By David S. Prescott, LICSW
I recently discussed the Good Lives Model with a psychologist from the UK. She was not the first to ask a question along the lines of, “How do I work in treatment with a client on the goal of ‘living and surviving’ when they have no job, little help from the government, and are at risk of losing their residence?” It became apparent that the best way forward under the circumstances was to provide resources for her client to remain housed and employed. She had been thinking of living and surviving in the abstract, viewing it through a purely clinical lens.
At a time when so many are focused on maintaining fidelity to evidence-based treatment approaches, we can miss the fact that our clients sometimes have urgent needs. Therapeutic conversations and case management can have a role in our work. We may even overlook not only the solutions around us, but our own strengths and resources in finding solutions with our clients. In so doing, we can improve our alliances and specific responsivity.
It's clear that many aspects of our changing world have at least moderately close relationships to risk. Global conflicts, climate change, decreased funding, and the evolving nature of public discourse around inclusion and equity can all influence client risk and protective factors. Although we have historically improved our ability to understand individual clients’ functioning, there is much we don’t understand about how a changing and increasingly uncertain world intersects with re-offense risk. To examine this further:
· While climate change is beyond the scope of this blog and ATSA’s mission beyond, if the trends continue, treatment providers, supervising agents, and clients will all be affected. For example, how does extreme weather interact with risk factors such as relationship stability, self-regulation, and proneness to rapidly escalating affect and emotions? We’ve already seen how community distress can quickly result in looting. Are treatment programs and providers in a position to address these challenges with their clients?
· Recent reports show that housing and food insecurity are growing, while resources to alleviate them are not. These have occurred contemporaneously with deaths of despair and domestic violence. Meanwhile, within our field, many professionals have had difficulties finding staff due to cost of living increases. One might reasonably ask how we are all doing managing our own risk factors? Have our anxieties had an effect on our own self-regulation skills?
· Further, in many quarters, funding for treatment has decreased, while expectations around billing, documentation, and the threat “clawbacks” of payments already made to providers have increased. At the same time, many states maintain high standards for professionals working in this field. One wonders about a possible collision course between decreasing pay and the ever-increasing responsibilities that come with this work.
· Finally, there are the lingering after-effects of the pandemic. We still don’t know the full impact of the past several years on other forms of interpersonal violence, although we know that violence interacts with sexual re-offense risk.
Other questions remain. What are the effects of other world events? As of this writing, there are two major wars in the headlines. Coverage of them has been rife with partisan rhetoric that can make violence seem acceptable in the eyes of clients who have their own violent histories.
Speaking only for myself, I’ve experienced both sensitization and desensitization in response to world events and the ways that media outlets report on them. It can be difficult to place current events into any meaningful or predictive context. Certainty about anything in short supply. We professionals are experiencing these changes, often intensely. There is no way our clients aren’t as well. The question is how we respond to this, empirically and in practice.
Professionals in our field, like our clients, can be remarkably resilient and creative. The hope of the author and the intent of this blog post is that by outlining some questions that don’t often get discussed, we may be better poised to find solutions.