Although the small upstate New York cities that line the Hudson River were late to the party, so to speak, crack cocaine use had reached epidemic proportions by the late 1990s. Add in the increasing heroin use and the chronic alcohol and marijuana issues that the communities faced and it was not all that surprising that I found my first job after grad school in just such a city, working as a therapist in an outpatient rehab facility. Ours was an evening program, and we offered extensive group sessions four nights each week, along with a Saturday morning group, and individual, family and couples work as needed during the day. We also had doctors to manage detoxification and work with us on diagnostic issues or prescribe medication. Our clientele came from all walks of life: the suburban mom with a teenage son who was smoking marijuana, the penniless woman addicted to crack and living on the streets, a young man in his 20s hoping to beat a third DWI. We worked from a positive psychology perspective, although at the time we didn’t call it that. We called it strengths-based, or client-centered, but I always said that it boiled down to the basic social work principle I was taught: unconditional positive regard for the person in the room with you. It was the most fundamental value of the profession, and basis from which we all worked. It sounds simple and obvious—that of course any therapist, trained as a social worker or not, would maintain positive regard for his or her clients, but the truth is, it isn’t always easy. Anyone who has worked in addictions knows that when faced with someone who has hurt an innocent person, whether while drunk or high, by accident, or by design, it can be difficult to hold positive feelings for that person. But working from a positive psychology perspective, it becomes critical to do so. To flesh this out, I’ll share a case example. A young woman came into my office one afternoon seeking help. She was in her early 20s, and was homeless. She traded sex for crack, and was pregnant, and was also not sure of her HIV status. She was ill the day she came in, just a cold, but she was coughing and sneezing and used half my box of tissues in that first session. She was wearing poorly-fitting dirty clothes, and she needed a shower. Our first conversation included me inviting her to tell her story—why she had come in and what she wanted. She wanted to go away to rehab, although sending people away was something we rarely did. She knew that but begged me to make an exception. She needed to get off the streets for a while, she explained, because her boyfriend beat her and she was trying to avoid him. After spending some time listening to her, I asked her about her strengths—about the parts of herself she felt proud of, and the aspects of her personality she felt had been responsible for surviving such a tough existence. I asked her how she coped, and she admitted that crack was a big part of her coping now, but I pushed her to come up with a list of things she did well, or valued about herself. She was surprised, to say the least, that as the minutes ticked by on this initial assessment, I was choosing to focus on these parts of her, and not on her drug use, her homelessness, or the violence she was experiencing in her relationship. She patiently answered but kept circling back to the “can I go to rehab?” question. It would have been easy to focus our first meeting on all that was wrong in her life. Question after question about her drug use or her sexuality would have yielded really important information, and it was likely what she expected, but it would have been overwhelming and depressing, and possibly—no matter how hard I would try to avoid it—shaming. It seemed most important to focus on who she was and how she survived these incredibly difficult circumstances; underlining and highlighting each difficulty was less important. If I expressed interest in her, not in her behaviors, her addiction, or her circumstances—all of which were compelling in their own way—but in her as a person, maybe she could begin to see herself as separate from all the problems, labels and prejudices. And maybe she could connect with a hope, a dream or a goal that she may have had before the addiction stole all that from her and left her with nothing. She did go to rehab, and when she returned, she arranged to stay in the battered women’s shelter as a way to support her sobriety and stay away from her former boyfriend. I’ve always hoped that she made it out of the lifestyle she had gotten stuck in, but whether or not she did, I knew that she had the strengths she’d need to do so, and that at least once in her life, someone had helped her identify them.
