NCAD: Don`t take sides when patients wrestle with extreme positions

When patients are facing two apparently opposing truths about themselves or their addiction, clinicians should do all they can not to align with one side or the other, advised the Aug. 20 plenary speaker at the National Conference on Alcohol and Addiction Disorders (NCAD).

Bari K. Platter, MS, RN, a clinical nurse specialist at the Center for Dependency, Addiction & Rehabilitation (CeDAR) in Colorado, said that anything that reinforces patients' thinking at the extremes can have harmful consequences. For example, a woman in recovery who steadfastly believes she has always been a good mother might be at risk of missing the warning signs of a relapse, while one who dwells on the parental mistakes she made in her addiction might be too overcome with guilt to pursue a healthy recovery path.

“Balance lies in the synthesis of these two truths,” said Platter, a trainer in Dialectical Behavior Therapy (DBT) who has educated professionals on integrating DBT with the 12 Steps.

Her messages to conference attendees also focused on balancing acceptance and change in their professional lives. Two examples of how this might play out are:

• Believing in the effectiveness of one's own preferred clinical interventions, and acknowledging that others' favored strategies also have merit.

• In learning of a tragic outcome for a former patient, a clinician can say he/she wants to help people live healthy lives in recovery, and acknowledge that he/she is working with a population with a chronic and potentially deadly disease.

The teachings of DBT focus largely on the power of “and,” a conjunction that largely replaces “but” or “however” in Platter's vocabulary. “It creates a leveling,” she said. “One side is not more truthful than the other.”