It is important for alcohol counselors to be knowledgeable about occupational programs. Counselors can thereby better coordinate treatment efforts for the employed alcoholic or problem drinker. Does the client’s employer have a program? If so, who is the counselor, what services are offered? For any client it is important to know if there have been any work-related problems. If so, what is the current job status? Has a disciplinary procedure been instituted, or has the employee been informally warned and referred for treatment? In addition, to avoid future conflict, learn about any union involvement. Such information can help in formulating realistic treatment plans.It is important for the counselor to be sensitive to the policies and politics of the employed alcoholic’s work setting. Without this knowledge and awareness, there is the danger of violating the client’s confidentiality or, conversely, of not taking full advantage of the opportunity to cooperate with the employer on the client’s behalf. If there is a company policy, learn about it in order to plan realistically and avoid treatment/work conflicts. The type of medication, if any, will also be affected by the nature of the client’s work. A follow-up plan must consider the working person’s hours and geographical location. The flexibility and accessibility of the treatment facility can be a key factor in the successful rehabilitation of the employed alcoholic. Evening office hours and early-morning and weekend appointments may have to be arranged by the counselor, so that treatment will not interfere with the individual’s job.You may also find that some clients will have to receive outpatient care even when inpatient services are more appropriate. The employee may not be able to take the time off or may not have adequate insurance coverage. In fact, insurance companies who have been covering inpatient alcholism treatment are now attempting to change their policies to cover outpatient care exclusively, or at least preferentially. They cite the fact that it is less expensive and that little or no evidence indicates that inpatient care provides better treatment outcomes. As we hope this text has made clear, all alcoholics are not alike, and blanket assumptions regarding their treatment should not be made.Occupational programs have made significant progress in demonstrating that the “human approach” is good business. Yet there is still a great deal to be done, and it can be better accomplished with cooperation among those involved in the occupational program field and alcohol clinicians.*114\331\2*
When we come to consider other ways in which symbolism might produce body symptoms, we need to consider organ language. People sometimes express their emotions and feelings by using words appropriate to the function of organs in the body. I saw an adolescent girl in the hospital casualty department when I was a resident medical officer, complaining of painful red areas on the sides of the neck. The girl was very tense and irritable. She said, ‘My mother is a pain in the neck! Whatever I do is wrong, I can’t win and I’m sick of it!’ We might say that this girl was ‘hot under the collar’.
Other people complain that someone ‘makes me sick in the stomach!’, thereby giving some clue to the cause of symptoms of nausea and diarrhea.
Some people adopt a ‘stiff-necked’ approach to criticism by others, refusing to respond to it, holding their heads up with pride and perhaps suffering from neck pain.
Another common example of organ language, is the development of the feeling of a ‘lump in the throat’, which doesn’t in any way interfere with the person’s ability to swallow (we must of course always exclude organic causes first, before diagnosing this symptom as psychosomatic), called globus hystericus. It has been, in my experience anyway, associated with an emotion indicated by ‘I’m not going to swallow that!’, meaning, of course, ‘I’m not going to naively accept what you’re trying to ram down my throat!’ I remember a patient who developed this symptom when her ex-husband, at the last minute in a property settlement court case following their divorce, suddenly tried to force her to accept terms of settlement that would be humiliating to her. She actually said to me, ‘I wasn’t going to swallow that rubbish!’
*67/129/5*
Another discovery made in the sleep laboratory is that a normal adult will wake up a few times during the night. Some may wake as often as 10 to 15 times. Each time can be as short as a minute. The person then falls back into sleep and never remembers that he has in fact woken at all This discovery is important for allaying the fears of problem sleepers. When people who suffer from insomnia wake up in one of these normal awakenings they panic. They say to themselves. ‘This is it, I am awake in the middle of the night, and I will not be able to sleep again tonight’. This fear and anxiety of not being able to sleep after awakening at night causes further insomnia.
So next time you wake in the middle of the night, tell yourself that this is completely normal. Just relax, do nothing, let nature take its course, and you will fall back into natural sleep again. Never look at the alarm clock; in fact, knowing the time of night will normally increase your anxiety. You will find yourself sleeping better if you put your alarm away.
*22\174\4*
We have seen that anxiety may arise from a great number of causes. When we come to examine them and understand them, we see further that many of the causes can in fact be remedied. This of course is the first step in the self-management of anxiety. Those causes that have a basis in external reality are the easiest to remedy. For instance, a perfectionist working in a job in which he is involved with dirt and untidiness will have much less tension if he changes to a more suitable occupation, or a couple may be able to free themselves of tension if they can make sensible mutual adjustments in their sex life together.
However, it is clear that many of the causes of anxiety are with us, and there is really nothing we can do to escape them. In these circumstances the mere fact of understanding the origin of our tension helps us to bear it. We must understand it in the full sense of the word. I do not mean that we have to know the technical psychological mechanisms involved. In fact this is really little help, as is proved by the generally high level of tension in psychology students. What is required is a kind of philosophical understanding—knowing the cause, together with a calm and easy acceptance of the situation.
Some tension, of course, may be due to an unknown cause, and this tension is much more difficult to tolerate because of our innate fear of the unknown. Our fear keeps prompting us to find the cause, and when we cannot do so, we begin to feel that we must be going out of our mind.
We see then that in some cases the cause of tension can be removed; in other cases, we cannot remedy the cause, but we can still reduce its effect by a proper understanding of the situation. In the vast majority of cases, however, we are faced with tension, the cause of which we can do very little, if anything, to modify.
*47\57\2*