Clinical Boundaries

Ann_Matino_Executive_DirectorWorking within the field of addiction treatment provides unique challenges to professionals with respect to keeping boundaries while providing compassionate care. When individuals working in treatment centers are also in recovery—and both staff and clients are involved in community groups and fellowship—lines can blur with the best of intentions. The opportunities for all staff forming more of a friendly relationship and less of a professional one are also increased in residential settings. One common issue is “over sharing.” Sharing one’s story is an important piece of recovery. When, however, does staff sharing details of their story become more about the staff member than about the client? How much personal information should clients know about their treatment providers?  Another issue can be the “physical comfort” aspect of fellowship. Many women in treatment have experienced sexual abuse and physical trauma and may also have deep rooted sex/love/relationship issues or addiction.  How do staff manage this for themselves, in community meetings and in the milieu?

Setting and keeping good boundaries requires practice, effort and professional collaboration—regardless of the role of the provider in the treatment setting. In addition to boundary issues specific to the substance use disorder treatment field, all staff should be aware of general boundary guidelines and principles of ethics set forth by behavioral health licensing entities—even if they themselves are not licensed or credentialed. One way to increase awareness of boundary issues is to have a forum to discuss case examples—perhaps in a staff meeting or before or after a designated training day. Specific training on this subject would also be very valuable as most staff want to do the right thing but need guidance in understanding boundary issues.

The Rose House is a 16-bed, gender-specific, dual-diagnosis treatment center in Boulder County, Colorado.  For nearly 10 years, our three-month-plus program has been helping women heal through evidence-based addiction, mental health, and trauma treatment.

The Rose House: Women get better here.

Ann Matino, LCSW
Executive Director, The Rose House

Harmony CEO speaks out about GOP sponsored bill

Yesterday, Congress voted to repeal and replace the Affordable Care Act with a new GOP-sponsored bill, which will now go to the Senate for confirmation. While this bill passed by a very small margin (217 votes to 213) it did pass. From a treatment center perspective, I would like to share my opinion (keep in mind this is my opinion) on the current proposed plan, as it relates to treatment.

For decades, treatment providers worked hard, lobbied hard, and ultimately gained parity for mental health and substance use disorders—meaning that these conditions needed to be covered “as any other illness” in health insurance plans. It was a giant step in getting care for those individuals suffering from diagnosed mental health and substance use disorders. The next step was the inclusion in the Affordable Care Act of treatment for these illnesses as an “essential benefit.” This was, in the eyes of those of us working in this field, a triumphant victory! Millions of individuals who previously lacked coverage for mental health and substance abuse treatment gained that coverage and were able to seek help.

The current plan would reverse the essential benefit provision at the federal level and place the decision of providing or not providing coverage for mental health and substance use disorders to each individual state. State legislators would decide whether or not to include treatment for mental health and substance abuse as required coverage within their state. We could see ourselves in a situation where families have to move state to state to purchase needed coverage, or where pre-existing conditions prevent addicts or alcoholics from obtaining coverage for treatment. This is not far-fetched. In my tenure at Harmony, I have seen insurance carriers refuse to pay for treatment under the pre-existing condition clause, just because an alcoholic went to AA before going to treatment.

I feel this bill is a giant step backward and very short-sighted. The potential impacts of individuals not getting appropriate treatment for these illnesses are numerous, frightening, and have been well documented.

Next steps? I am hopeful that the bill in its current form will not pass the Senate. I am hopeful that the changes made by the Senate (and there will be many) will re-establish essential benefits and protection for those with pre-existing conditions. I am hopeful that the Senate will not rush this bill through, as the House of Representatives did, and will carefully weigh the analysis of this bill by the OMB. The OMB’s report on the previous House bill estimated that over 20 million Americans would lose coverage. The House members did not bother to wait for a determination of this number for the new bill, and it could be higher.

Once modified by the Senate, the bill will return to the House of Representatives for another vote. I think it is critical—as concerned citizens with both personal and professional knowledge of substance use and mental health disorders—that we contact our congressional representatives and our Senators, and make our opinions known.