Overcoming Preconceptions in Patients with Trauma and Addiction

Behavioral Health Behavioral Health
The therapeutic relationship has many facets. It’s not only patient and therapist; it’s also a relationship between two unique individuals. Sometimes the therapist plays the role of teacher, coach, or cheerleader. One aspect often rings true: for those suffering from trauma and addiction, this type of close, one-on-one relationship can be very uncomfortable.

“This patient population is sometimes viewed as more resistant, less motivated, and more challenging to work with,” says Sarah Carstens, LCSW, LCADC, Clinical Manager of the Women’s Program at Eatontown. “Yet much of this stigma stems from negative experiences in their previous relationships. It can be very difficult for them to know who to trust or even how to trust.”

To reframe this in a more beneficial way, Carstens suggests that behavioral health providers:

  • Take the extra time needed to build trust before diving into any substantive work.
  • Focus less on what might be perceived as a lack of motivation and instead consider external motivators, such as a desire to regain family relationships or maintain a job.
  • Acknowledge the freedom to choose in the absence of alternative. For example, recognize that patients may not want to be in therapy; they may be there because they believe they have no other alternative that would enable them to maintain a job or relationships with family members. Pair that with a goal to identify what can be reasonably done to improve their situation should they choose to remain in treatment, which will allow them to take steps toward recovery and reach their goals.


Stigma on Both Sides

The stigma of being an “addict” can play into the perspectives of patients as well. They may be experiencing environmental stigma, whereby they are treated differently by family and friends based on the decisions they’ve made. Self-perception also can be clouded by stigma. Signs of this include a distorted sense of self, a lack of self-compassion, and a lack of awareness of how forces beyond one’s control impact self-perception.

For therapists, recognizing the role stigma has played in a patient’s journey and using dialectical behavior therapy (DBT) strategies can help. In particular, mindfulness, distress tolerance, and reality acceptance skills are critical for patients suffering from trauma and addiction.

“Acceptance doesn’t mean that you agree with a situation, but rather you recognize it for what it is,” says Carstens. “These DBT strategies are most effective when the practice starts with us as therapists. Our own mindfulness and the use of behaviorally specific language can provide clarity, diffuse emotion, and enable progress.”

These strategies are all applied at the Women’s Program at Princeton House for those dealing with trauma and addiction. In addition to providing a safe space in which women can work through complex issues, the program equips them with tangible skills they can begin using immediately to replace ineffective coping mechanisms. 

"We offer a safe relationship that they can carry with them moving forward on their own journey toward personal growth and healing,” says Carstens. 


For information about the Women's Program, visit princetonhouse.org/women or call 888.437.1610.

Article as seen in the Spring 2019 issue of Princeton House Behavioral Health Today.