Clinical Approach

About My Background and Clinical Approach

I did not set out to be a specialist. In counseling school, I received the advice that every therapist should have basic competence in addictions, because addictions show up in every population. My early experiences in substance use work were so powerful, however, that I dove in deeper to learn as much as I could. Before opening my practice, I worked in recovery residences, intensive outpatient, and partial hospital settings, always primarily with substance use clients. This sub-field is my professional home.

People assume that addictions treatment is frustrating and depressing, and it often is. But it’s also fascinating, because addiction is really just one expression of the same issues underlying most unhealthy patterns. The need to numb or escape one’s experience; the self-destruction; the denial and rationalization; the pretending to be in control: such tendencies of addiction are present in all of us–part of what Carl Jung might call the shadow self. People with substance use disorders simply face more serious consequences. So even in the early, shaky stages of recovery, I see clients being more honest about themselves than some people ever will in a lifetime.

Sometimes progress ends there: admitting that there’s a problem. It is tempting to simply acknowledge that something is wrong, and then start talking about the weather. To actually attempt change is a much greater challenge. We’re not sure we want to defeat our shadow tendencies. We might even be identified with our dysfunction, not knowing who we would be without it. I see this dilemma not just with substance use disorders, but with many other behavioral and mental health issues, as well as in work and relationships.

Therapy can help people move through this mysterious realm, between acknowledging a problem and actually doing something about it. I gained this perspective working with addictions, but it guides my philosophy in all treatment. I show clients the greatest care and respect by believing in their potential, and helping them to keep sight of it even in dark times. People in recovery are capable of anything. To quote Hannah Gadsby (and to use “woman” the way we usually use “man”): “There is nothing stronger than a broken woman who has rebuilt herself.”

Rosalie Kuzma Genova

2022