Eleven ways you know your program isn't person-centered

Like nearly all of the treatment jargon tossed around on websites and marketing materials, the term “person-centered” has become as useless as it is ubiquitous. The tradition of sloppy thinking and a lack of focus or intention around the development and quality of therapeutic programming results in all sorts of situations that should produce intolerable amounts of cognitive dissonance. So, instead of rehashing the requirements of person-centered programs and practice, looking over the Rogerian philosophies, or waxing about the power of unconditional positive regard, we are going the listicle route. Eleven ways you know your program isn’t person-centered.

1. Staff declare people, “not ready”

• Not ready for what? Not ready for the change that you have defined for them? Not ready or interested in jumping through the hoops we have selected for them? Everyone is ready for something. Our job is figuring out what that is and how we can work with it. “But I’m a highly trained expert and know what they need to do!” Cool. That’s great. Who cares? The client? No? Ok, let’s move on…

2. Treatment planning isn’t personalized/individualized

• I worked at a famous treatment organization that has an EMR that doesn’t allow for custom inputs for treatment planning. I can’t tell how many times I’ve worked with organizations where when we examine their treatment plans, we are seeing some variation of Step 1, 2, 3; or another rigid, formulaic plan for care. It’s not that we need to reinvent a therapeutic approach every time we sit down with a client, but if we are exclusively using bibliotherapy resources from the 80’s and 90’s and 90% of treatment plans look the same, let’s stop describing it as person-centered.

3. Family systems are ignored, cut off, or demeaned as “enabling”

• This idea of detachment is often harmful, whether we do it with love or with extreme prejudice. This pseudo-clinical approach is often misused and turned into a simple (and wildly ineffective) cure for family issues. Are there usually some things that supports and little “f” family can do a little better or differently to best support their loved one? Yep. Usually. But, that conversation is very different than the head-scratching approach that has mutated into clinical violence masquerading as help.

4. “Denial” is a living concept in services

• Another pseudo-clinical term. What does denial mean in the clinical context? A protective psychological mechanism that serves to prevent complete obliteration of the self? A primitive ego defense? A giant, intentional lie that is not only a harmful way of thinking, but a chosen, intentional, morally-linked decision? Regardless, this concept is just plain problematic, for many reasons. Chiefly, it’s that it has lost all meaning except being a target for the ole clinical sledgehammer, AKA unethical, ineffective confrontational approaches. Boo.

5. Program identity is restricted to abstinence-based approaches, but lack thorough informed consent processes or appropriate referrals

• How often is the “clinical” front end measured on their sales or conversion numbers? Always? Great. There is simply no alignment between the financial needs of the organizations and the individuals and families seeking help.

• “Thanks for calling the Healing Hope Haven of Harmony and Health. Yes! We are appropriate for everyone looking for services for substance use. Everyone would benefit from our healing honey baths, where participants are covered in our homegrown honey made from our organic cannabis and poppy fields while we chant E. E. Cummings poems and flog each other with hemp ropes. No medications available. No insurance accepted.”

6. Staff speak differently about clients in private

• This is a stressful and thankless job, but so is working at Chick-Fil-A, and they actually fire people for treating paying customers poorly. We tolerate so much intolerable behavior from frontline staff and so many clinicians who speak poorly about their clients in private. This incongruence can be sensed by our folks from miles away. It is the single-biggest sign of a problematic culture within a program.

7. Time-limited programs

• Why do we have a 30-day program? Because — long, long ago — Lynn Carroll thought that it made sense. Or — alternatively — that’s how long our curriculum rotation lasts… While Henry Ford may have revolutionized the manufacturing industry, we are not looking to be an industrially-scaled assembly line.

8. Programs that discharge for continued use or other return of symptoms

• We diagnose people with an issues that is marked by continuation of drug use despite negative effects. We also discharge people from programming for demonstrating symptoms of their illness — that we diagnosed them with and are charging money to help them with. These procedures are terribly harmful for people affected, and often has nothing to do with clinical rationale.

9. Demeaning other pathways to recovery, including abstinence/ or religious-based approaches

• Less common — but as harmful as the discrimination we see around non-12-Step pathways or use of medications like methadone or buprenorphine — is the discrimination around religious supports, 12-Step involvement, or problems with drugs like cannabis. We have seen an uptick in behavior from clinicians that delegitimizes the problems our folks experience related to cannabis, especially as the pendulum swings from “Reefer Madness” to “Weed can’t hurt anyone.” Legalize, but recognize the problems that come with heavy use, especially among youth with underlying mental health issues.

10. Stigmatizing language is used, “typical addict behavior; borderline used as a noun to describe a person; treatment resistant; drug-seeker; etc…”

• For all of the talk about stigma coming from the general community and folks outside the world of treatment and recovery, the call is coming from inside the house. In our own programs, we often hear things that demonstrate a complete misunderstanding of the nature of mental health issues, including addiction, by clinical, medical and recovery professionals. Oftentimes, the worst offenders are people with personal experience, or people in recovery. “I call myself an addict all the time!” Yeah. Cool. That’s great. We are at work and that has been shown to be harmful.

11. Staff enforces strict hierarchical, paternalistic, or punitive power structures

• We aren’t the healthiest group of people on the planet, us helping professionals. Some of us take to this power like it is our natural reward. This sort of prescriptive, domineering culture is not only harmful to the folks we serve, but their families, our staff, and everyone who has to undo the damage caused by the large and small traumas created or worsened by this approach.

If you have read this far, thanks and congratulations. What am I missing? What would you add to this list?

Jordan Hansen November 4, 2020