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The Clinical Staffing: It Works Like an Intervention

March 1, 2006
by Ken Lucas, LISAC, CADAC
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Clients can benefit when the two processes are more closely integrated

One hundred years ago, when Albert Einstein noted that mass and energy were one in the same, he turned the world on its head. A century later, this therapist has come to the conclusion that clinical staffings and formal interventions are manifestations of the same thing. This recognition won't impress Nobel Prize judges, but it is interesting to ponder the fact that clinical staffings might one day come to be seen as merely a continuation of the formal intervention process—a grand unification theory, as it were.

Every therapist knows the value of daily or weekly staffings. They inform as to the progress of a patient, attention is paid to following (or modifying) the treatment plan, and everyone works together toward a successful treatment outcome.

Every therapist knows the importance of the formal intervention, as well. Whether a particular facility offers such interventions in-house as part of its continuum of care or benefits from the work of an outside interventionist, therapists see daily reminders of the important work of those who do interventions for a living.

But perhaps it's time to remind ourselves that one of the many reasons staffings are so important is because they often function as a formal intervention. I often attend, as a marketer, a daily one-hour staffing held at a 56-bed residential facility for people with alcohol and other drug addictions. Every time I do, I'm reminded of the formal intervention held around me when I began my recovery 24 years ago.

For instance, consider the following conversation during a mandatory five-day chart review:

  • Therapist One: “Mark is a 39-year-old alcoholic who is married and employed at a semiconductor plant. He maintains that his health is good and while his wife is not upset by his drinking, he's willing to try to do something about it. This is his first treatment episode.”

  • Therapist Two: “That's funny: Mark is telling us in small group that his experience has been around drugs only. He denies any use of alcohol.”

  • Therapist Three: “Also funny is the fact that in one-on-ones, Mark denies being married.”

  • Director of Nursing: “What's equally interesting is the fact that Mark's ‘good health’ is anything but. He has an enlarged liver and his detox was rather difficult.”

  • Family Therapist: “And that part about his wife being OK with his drinking? Absolutely untrue. He's here because she threatens to leave him because he just lost his job.”

  • Program Director: “Well, this is interesting and it shows that we all need to get on the same page about Mark. I have a hunch that when we do, a much-confronted Mark will stop leading us around and start confronting who he really is.”

Those who have been part of a formal intervention can't help noticing that the process of uncovering all the untruths and misinformation about a patient is among the first tasks of the intervention team. It's when the interventionist makes sure that each person on the team (spouse, pastor, friend, etc.) understands just how drug-dependent the client is and how much enabling is going on in his support system.

In my newly revised book Outwitting Your Alcoholic, I write:

That's exactly what happens in the staffing, as well. Everyone on the treatment team is now aware that there's more to patient Mark than meets the eye. He's either not telling the truth or his drug-induced confusion has rendered him incapable of knowing exactly what the truth is. If he has never been involved in a formal intervention, Mark may well believe that all those he “misinforms” will never get together in the same room and discuss what they know about him. This is not true; staffings are a vital part of each facility's work.

A continuum of interventions

A clinical staffing is nothing more than a formal intervention in which the influence over a patient has moved from family and friends to a group of professional therapists and a medical team. Later, it is hoped, the intervention will manifest in a combination of transitional living, aftercare programs, and 12-Step meetings.

Among the other similarities between staffings and interventions are these:

  • Staffings and interventions stop game playing. Formal interventions work chiefly because they collapse the enabling system of the identified addict. I've always believed that if the patient's family and support system stop enabling and develop their own support group, the intervention is already a success before the addict walks into the room. He may elect to stay in the room; he may elect to leave. Regardless, his family has stopped playing the game. If the addict elects to continue playing, his condition will plummet down the left side of the Jellinek Chart until pain causes him to reconsider. Similarly, staffings stop game playing by continuing to uncover the truth about a patient and confronting him/her with that truth.

  • Staffings and interventions are loving but firm. Formal interventions always walk a fine line between warmth and carefully considered boundaries. In the clinical staffing, every effort is made to restructure the cognition or behavior of the client while at the same time never forgetting that the client is an ill person who deserves compassion.

  • Staffings and interventions maintain a united front. They don't allow the old “divide and conquer” game to be played. One of the many reasons formal interventions are successful is that they ask the addict's family to discontinue its habit of caving during a crisis and to adopt a new policy of staying united. A clinical staffing does this by presenting a united front wherein the client has little recourse but to own his/her issues.