Individuals who have mental health disorders often do not have just a single disorder. The term co-occurring conditions has recently replaced the term dual diagnosis. Co-occurring refers to two or more mental health or substance use conditions. An example would be alcohol abuse disorder with underlying depression. Patients with co-occurring conditions can be difficult to work with as they are often stressed out and portray their own feelings onto the therapist, a term known as transference. Learning and practicing strategies to help patients with co-occurring conditions can be beneficial to the therapist. Below are five well-known strategies to help therapists counsel their patients with co-occurring disorders.
1. Maintain a recovery perspective.
Recovery is a long-term and even life-long process that may hold different meanings to each individual on the path. Recovery can mean actively working a program such as a 12-step program or actively working toward a goal. It can also imply changes in an overall healthy lifestyle including physical and mental health self-care.
“While ‘recovery’ has many meanings, generally, it is recognized that recovery does not refer solely to a change in substance use, but also to a change in an unhealthy way of living. Markers such as improved health, better ability to care for oneself and others, a higher degree of independence, and enhanced self-worth are all indicators of progress in the recovery process,” according to a Substance Abuse and Mental Health Services Administration (SAMHSA) article.
2. Manage countertransference.
Transference is when a patient projects his or her feelings onto the therapist, and countertransference is when the therapist reflects his or her feelings onto the individual patient. In other words, both people can be a mirror of self-reflection on one another and, unfortunately, have the potential to reflect negative energy. Therefore, it is important for clinicians to recognize and manage their own self-care.
“Particularly when working with multiple and complicated problems, clinicians are vulnerable to the same feelings of pessimism, despair, anger, and the desire to abandon treatment as the client. Inexperienced clinicians often are confused and ashamed when faced with feelings of anger and resentment that can result from situations where there is a relative absence of gratification from working with clients with these disorders,” the SAMHSA article states.
3. Monitor psychiatric symptoms.
When working with patients who have two or more co-occurring disorders, it is important to be aware of their entire medication and treatment plan. If a patient has a history of substance abuse, it is important for the substance abuse counselor to be present at therapy sessions and vice versa. It takes a multidisciplinary team to help counsel a patient with a co-occurring disorder. As a therapist, it is important to have a standardized method to monitor symptoms and changes in symptoms at regular intervals and, most importantly, to monitor for suicide, self-harm and harming others.
4. Use supportive and empathic counseling.
Empathy is the foundation of patient care and the technique adults use to relate and interact with other adults. While having consideration and empathy for others’ feelings, it is important to also keep an unbiased and healthy outlook on the patient and the treatment approach. Nonjudgmental communication, a supportive environment, positive reinforcement and listening are all important skills that encompass empathy.
5. Employ culturally appropriate methods.
Understanding the patient’s culture can dramatically help in the care of the individual. Different cultures have different characteristics, communication styles, interpersonal interactions and family values. Some cultures will want their family actively involved in the treatment process, while other cultures are more independent.
“The level of acculturation and the specific experiences of an individual may result in that person identifying with the dominant culture, or even other cultures. For example, a person from India adopted by American parents at an early age may know little about the cultural practices in his birth country. For such clients, it is still important to recognize the birth country and discover what this association means to the client; however, it may exert little influence on his beliefs and practices,” the SAMHSA article explains.
The Sovereign Health Group is a leading behavioral health treatment provider with locations across the United States. We treat people with mental health disorders, substance addiction and co-occurring conditions, using a vast array of evidence-based treatment modalities so that each treatment plan is customized to each individual patient. For more information, please call our 24/7 helpline.
About the author
Kristen Fuller, M.D., is a senior staff writer at the Sovereign Health Group and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.