The Clinical Staffing: It Works Like an Intervention

One hundred years ago, when Albert Einstein noted that mass and energy were one in the same, he turned the world on its head. A century later, this therapist has come to the conclusion that clinical staffings and formal interventions are manifestations of the same thing. This recognition won't impress Nobel Prize judges, but it is interesting to ponder the fact that clinical staffings might one day come to be seen as merely a continuation of the formal intervention process—a grand unification theory, as it were.

Every therapist knows the value of daily or weekly staffings. They inform as to the progress of a patient, attention is paid to following (or modifying) the treatment plan, and everyone works together toward a successful treatment outcome.

Every therapist knows the importance of the formal intervention, as well. Whether a particular facility offers such interventions in-house as part of its continuum of care or benefits from the work of an outside interventionist, therapists see daily reminders of the important work of those who do interventions for a living.

But perhaps it's time to remind ourselves that one of the many reasons staffings are so important is because they often function as a formal intervention. I often attend, as a marketer, a daily one-hour staffing held at a 56-bed residential facility for people with alcohol and other drug addictions. Every time I do, I'm reminded of the formal intervention held around me when I began my recovery 24 years ago.

For instance, consider the following conversation during a mandatory five-day chart review:

• Therapist One: “Mark is a 39-year-old alcoholic who is married and employed at a semiconductor plant. He maintains that his health is good and while his wife is not upset by his drinking, he's willing to try to do something about it. This is his first treatment episode.”

• Therapist Two: “That's funny: Mark is telling us in small group that his experience has been around drugs only. He denies any use of alcohol.”

• Therapist Three: “Also funny is the fact that in one-on-ones, Mark denies being married.”

• Director of Nursing: “What's equally interesting is the fact that Mark's ‘good health’ is anything but. He has an enlarged liver and his detox was rather difficult.”

• Family Therapist: “And that part about his wife being OK with his drinking? Absolutely untrue. He's here because she threatens to leave him because he just lost his job.”

• Program Director: “Well, this is interesting and it shows that we all need to get on the same page about Mark. I have a hunch that when we do, a much-confronted Mark will stop leading us around and start confronting who he really is.”

Those who have been part of a formal intervention can't help noticing that the process of uncovering all the untruths and misinformation about a patient is among the first tasks of the intervention team. It's when the interventionist makes sure that each person on the team (spouse, pastor, friend, etc.) understands just how drug-dependent the client is and how much enabling is going on in his support system.

In my newly revised book Outwitting Your Alcoholic, I write:

That's exactly what happens in the staffing, as well. Everyone on the treatment team is now aware that there's more to patient Mark than meets the eye. He's either not telling the truth or his drug-induced confusion has rendered him incapable of knowing exactly what the truth is. If he has never been involved in a formal intervention, Mark may well believe that all those he “misinforms” will never get together in the same room and discuss what they know about him. This is not true; staffings are a vital part of each facility's work.

A continuum of interventions

A clinical staffing is nothing more than a formal intervention in which the influence over a patient has moved from family and friends to a group of professional therapists and a medical team. Later, it is hoped, the intervention will manifest in a combination of transitional living, aftercare programs, and 12-Step meetings.

Among the other similarities between staffings and interventions are these:

• Staffings and interventions stop game playing. Formal interventions work chiefly because they collapse the enabling system of the identified addict. I've always believed that if the patient's family and support system stop enabling and develop their own support group, the intervention is already a success before the addict walks into the room. He may elect to stay in the room; he may elect to leave. Regardless, his family has stopped playing the game. If the addict elects to continue playing, his condition will plummet down the left side of the Jellinek Chart until pain causes him to reconsider. Similarly, staffings stop game playing by continuing to uncover the truth about a patient and confronting him/her with that truth.

• Staffings and interventions are loving but firm. Formal interventions always walk a fine line between warmth and carefully considered boundaries. In the clinical staffing, every effort is made to restructure the cognition or behavior of the client while at the same time never forgetting that the client is an ill person who deserves compassion.

• Staffings and interventions maintain a united front. They don't allow the old “divide and conquer” game to be played. One of the many reasons formal interventions are successful is that they ask the addict's family to discontinue its habit of caving during a crisis and to adopt a new policy of staying united. A clinical staffing does this by presenting a united front wherein the client has little recourse but to own his/her issues.

• Staffings and interventions provide the client with a “therapeutic crisis.” Everyone knows that one of the reasons formal interventions have proven so effective is because they don't wait for the addict to experience a “crisis.” Through carefully choosing an intervention team, crafting a series of loving but firm “I-messages,” and developing a list of consequences that the team plans to follow through with, the team brings a “crisis” to the addict. Tacitly, he or she is asked, “How does this crisis sound to you? Would you like to act on our invitation to recovery?” In the clinical staffing, the team continues to develop the idea of a “therapeutic crisis” facing the client, especially in one-on-ones, in small groups, and during the family program.

• The clinical staffing continues what the formal intervention begins. In the words of intervention pioneer Vernon Johnson (Intervention: How to Help Someone Who Doesn't Want Help; Johnson Institute Books), interventions work by “presenting reality to a person out of touch with it in a receivable way.” In his words, specific facts about a person's behavior are presented to a patient, in a compassionate, nonaccusatory manner. Clinical staffings build on this fact-finding process when they take the time to gather the truth about a particular client so that staff may challenge his/her distorted view of reality.

Integrating the two processes

Why is it important to see the clinical staffing as a continuation of the formal intervention? Because all too often, therapists working in a clinic believe that the formal intervention is a discrete process that has nothing to do with them. They often don't know that their client entered recovery through an intervention, and some of them may not care (“He's here; that's all that matters”). They fail to see that the intervention and the clinical staffing may be thought of as one in the same—that there is a certain flow between them that can benefit the patient. If attention is not paid to information generated during the intervention process, the clinical staffing will waste time in “reinventing the wheel.”

In a perfect world where staffings and interventions are fused, the interventionist could be given a key role to play in the clinical staffing. As a result, valuable information regarding the denial system and the client's lifestyle could be delivered in a timely manner. Also in this perfect world, a formal interventionist could actually invite a therapist (representing the facility to which the addict soon may be admitted) to become a valued member of the intervention team. This would make seamless the transition from intervention to clinic.

For this to happen, interventionists must learn to work more closely with the clinic to provide information about the client. And the clinic will need to develop some formal process whereby those who enter through a formal intervention will be “red flagged,” with a note entered in the patient chart showing that an intervention was done and listing the name of the professional who did it. Adding a sentence to the admission questionnaire (“Did you enter treatment through a formal intervention?”) would be a great place to start.

Interventions and staffings must be viewed as pieces of the same puzzle. If they are, interventionists and clinicians will no longer dwell in the land of “clinical chauvinism” but will work as partners for the benefit of the deserving patient.