08 Sep Luxury Treatment: Guidelines for Culturally & Clinically Competent Care
In the following article, which first appeared in Rehabs.com, I address what patients and families should look for when seeking addiction and mental health services from providers that hold themselves out as purveyors of “luxury” treatment.
Luxury Treatment: Guidelines for Culturally and Clinically Competent Care
Posted May 7, 2014 in Addiction Treatment Methods by Paul Hokemeyer
Addiction professionals are offered many opportunities for cultural sensitivity in treating the patients they serve. These can be broken down by a host of segments we can rattle off the tops of our heads: race, religion, gender, sexual orientation, disability and even diet. But what about wealth? When have any of us considered wealth, power and celebrity to be identity markers that require unique cultural and clinical interventions?
There are plenty of facilities that charge hefty fees and provide luxurious settings and amenities, but ask what they’re doing to address the unique issues elite patients bring into treatment and you’ll be met with a vacant stare.
-DR. PAUL HOKEMEYER
Unfortunately, too few treatment professionals ever have. When it comes to women, men and families of wealth there’s huge resistance to acknowledging that these human beings bring unique issues into the realm of treatment. Yes there are plenty of facilities that charge hefty fees and provide luxurious settings and amenities, but ask what they’re doing to address the unique issues elite patients bring into treatment and you’ll be met with a vacant stare.
As a clinician whose research and clinical impressions on the treatment of elite substance abuse patients have been widely published, I believe that everyone, regardless of his or her place on the power and income spectrum, deserves care that meets them where they are, rather then where the clinician based on their limited knowledge and experience expects them to be.
The truth of the matter is that elite patients, and the systems in which they live, are exceedingly sophisticated, complicated and nuanced. Typically the patients and families I treat have been through several programs and clinicians before they find effective care. Their emotional lives and the lives of their families have been ravaged by what is known as Addictive Interactive Disorder – meaning, their addictions manifest in several forms.
These often include prescription drug dependence, alcoholism, stimulate abuse, gambling, sexual infidelities, disordered eating and other destructive compulsions. They frequently hide behind facades of bravado and entitlement and are masters at manipulating the people, places and things in their external lives.
-DR. PAUL HOKEMEYER
These often include prescription drug dependence, alcoholism, stimulate abuse, gambling, sexual infidelities, disordered eating and other destructive compulsions. They frequently hide behind facades of bravado and entitlement and are masters at manipulating the people, places and things in their external lives. In addition, their addictions and destructive personality traits are supported by legions of enablers, “handlers” and other people who are financially dependent on the patient and terrified of change. In short, these patients with issues endemic to their socio-economic class must be treated with an appropriate clinical and cultural acumen.
Distinct Cultural Markers
Like other minority groups, elite patients have distinct cultural markers that are highly relevant to their treatment for substance abuse and mental health disorders. For starters, they are suspicious of outsiders and resist attaching to their clinicians.
This resistance to attach is perhaps the greatest hindrance to treatment and as such, requires clinicians to possess a keen mind, a honed intuition, a heightened level of maturity and an empathetic heart. In addition, elite patients occupy positions of power in the world. In contrast to other minority groups who occupy positions of powerlessness, elite patients enjoy high levels of external success and its accompanying influence. As such, they react negatively to authoritative clinical stances and must be approached collaboratively to acknowledge and build on their strengths rather than criticizing their weaknesses.
Money is an Energetic
Money is a highly charged and complex energetic. Like electricity, money’s energetic has both productive and destructive qualities; and like electricity, money’s energetic must be properly used and contained. For example, the patients I treat often use money in the following ways:
To control and manipulate others
As a substitute for an authentic ego identity
To “buy” their way out of problems
To distance themselves from others
As a substitute for intimate connections with family and friends
To medicate over the guilt they feel from being absent parents and partners
However, most clinicians fail to address these unhealthy dynamics while the patient is in treatment. As a result, once back out in their lives, the patient resumes using their wealth and power in ways that continue to erode the integrity of their interpersonal relationships and ultimately lead to their relapse.
Money is a Taboo Topic
The denial, rationalization and minimization of a significant aspect of the patient’s life cheat the patient and perpetuate the destructive interpersonal and addictive cycles.
-DR. PAUL HOKEMEYER
The failure to address these critically important issues is in large measure because of the fact that money remains a taboo topic in our culture. As a result, clinicians are resistant to raise issues of wealth, power and celebrity with their patients. Instead of addressing these topics as a dynamic that plays out in significant ways in their patients’ lives, they shy away from them and rationalize they don’t matter. The denial, rationalization and minimization of a significant aspect of the patient’s life cheat the patient and perpetuate the destructive interpersonal and addictive cycles.
Moreover, elite patients are resistant to discussing their wealth, power and celebrity with their clinicians; or, they use their elite status to impress, and distance themselves from their treatment team. Those who are resistant to discuss their wealth do so out of fear of being judged, objectified, manipulated and even extorted. Those who wear their wealth on a sleeve of bravado do so out of insecurities and low self worth. Both positions require smart clinical interventions that simultaneously honor, but also test the patient’s reality. Elite patients must be held, but they must also be challenged.
Elite Patients Require Distinctive Clinical Care
Elite individuals, their families and referents seeking effective treatment for substance abuse and mental health issues should look for clinically competent programs rather than those that merely provide luxury amenities. Central to this competency is the level of maturity and professional acumen of the entire treatment staff. A lovely view, gourmet food and high thread count sheets are good, but smart, committed and seasoned professionals are better.
First and foremost, look for clinicians who:
Understand the powerful energetic that wealth, power and celebrity interjects in their patients’ lives
Are not afraid of talking about money and it’s inherent energetic
Evidence clinical acumen and personal maturity
In my own practice, I look for dedicated and intuitive clinicians who have spent a significant portion of their professional careers and personal lives honing their craft. These are the men and women who have mastered the fine art and science of the psychotherapeutic process – not babysitters afraid of clinically confronting sophisticated and challenging patients.
The clinical team must be willing to use a variety of psychotherapeutic techniques that enhance, and at times will fall outside, the classic 12-step model. These include the Socratic Method of Inquiry wherein the clinician utilizes logical thinking and reason, Feminist Theory, which requires the clinician to work collaboratively with the patient, and experiential techniques that connect the patient with their emotions.
-DR. PAUL HOKEMEYER
In addition the clinical team must be willing to use a variety of psychotherapeutic techniques that enhance, and at times will fall outside, the classic 12-step model. These include the Socratic Method of Inquiry wherein the clinician utilizes logical thinking and reason, Feminist Theory, which requires the clinician to work collaboratively with the patient, and experiential techniques that connect the patient with their emotions. Used together this mélange of treatment approaches will honor their patients’ intellect and external successes while showing them how they can benefit from change.
Clinically and culturally competent care does not have an economic threshold. All patients, regardless of their place on the socio-economic spectrum deserve addiction treatment that honors who they are in the world rather than pandering to or diminishing their existence. Addiction treatment programs that market to high-end patients have a moral and ethical responsibility to deliver this heightened level of care. Luxurious amenities alone are woefully deficient in meeting this standard. Clinical care must be delivered through a sophisticated team of clinicians trained in the unique needs of their unique patient population.