Alcohol, Drugs and Suffering Part 1.

Institute of counselling

Hello Everyone,

I would like to introduce you to the first of two parts of Terry Callahan’s article ALCOHOL, DRUGS AND SUFFERING. published in the Institute of Counselling’s journal ‘The Living Document’. The article is from the Autumn 2010 edition.


The following article introduces readers to some popular concepts in Narrative Therapy.


As a counsellor new to the field of alcohol and other drugs, I have been struck by the appearance of pain and suffering in the stories of almost all those who consult me. Often the appearance of pain and suffering coincided with that of alcohol and/or other drugs in the life of the person. In fact, in many instances the person’s story of their relationship with alcohol/drugs is almost inextricable from their story of pain and suffering.

This paper is a brief report on a project in which I attempted to witness to the stories of suffering and alcohol use by Mary (not her real name), who has been in conversation with me for nearly eight months.

I found myself constantly running into brick walls as I tried to think my way through this work. I am now familiar with at least one of those brick walls, and it is what I call the Theory Wall.

I quickly discovered that Alcohol and Other Drugs counselling is a minefield of competing theories, especially when it comes to the relationship between drug use and pain.

This paper is a brief report on a project in which I attempted to witness to the stories of suffering and alcohol use by Mary (not her real name), who has been in conversation with me for nearly eight months.

I found myself constantly running into brick walls as I tried to think my way through this work. I am now familiar with at least one of those brick walls, and it is what I call the Theory Wall.

I quickly discovered that Alcohol and Other Drugs counselling is a minefield of competing theories, especially when it comes to the relationship between drug use and pain.

I started hearing phrases like ‘self-medication’ in reference to persons who used drugs to manage a psychiatric condition. I also started to notice in newspaper stories and other articles, constant references to drug ‘addicts’ or ‘alcoholics’ who abused these substances to ‘avoid pain’, and that this pain was often tied to early experiences of abuse and so on. The implication seemed to be that getting in touch with this pain and experiencing it fully or cathartically would be healing and help overcome the person’s need for alcohol/drugs. In other words, the addict/ alcoholic was really ‘running away’ from things.

It is unremarkable that these theories should have influenced me. Eventually you hear what you expect to hear. The temptation of Theory for me is also tied up with wanting to have control of a conversation, wanting to know in advance where the conversation is likely to go.

I did not want to stay stuck in front of or behind the Theory Wall. But the temptation is strong because it is theoretical and ‘scientific’ discourse that is most legitimated and legitimating in our culture.

That was the problem. I had not realised how deeply ingrained this scientific attitude is in me.

But coming to name it and tell something of the story of it frees me to properly situate this work as fitting within a different framework of understanding – a narrative approach.

Story or narrative holds complexity, celebrates it, nurtures it in strange twists and turns, metaphors and images, that radiate in every possible direction. Story is a strong/ fragile ever-changing plotting of abundant life. Indeed, narrative is constitutive of identity and action. The stories we make up make us up.

The Interplay of Suffering/ Pain and Alcohol/ Drugs: Drinking in Liminal Space

I was faced with an initial dilemma in these therapeutic conversations. Should we externalise Pain or Alcohol? In the end, we externalised both, foregrounded one and then the other.

I understand externalising from a number of different viewpoints:

  •    It locates the problem outside the person.

  •    Externalising is also congruent with a social-constructionist view of the world. That is, all aspects of the person are situated historically, politically, socially and culturally. Externalising opens the space for the person to rethink their relationship to the problem and its supporting ideas and practices.

  • Externalising also situates the Problem in such a way that others can reflect on their respective relationships to the problem, rather than seeing ‘the person-as-the-problem’.

As Mary and I entered into these conversations, it soon became clear that Mary held complex and often very nuanced positions with respect to the effects of alcohol or suffering in her life.

Part two of Terry Callahan’s article ALCOHOL, DRUGS AND SUFFERING will be posted in the next few days.

Please Like and Share this article.

If you have any questions or comments about the first part of this article or on the fast growing area of drugs and alcohol counselling, in general, then post them in the comments section below. I can also respond to any questions you might have.

Thanks everyone.

Best Wishes


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A students reflections on studying counselling skills

Hello everyone,

I would like to share an article with you today, the article is an excerpt taken from the Institute of Counselling’s Journal ‘The Living Document’.

This article was written by a former student of the Institute of Counselling.

The article details the students reflections and thoughts on studying counselling skills and how the process has enriched her understanding of her personal life.

I hope you enjoy.



This article traces my progress through my studies with the Institute of Counselling. However it does not primarily focus on what I have learned, the knowledge I have gained and the skills I have acquired. Rather, it discusses the challenges I have faced, and it charts how my experiences have informed my learning, and conversely how my learning has enriched my understanding of my own personal life.


I am a staff nurse working in a unit for people with severe dementia. In the words of our psychiatrist, it is essentially “a hospice for people with dementia”. It is where clients are referred when all other care options have been exhausted. Thus, I frequently provide end of life care. This was one of the reasons I decided to explore a course in grief and loss.


While researching this, I stumbled across the Institute of Counselling’s Graduate Diploma in Counselling Skills. I chose this course for a number of reasons …


First, it offered a module in Grief and Loss Counselling; second, it provided training at a higher level than my undergraduate degree; third, I have always had an interest in, and hoped to study counselling; and fourth, it included an element of pastoral counselling. This was important to me, as I am a practising Christian.


I commenced my studies in 2008.

During my first year, I studied two modules:

Foundation in Counselling Skills, and Grief and Bereavement Counselling Skills. On commencing the first module, I quickly realised that the essential qualities of Carl Rogers’[1] and Gerard Egan’s[2] approaches are those that underpin all elements of my nursing practice. These are genuineness, warmth and empathy. In fact, these qualities are the building blocks for all my relationships in life – both at work, and with my friends and family.


