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Article Excerpt
The purpose of this quantitative study was to investigate the effect of counselor active rehabilitation service compared with the effect of standard rehabilitation counseling in assisting individuals with coexisting psychiatric and substance abuse disorders in attaining desired life roles. Results indicate a significant positive effect for the treatment intervention.
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The term disability refers to a physical or psychological impairment that hinders attainment of a person's desired life role. The participants for the current study were individuals who have dual diagnosis disorders. The term dual diagnosis refers to the co-occurrence of two separate diagnostic entities in the same individual (Gold & Slaby, 1991). The most common of the dual diagnosis disorders is the co-occurrence of a substance abuse disorder and a mental illness (Drake, Mueser, Brunette, & McHugo, 2004; Petrakis, Gonzalez, Rosenheck, & Krystal, 2002). The term substance abuse disorder refers to individuals who are dependent on or abuse either alcohol or psychoactive drugs (Drake et al., 2004), and the term mental illness refers to individuals who have a psychiatric disorder that can include but is not limited to depression, bipolar disorder, or schizophrenia (Hersen & Turner, 2003; Kessler et al., 1994).
The incidence of mood disorders for individuals with a dual diagnosis is high. The Epidemiologic Catchment Area study found that 29.2% of respondents with alcohol dependence disorder reported a concurrent mood disorder (Regier et al., 1990). The National Comorbidity Survey, which had 20,291 respondents (ages 18 years and older), found that 12.3% met criteria for mood disorder that included major depression (Kessler et al., 1994).
Clients diagnosed with co-occurring disorders have significant barriers to overcome to attain a life role that they consider to be successful and satisfying (Anthony, 1993). Because people often first experience mental illness or start abusing drugs or alcohol during their teenage years, they frequently have concerns that include limited developmental experiences, underdeveloped social or vocational skills (A. Kaufman, personal communication, August 16, 2005), higher-than-average school dropout and unemployment rates, and limited social networks that are commonly centered around drug use. These concerns contribute to a lack of ability to tolerate frustration or delay gratification.
Individuals with dual diagnosis disorders typically have not experienced positive milestones such as a graduation or a paycheck (Peterson, Maier, & Seligman, 1995). In addition, a high percentage of these individuals have been convicted of drug-related crime and have only distant ties to family and friends (Cheevers, 1999). These difficulties are often complicated by a psychiatric component, which causes individuals to doubt their own judgment, and a substance addiction component, which causes them to have a mistrust of authority figures, including counselors (A. Kaufman, personal communication, August 16, 2005). These realities make the quality of interaction between practitioners and clients a key factor that determines whether clients are able to attain and sustain a desired life role.
THE GOAL OF PSYCHIATRIC REHABILITATION
Assisting clients in choosing, attaining, and maintaining a new life role that is personally fulfilling is the goal of psychiatric rehabilitation (Anthony, 1994; Anthony, Howell, & Danley, 1984). Attaining a fulfilling life role and improving one's quality of life are essential components of a successful treatment process (Roessler & Rubin, 1998). Moreover, quality of life includes the well-being of the individual in physical, psychological, vocational, and social areas and can be positively influenced by rehabilitation services (Murphy & Williams, 1999; Roessler, 2004). For clients with co-occurring mental illness and substance abuse disorders, the challenges associated with leading a fulfilling life are compounded. These individuals often have not learned how to navigate today's society to access available resources. Their worldviews are commonly clouded by a pervasive sense of mistrust, and they often perceive the system as adversarial and something to be worked rather than to be worked with (Pedersen & Corey, 2003).
Given the preceding contextual factors, how can a counselor and client effectively work together to help the client attain a role that will improve his or her quality of life? Two key considerations are the treatment intervention and the quality of the therapeutic alliance. Regarding the former, McLellan, Childress, Griffith, and Woody (1984) asserted that effective counseling matches individuals with the treatments best suited to their personal characteristics, needs, and goals. Regarding the latter, Bordin (1979) stated that counselors and clients need to work within a counseling model that builds a strong therapeutic alliance that will be the foundation for doing meaningful work. We believe that the Counselor Active Rehabilitation Service (CARS) model meets both of these requirements by allowing flexible treatment application and emphasizing the quality of the therapeutic alliance.
THE CARS MODEL
The CARS model is not a well-known counseling model. The model was first introduced by Ferdinandi and Li (2005) at the National Rehabilitation Association Conference and later presented by Ferdinandi (2006) at the American Counseling Association Conference. The CARS model is a humanistic approach in which the counselor uses inclusive and esteem-lifting language (for example, the use of the words we and together) combined with a hands-on approach to assist the client in overcoming barriers to role attainment. The counselor's collaborative approach gives the client a sense that the counselor is doing something with, rather than to or for, the client (Meyer, 2006).
Clients with co-occurring disorders usually enter counseling feeling disconnected from support, feeling mistrustful of others, and needing to believe that the future can be better than the past. The...
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