I landed my first job in co-occurring disorders in 2008.
I was hired into a co-occurring position as an assessment specialist, working in an assessment and referral clinic operating within the University of Utah Department of Psychiatry. Of course, no one was calling it co-occurring disorders, nor was I providing direct clinical interventions aside from a weekly “pre-treatment group.” But that is what it was, co-occurring, at least in a nascent form. What we did were clinical interviews that resulted in a fully integrated mental health and substance abuse (still called that back in the day) assessment.
This idea, still novel for many at the time and only four years removed from SAMHSA’s TIP 42, that mental health conditions and addiction might share common elements and might be most effectively addressed under a common framework, had not filtered very far down into the world of treatment for either condition. In many ways, that is what makes co-occurring disorders training so important even now. At that time, we were encouraged to view assessment work as the first intervention, and we were trained in motivational interviewing techniques.
So there I was, talking to people about their history of substance use, their mental health struggles and emotional lives, their families of origin and current relationships, their work and education, their hobbies and physical health, and their religion and spiritual lives, tying it all together as we went along, making reflections back, and wrapping up themes in summaries. Basically, I was trying to integrate and provide some kind of context for a person to look back on their own life, to see some of the primary factors that had led up to them sitting with me, a stranger, and to consider where they might want to go next.
I wish I could say that I was just gifted at doing this from the start and that I had some preternatural talent for it. That would have been super cool. But I was not, and that is not how it happened. Like most of us working out in the field, where human life has taken a turn for the bad and worse, I was taught primarily by all the mistakes I made. I had to get kicked around long enough for some lessons to begin to sink in, which for the most part can be reduced to a couple of things.
First, the person sitting across from me was, in fact, a whole, living person, not a collection of broken parts that I was going to analyze and fix. And along with that, people justifiably resented and rejected being treated that way.
Second, to the degree that we can help make change at all, it begins with listening. Genuine curiosity and empathy. That is true whether you are doing assessment, therapy, or working in psychosis and substance use treatment more broadly.
So I started out getting yelled at regularly or having people walk out on me. Yes, that really is where I started. And then, three years and roughly a thousand interviews later, I had clients say, genuinely, that this was the first time they had really felt like someone truly heard them. Now that felt good, not going to lie, but that is not really a point of pride for me. I'm an exceptionally slow learner, and I am sure that, based on both ignorance and arrogance, I probably ended up doing at least as much harm as good in those early days. But it did provide the foundation for all of the work that followed.
Most importantly, it grounded me in a co-occurring framework that I have continued to build on in the years since, and one that I now believe mental health clinicians need far more support and training in than most of us ever received.
I was hired into a co-occurring position as an assessment specialist, working in an assessment and referral clinic operating within the University of Utah Department of Psychiatry. Of course, no one was calling it co-occurring disorders, nor was I providing direct clinical interventions aside from a weekly “pre-treatment group.” But that is what it was, co-occurring, at least in a nascent form. What we did were clinical interviews that resulted in a fully integrated mental health and substance abuse (still called that back in the day) assessment.
This idea, still novel for many at the time and only four years removed from SAMHSA’s TIP 42, that mental health conditions and addiction might share common elements and might be most effectively addressed under a common framework, had not filtered very far down into the world of treatment for either condition. In many ways, that is what makes co-occurring disorders training so important even now. At that time, we were encouraged to view assessment work as the first intervention, and we were trained in motivational interviewing techniques.
So there I was, talking to people about their history of substance use, their mental health struggles and emotional lives, their families of origin and current relationships, their work and education, their hobbies and physical health, and their religion and spiritual lives, tying it all together as we went along, making reflections back, and wrapping up themes in summaries. Basically, I was trying to integrate and provide some kind of context for a person to look back on their own life, to see some of the primary factors that had led up to them sitting with me, a stranger, and to consider where they might want to go next.
I wish I could say that I was just gifted at doing this from the start and that I had some preternatural talent for it. That would have been super cool. But I was not, and that is not how it happened. Like most of us working out in the field, where human life has taken a turn for the bad and worse, I was taught primarily by all the mistakes I made. I had to get kicked around long enough for some lessons to begin to sink in, which for the most part can be reduced to a couple of things.
First, the person sitting across from me was, in fact, a whole, living person, not a collection of broken parts that I was going to analyze and fix. And along with that, people justifiably resented and rejected being treated that way.
Second, to the degree that we can help make change at all, it begins with listening. Genuine curiosity and empathy. That is true whether you are doing assessment, therapy, or working in psychosis and substance use treatment more broadly.
So I started out getting yelled at regularly or having people walk out on me. Yes, that really is where I started. And then, three years and roughly a thousand interviews later, I had clients say, genuinely, that this was the first time they had really felt like someone truly heard them. Now that felt good, not going to lie, but that is not really a point of pride for me. I'm an exceptionally slow learner, and I am sure that, based on both ignorance and arrogance, I probably ended up doing at least as much harm as good in those early days. But it did provide the foundation for all of the work that followed.
Most importantly, it grounded me in a co-occurring framework that I have continued to build on in the years since, and one that I now believe mental health clinicians need far more support and training in than most of us ever received.