The second module focused on Grief and Bereavement Counselling Skills. Although the focus was on helping those who’ve lost a loved one, I found myself thinking more about how best to support families who were trying to make sense of this devastating illness, and the impact it was having on their lives. Indeed, many families grieve the loss of “the person they once knew” as dementia changes “the person they now are”.


I can identify with this sense of loss as my own much-loved grandma had dementia for five years. During that time, I witnessed her change from being a vibrant lady who loved to sing and dance to being a mere shadow of her former self, where she depended on others to meet her every need.


Gerard Egan’s model, ‘The Skilled Helper Model’ [1] was particularly relevant to my work as a nurse.


For example, when supporting loved ones I frequently find that the problems they present me with are not the core issues. This model helped me to explore and identify ‘what was really going on’ beneath the surface.


A case which illustrates this is a lady who was finding it hard to come to terms with her husband’s illness, and move him into long term care. By applying Egan’s model we were able to uncover that the key issue for her was actually guilt. Specifically, guilt that she had let her husband down, guilt that she had failed in her role as wife, and guilt that she could no longer cope with caring for her husband. Over time, she was able to work through these issues, using different counselling techniques and tools.


For example, we used Force-field Analysis to help the wife decide whether it was better for her to care for her husband at home or whether long term care would be more appropriate. This also helped her deal with her negative guilt feelings.


During my second year, I began to study Couple and Family Counselling Skills. This was a challenging module for me as both of my parents are alcoholics, and as a child I witnessed and experienced things that no child should see or experience.


Thus, studying the material highlighted my own need to address buried issues that I still needed to work through in an honest and open way. This was often very difficult for me. From a professional perspective, this experience showed me how important it is for a counsellor to work through issues that could interfere with the counselling process and relationship. That can help alleviate the likelihood of transference and counter- transference occurring.


When I started on this second module, I didn’t realise how useful it would be to my work as a nurse. I had viewed studying families as a means to an end: it was simply a module I had to complete to fulfil the requirements of my graduate diploma.


Although I frequently worked with my patients’ families, developing family and couple counselling skills seemed largely irrelevant to my job. However, I soon realised that my assumptions had been wrong, as studying a Family Systems Approach helped me better understand the dynamics within the family unit. This was reinforced by my research for an essay which detailed the benefits of using Systems Theory in the field of palliative care.


Studying this module proved to be challenging in other – unrelated- ways as well.


I suffer from severe asthma which is usually kept under reasonable control. However, during this time it became more problematic. I also developed polyarthalgia which was difficult to treat because of my asthma. In addition to this, I am a carer for a close friend. As her health deteriorated significantly, this increased the demands on me.


Although this was proving to be a very tough year, my module leader, Neil, was able to support me, so I managed to make it, and complete the work.

At present, I am working on the final module: Crisis and Trauma Counselling Skills. I have always found this area interesting. I am also aware that people facing crises have acute and serious needs.


In terms of my personal situation, shortly after commencing with my third year module I was admitted to hospital because of my asthma. There, my consultant gently shared that there was nothing more medicine could offer me. This was devastating news as I had always held out hope – but now that hope was gone. I returned home left to deal, in whatever way I could, with the impact that this news had had on me.


My consultant is excellent; however, I felt let down as there was a complete lack of emotional support in dealing with the news. I know my experience is not unique, and I really feel that counselling could offer a lot to people who are coping with a long term illness. Although the health service can offer us partial support, there is definitely a lack of holistic care.


On top of these concerns, a good friend passed away while I was preparing my first essay for the module. I felt heartbroken as the loss was sudden-yet many failed to understand the very real impact it had on me. To be honest, in some ways it felt silly as my friend was not a person: it was my guinea pig, Prince Harry. I had adopted this lad from a rescue centre. He was in terrible condition when I took him home – but he had thrived and blossomed into a cheeky little character. Hence, I was very attached to my pet. What made this so hard, even though he was in pain, was the guilt I experienced over ending his  .


The death of a much- loved pet is frequently underestimated and dismissed by many. As I prepared this article I spoke to several people who had lost their pets. All described it as a devastating experience, and one person likened it to ‘the loss of a limb’. Many described the same emotions as those associated with the loss of a human friend. However, they sensed few people understood how they felt, dismissing their grief as an overreaction. This is something that counsellors should note � as often a strong bond of trust and love exists between a much loved pet and its owner. Hence, the loss of a pet can be devastating.


I am almost at the end of my studies now, and I can look back and say I have enjoyed it immensely. It has presented me with many intellectual challenges and life has added its own as well. It has certainly been hard work and has required me to juggle and prioritise my time and responsibilities. However, I have developed my skills and increased my knowledge.


I also believe I have grown as a person, and become much more confident. I am now considering my future options as I would like to move into an area of  work that is less demanding physically. That would accommodate my health issues-but also allow me to use my skills and knowledge to help other people in a meaningful way.


When I complete this course, I will embark on the Diploma in Youth Counselling. This should help me in my volunteer position as the children’s advocate in my church. I am sure this new course will bring further challenges, as well as new opportunities for developing my knowledge, skills and qualities as an individual and a counsellor.



[1] Egan, G. (2010). The skilled helper (9th Ed.). Pacific Grove, CA:


[2] Rogers, C.R. (1995). On becoming a person: A therapist’s view

of psychotherapy. Boston: Houghton Mifflin Co.


I hope you found this article interesting and insightful, remember you can let me know your thoughts in the comments below.

My next blog post will be posted in the next few days. Cheers.


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