Drug and Alcohol Treatments - Psychotherapy
The traditional insight-oriented and cognitive behavioral approaches are thought to be of limited usefulness until there has been a suitable period of substance free functioning. Close coordination between the therapist and the family is very necessary for a substantial period of time and the therapist needs to have considerable expertise in the management of substance abusing teenagers.
The typical licensed professional psychotherapist may be a psychiatrist, psychologist, psychiatric social worker, psychiatric nurse or substance abuse counselor functioning in either a private practice or agency setting (outpatient, day treatment, or residential).
Private practice settings, except in limited cases, are usually contraindicated because teens typically require closer ongoing supervision for a major portion of the day. The private practice setting is probably more appropriate once the teen has advanced well into the recovery process.
Other potentially problematic issues in private practice settings are confidentiality and the manipulativeness of the teen substance abuser. The individual practitioner must rely on his or her own expertise to make informed judgments in matters of confidentiality and patient manipulativeness while these issues can be avoided in larger more structured settings.
The psychotherapist must be well experienced in the treatment of adolescents, particularly with those who abuse drugs and alcohol, knowledgeable about drugs and alcohol and their effects, and familiar with the community in which the abuse behavior has occurred. Additionally, there needs to be a willingness to engage with the abuser's family and school system and in some cases, the criminal justice establishment. Thus the individual practitioner will frequently be called upon to act as an advocate for the teen and this will often blur the traditional ngbtral psychotherapist role.
That role is further impacted by today's managed care environment which limits the directions and time available for the therapist to utilize in the professional management of the teen patient. The documentation paperwork and treatment certification requirements often act as contraindications for agreeing to work with these patients.
Thus it is likely that private practice psychotherapy for substance abusing adolescents is more available and indicated in more affluent communities where concern about insurance reimbursement is not a critical issue.
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