment organization, the Hazelden Betty Ford Foundation, have improved its overall awareness of why these topics need to be incorporated into clinicians' academic training.

Another goal here involves the effort to grow clinicians into future leaders within their organizations. “We're trying to increase the leadership aptitude of the next generation of counselors,” Delisi says. “If [we can develop] a healthier culture, that will help with burnout and turnover.”

Importance of master's training

In an interview with Addiction Professional to discuss trends in higher education for addiction professionals, Delisi emphasized first the continued establishment of the master's degree as the degree of choice, both for individuals who are newly entering the field and those advancing their training and credentials.

Again, the changes occurring in the treatment environment offer a model for what needs to be happening at the academic level. Delisi points to how Hazelden Betty Ford's clinical model has dramatically transformed, to the surprise of many nationally at first.

“Why do we now have patients on Vivitrol, and Suboxone, and specialized opioid support groups?” he says. “Higher education has to be keeping up with that. How does the curriculum equip the next generation for those integrated treatment approaches?”

In today's behavioral health treatment organizations, it is the master's-level clinicians who are securing the unit manager and program director jobs. Delisi says. The master's degree also offers the only pathway to the licensed professional clinical counselor (LPCC) credential. Having more LPCCs on staff in an organization can allow treatment facilities to hire fewer psychologists and to be able to use them more in a consulting capacity, he says.

An ever-present question in recent years has been whether the master's degree will move from highly desirable to mandatory for any clinical practice in addictions. Delisi identifies some components of the field where this might be true. For example, front-line staff in treatment organizations that address co-occurring substance use and mental health disorders in a truly integrated fashion will need to be master's-trained professionals, he says.

Also, as the field collaborates with larger health systems, the master's-trained professional will serve as the entry point for integration with primary care, he says. “If you're going to have addiction professionals in medical homes, they're going to need a master's,” Delisi says.

Evolution of curriculum

Delisi outlines several areas in which the Hazelden school has sought to broaden its curriculum for today's clinicians:

• It has expanded its advanced course in differential diagnosis as part of an effort to broaden its offerings that address co-occurring disorders.

• Its examination of evidence-based practices now goes well beyond the traditions of 28-day treatment to address areas that include contingency management, 12-Step facilitation, cognitive-behavioral therapy, dialectical behavior therapy and motivational interviewing.

• Other components that have expanded at the graduate school include multicultural diversity, the effects of trauma and adverse childhood experiences, and neurobiology.

Applications of technology also are growing in importance. Today's clinicians no longer have to be familiar with an electronic health record only—they also must be prepared to conduct therapy groups online and offer access to treatment for individuals in remote communities. Hazelden students have the opportunity while in the program to interact with clinicians who are employing telehealth strategies in their practices, Delisi says.

Today's clinicians in training, whether new to the field or expanding their professional expertise, are becoming savvy observers of the directions in which professional practice is moving. Delisi says this is playing out not only in their interest in applications of technology, but also in outpatient levels of care that are growing in importance in today's cost-conscious and more integrated environment.

Delisi sees the continued attention around the opioid crisis as a major factor for many individuals pursuing a career as an addiction professional. “The national discussion occurring because of the opioid epidemic is shedding light on the larger issue of addiction in general,” he says.

But the training should not reflect an effort to “solve” discrete crises, he says, because the waning of one drug phenomenon inevitably will give way to the rise of another, he says. “The goal should be one of addressing addiction as a disease,” Delisi says.