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Stages of professional development of addiction therapists

In the professional development of addiction therapists, as in the case of other professions, four stages can be distinguished: unconscious incompetence, conscious incompetence, conscious competence, unconscious competence (mastery).

Each of these stages has very distinct characteristics, its good sides and dangers. Going through subsequent stages, we often experience painful symptoms of burnout syndrome. On each of them, for completely different reasons, a decision to leave the profession may arise.

Unconscious incompetence

Every student of apprenticeship experiences it. A characteristic feature of the early phase of this stage is considerable optimism in assessing its therapeutic options, often despite the lack of elementary knowledge and skills. It seems that in order to effectively influence others, it is enough to have your own rich experience, a friendly attitude towards alcoholics, a willingness to help, a certain efficiency in interpersonal contacts. The therapist at this stage works almost exclusively with himself – his personal resources, experiences. He works mostly intuitively. He invests a lot of time in contact with patients. He is emotionally involved. He often cannot separate his professional life from his personal life. He expects that the effort he has put in helping should bring a positive change and he feels disappointed when the patient returns to drinking. Not understanding the mechanisms of addiction, he interprets the functioning of patients as a manifestation of ingratitude or bad will. He often treats failure as a personal failure. He is tired of excessive involvement and entanglement in relationships unhealthy for both sides. He reacts to critical remarks about his work with a sense of threat. Therefore, he avoids supervision.

The intensification of negative experiences and emotions associated with helping in this phase may lead to a decision to change jobs. It may or may not. With the support of more experienced colleagues, a strong need to learn a profession may arise in this situation. I think that most therapists take this effort, but not everyone. Some do not give themselves a chance to learn. He will leave drug treatment with the conviction that he is not suitable for this job. Some, however, will remain in the profession without making any effort to learn, desperately defending the illusion of their agency and competence. The hope is that the process of certifying addiction therapists will slowly eliminate these people from addiction treatment.

Conscious incompetence
By starting science, therapists gradually discover areas of their ignorance. They are starting to see personal limitations and skill deficits. They go to the stage of conscious incompetence, which entails a lot of difficult experiences and emotions. It requires a critical analysis of your current professional functioning, surrendering to supervision and sometimes starting your own therapy. The therapist often experiences unbelief in himself, in his ability to interact. He experiences uncertainty about the majority of therapeutic decisions made. The patient’s lack of success confirms his inability to practice. It encourages some to continue learning, and discourages others. At this stage, therapists need a lot of kind, wise support. The easiest way is to make people aware of a lack of knowledge or incompetence. It is much more difficult to support them by encouraging them to continue learning, showing their strengths, praising for successful, even minor achievements, giving hope for the transition to the next stage – the stage of conscious competence.

The stage of deliberate incompetence can be shortened and eased. The path of vocational education set out by PARPA, which includes studying at the Study of Psychological Assistance, the Study of Addiction Therapy, clinical internship, clinical supervision are the next few years of study. The growing number of applicants increases the waiting time for the possibility of using each of these forms of education.
In anticipation of an invitation to SPP or STU, you can organize many very effective forms of professional development in your workplace. The easiest way to do it is that it does not involve any costs, i.e. various forms of internal training. The methods can be different:

presentation at the meeting of the therapeutic team of issues or problem areas prepared by the manager or other employees of the facility (this can be a thematically planned cycle of training or training on issues arising from the current need of clinical practice),
detailed presentation and discussion of cases at clinical meetings,
peer supervision work with the patient, both
in individual contact, as well as during group sessions,
presentation of new publications on addiction issues, initiating discussions and polemics on substantive topics and news published in the specialist press,
creating an atmosphere in the team conducive to asking questions, expressing doubts, revealing skills deficits.
All these seemingly obvious forms of education are not commonly used in rehabilitation centers. Sometimes there is simply no one to do it.

Conscious competence
At this stage, the therapist already has a fairly extensive knowledge about addiction, co-addiction, addiction psychotherapy. Has considerable therapeutic skills and is able to use them consciously. This does not mean that he knows everything and there is no doubt. However, he knows his strengths and feels competent at work with addicts and co-addictions. By accepting the basic canons of addiction psychotherapy, he can create his own programs and procedures for classes. He is happy to expand his knowledge. He willingly initiates discussions on substantive topics and supervises his work. He also knows his own limitations and is able to consciously give up the temptation to work with patients in situations where he does not have sufficient knowledge, skills and proven competences. Then directs them to other specialists.

At this stage of professional development, addiction therapists specify expectations for the organization of their workplace. And this can give rise to significant frustration. They have their vision of addiction treatment, a good addiction psychotherapy program and the conditions in which it should be implemented. They want to be appreciated and finally want to earn decently, have independence and real influence on what happens with patients in their workplace. These expectations often diverge from reality, because after completing the trainings they return to unchanged jobs for years in institutions negating the basic standards of modern addiction treatment. Growing conflicts, the still low prestige of the profession, the lack of a real perspective of changes induces some therapists to look for employment in other drug treatment facilities, and some to quit work in addiction treatment.

A characteristic feature of the stage of conscious competence is routine, especially in the field of conducting basic therapy for alcohol addiction. The limited goals of therapy at this stage of treatment necessitates the repetition of work procedures and methods. Regardless of the level of individualization of work with patients, it can give birth to this feeling of weariness and standing still. The way out is learning how to work with different groups of patients (addicts, co-addicts, victims, perpetrators of violence, cross-addiction, patients with double diagnosis, etc.), at various stages of addiction psychotherapy (basic program and after care), involvement in training activities for younger traineeships therapists and other professional groups, and further learning to expand medical, psychological and psychotherapeutic skills. Some therapists will leave drug treatment at this stage, considering that addiction psychotherapy programs limit their professional aspirations and therapeutic work opportunities too much. They will deal with psychotherapy, training and self-employment.

Unconscious competence (championship)
The stage of unconscious competence is the most difficult to characterize because hardly anyone experiences it. Most specialists remain at the previous stage of professional development, which is identical to what we used to call professionalism. So how is unconscious competence different from professionalism? In my opinion, apart from extensive experience, extensive knowledge in the field of medicine, psychology, psychotherapy and high psychotherapeutic skills, the hallmark is talent and extraordinary intuition that allow free use of our resources for the good of others.
And something very valuable: mental maturity, internal balance and impeccable ethical attitude. Despite the high standards, sometimes you can meet a champion on your way. For me, one of these people is my first teacher Bill Burgin.

Contrary to expectations, the professional development of addiction therapists does not guarantee stabilization of the drug treatment staff. Hope that people educated with enormous individual and institutional effort will remain in the profession may be groundless, provided that.

faster and wider than previously available opportunities for vocational training of therapists will not be created, especially before they start studying at SPP or STU,
activities strengthening the professional prestige of addiction therapists will not be intensified (and this is not only about activities initiated by IPZ or PARPA involving the integration of the environment, but primarily about activities strengthening the external professional image of people working in drug treatment, such as the process of certification of addiction therapists , establishing the profession of a specialist and instructor in addiction therapy, work aimed at creating a code of ethics),
there will be no rapid modernization of addiction treatment, which is unrealistic expectation at the time of the reform of the health service, where there is no place for development, because there is a desperate fight for maintaining the status quo, and the uncertainty of tomorrow does not create conditions for recruitment, professional development and retention qualified professionals in the profession.