“Day-to-day, it’s a roller coaster. It’s frustrating. It’s rewarding. It’s maddening and it’s enjoyable”: A qualitative investigation of the lived experiences of addiction counselors.

Abstract

Psychologists in medication for addiction treatment (MAT) settings routinely oversee the work of addiction counselors as supervisors, administrators, and human resource specialists. Limited research has explored the lived experiences of counselors who work in programs that have scaled-up MAT in response to the opioid crisis in the U.S. Thirty-one addiction counselors who worked in MAT programs that had scaled-up treatment capacity were interviewed about 3 facets of their lived experiences: work roles, work motivation, and perceived responses of others to their work. Interviews were taped and transcribed. An interdisciplinary team reviewed and coded the transcripts using grounded theory analysis. The main work roles that emerged were counselor, educator, and advocate. Counselors described multiple factors related to intrinsic motivation for their work: family and personal history, altruism, enjoyment of challenges and client complexity, and witnessing and facilitating change. Factors related to extrinsic motivation were workplace opportunities and positive feedback. The main themes concerning responses of nonclients were positive feedback; others’ narratives; negative feedback focused on the stigma associated with the treatment, the clients who receive it, and the counselors who provide it; and responses to anticipated negative feedback. Responses from clients were largely positive and focused on appreciation and respect. Psychologists in MAT settings can enhance the lived experiences of addiction counselors by helping them to savor positive feedback from clients and others, to recognize and appreciate their unique skillsets, and to recognize and address (not internalize) the multiple sources of stigma they encounter as addiction counselors.

Improving the Recruitment and Retention of Counselors in Rural Substance Use Disorder Treatment Programs

“…Interviewees lamented that they found recent applicants were overly concerned with pay and lacked a commitment to helping others. This relates to recent research that revealed how SUD counselors choose their profession because of intrinsic rewards and interest rather than the salary (Oberleitner et al, 2021). The interviewees in this study had similar commitments to the field when they started working so they expected new counselors to have that same passion.…”

“…The perception that SUD clients are more difficult to counsel, however, may impact recruitment because new counselors are less likely to apply for positions in SUD treatment if they think the job will be more stressful and less rewarding. They may also fear being stigmatized themselves due to their association with such a highly stigmatized group (Madden, 2019; Oberleitner et al, 2021).…”

“…They also promoted professional development opportunities for the staff, which were seen to improve morale. Research has shown that organizational factors like perceived fairness, communication, and support can alleviate counselor burnout and improve job satisfaction, possibly reducing turnover intention (Beitel et al, 2018; Ducharme et al, 2007; Fukui et al, 2019; Knudsen et al, 2003; McNulty et al, 2007; Oberleitner et al, 2021; Oser et al, 2013; Shoptaw et al, 2000; Skinner & Roche, 2021). This study revealed specific practices that could lead to these counselor perceptions which could improve retention.…”

“…Burnout is most often associated with job-related demands, such as workload (Beitel et al, 2018;Landrum, Knight & Flynn, 2012). Counselors who report higher self-efficacy and control over their job show lower levels of burnout (Shoptaw , Stein & Rawson, 2000;Vilardaga et al, 2011. Most research findings agree that coworker support, increased clinical supervision, and self-care were important strategies for managing emotional exhaustion and improving job satisfaction (Beitel et al, 2018;Ducharme, Knudsen & Roman, 2007;Fukui, Wu & Salyers, 2019;Oberleitner et al, 2021;Oser et al, 2013;Shoptaw et al, 2000;Skinner & Roche, 2021;Vilardaga et al, 2011). Vilardaga et al (2011) also found that negative attitude toward clients (SUD stigma) was related to higher levels of burnout.…”

Stigmatizing Our Own: Self-Relevant Research (Me-Search) Is Common but Frowned Upon in Clinical Psychological Science

“…Although guidance regarding disclosure highlights negative perceptions of self-relevant research (Prinstein et al, 2013), there are mental health professionals and stakeholders who hold positive perceptions of it. Several authors of commentaries and studies acknowledge the unique perspectives offered by mental health professionals with lived experience, also known as prosumers (Boyd et al, 2016; Devendorf, 2020; Kundra & Salzer, 2019; Oberleitner et al, 2021; Victor, Lewis, & Muehlenkamp, 2022). For example, people with lived experience and mental health advocates may view self-relevant researchers as having greater insight or possessing intrinsic motivation.…”