Walking with Patients Through Resistance

David Condos: Hello and welcome to this episode of Recovery Unscripted, a podcast powered by Foundations Recovery Network. I’m David Condos. My guest today is Jennifer Angier, a veteran addictions counselor who now serves as CEO of Talbott Recovery in Georgia, which offers specialized programs for professionals like doctors, nurses and lawyers. She sat down with me to share how her own personal journey has influenced the way she meets patients where they are and why it’s so important to listen to each individual story before doing anything else. She also explains how we can reframe 12-Step concepts to help patients overcome their points of resistance and tell their stories through the eyes of truth. Now, here’s Jennifer.

David: I’m here with Jennifer Angier. Thank you so much for being with us today.

Jennifer Angier: Thanks for having me.

David: Yes, of course. First off, let’s have you tell us a bit about your own personal story and the journey you took to get started in the world of recovery.

Jennifer: I hit a bottom with alcohol and drugs at a very young age. I was 18, but for me, the bottom really came earlier than that. It just came from being in my own skin. Alcohol and drugs weren’t a problem for me at first. I know this sounds cliché, but they were the solution. They were the solution for what it felt like to be inside of me. The problem for me came when they stopped working, when I felt alone back inside my own skin again.

That became the bottom for me, and there was no barrier between me and the world. I went into treatment in a time in the ’80s when treatment was very accessible for folks that were younger. I was able to stay in treatment for a couple of years. During that time away, I was able to start to uncover why it felt so difficult to be without alcohol and drugs. It’s taught to me from the very beginning that if I didn’t have a problem with alcohol and drugs, why did I have such a problem not having them in my system?

[chuckles]

Sober for me was always the issue. It didn’t matter what the consequences were of drinking and using, they weren’t as bad as not drinking and using.

The issue for me was that they stopped working. I’ve heard that story so many times with people that the desperation comes when there’s the silence of a solution. Getting sober was extremely challenging not just because of the physical dependence on the drugs, but because I didn’t know how to live in my own skin. Knowing that the solution was gone, that grief was overwhelming, the depression was incredible. To be able, though, to for the first time in my life look back and see the truth about my relationship with alcohol drugs took time.

Treatment for a few years and really finding my solutions as I worked through the 12 Steps and work through the issues of having to do with diagnosis. Somewhere along the way, I realized that this is what I needed to do. I wanted to work around people that were looking for the truth about who they were and that had found that solution. I wanted to be in the presence of that.

David: It sounds like, like you said, you’ve heard your story for a lot of people where once they decide to stop using or stop drinking, they have to meet themselves for the first time because they’ve had this buffer between them and the world.

Jennifer: It was more terrifying to me that it wouldn’t work to be sober. To hear that there was a solution was even scarier than not knowing there was one because my history, my experience said it wouldn’t work for me. For my first couple years sober, I was so afraid. I was so afraid all of the time that I was going to mess it up, that I wasn’t going to be able to stay sober. I’m so grateful for all the men and women who just assured me that it could work, that I had to be where I was at that moment to be able to recognize that I was sober, and that I wanted to be sober, and that the disease was treatable.

David: You’ve been with Foundations for a while now, right? Can you tell us about how you got started there and how you came to serve as CEO of Talbott now?

Jennifer: My first job in the industry was at a place called Safe, which was a Talbott program. Dr. Talbott and Mr. Underwood, the CEO of Talbott, started Safe. Even after Safe, I worked at Talbott as it is today. While I was at Talbott, I was approached by the people at Foundations and heard about our model and how we approach patients and the love, and the kindness, and the dignity that we afford them. I couldn’t not come.

I started an outpatient program in Roswell, Georgia. I got to open that, and then was able to be a part of Black Bear as the CEO of Black Bear. When Talbott came into the Foundations company, we had an opportunity to step back in, and look at it, and see what their needs were. I’m back at Talbott as the CEO with the number of people that were there when I was there. The history and the legacy of Talbott runs very deep.

David: Yes, I know a little bit about Dr. Talbott himself, and the seminal figure that he was, and the role that he played. Could you give us just a brief history of that? Because that’s something we haven’t covered before.

Jennifer: Dr. Talbott was an incredible man. I got to work with him when I was at Talbott previously. He was really, truly one of the first people that had a role in breaking the stigma of the disease of addiction. He was seen as someone that sold snake oil. He stood on any podium that he could and described the disease of addiction. For him, the most important message was to get to the people that were suffering so silently. That was, in his mind, a lot of the professionals. Dr. Talbott and Ben Underwood started a program specifically for impaired professionals. At the time, it was just for physicians.

The belief and the truth is that physicians to have access that most don’t. Families are dependent on their income, they’re dependent on the prestige, most people around them in the workplace and in the home are used to them being right, are used to them being able to explain things. A lot of their alibis would stick. The other issue is that they couldn’t fit into the regular milieu of other patients. Other patients would defer to their professional opinion, there was another same level of confrontation or the same level of connection between their peers.

David: That’s interesting, the thing about the interaction between them as patients with other non-physician patients.

Jennifer: They don’t settle into a community as well as they do a community of their peers. From that, we started to treat lawyers, and then nurses and other professionals who have a risk on society, a higher risk of access, a risk of accountability, all of those different types of things. Also, within the milieu, with other peers, they challenge each other in ways that is very specific to who they are. At Talbott, we separate out patients in specific groups, by their profession. Otherwise, they’re mixed in with the whole population. That dynamic of working together is something you just — You have to see it to see the power of how those communities work together.

We also get to address the issues for a little bit longer than most places. A good number of our folks stay with us for 60 to 120 days in their primary treatment. While they’re there, we don’t keep them away from their life. They go home on passes, they have to attend to some issues around work, they have to attend issues of consequence, which are huge in their field. Also, the other thing that is important for professionals is that accountability after treatment.

Our physicians, our pilots, our lawyers are monitored for a very long time with drug screens. They meet with their peers on a weekly basis. The biggest need is to be able to challenge their intellect, to help them to use the tools that they already have in place rather than to avoid them. A lawyer is really good at finding, they’re really good at finding a number of different ways to look at an issue and look at a problem. If you meet them head on around their disease, they’re going to have a justification or an argument on either side of it, but use that same skill, they are able to see both sides of the truth as well.

David: At the Moments of Change conference, you presented on helping patients who show some resistance to treatment. You specifically talked about the 12 Steps. First, could you start by describing some of the different types of resistant patients that you might encounter?

Jennifer: Well, first, what I encourage professionals to do is look at the term resistant, to really challenge themselves, to see that just because they aren’t feeling connected to what that patient is presenting with, that it isn’t necessarily the patient is resistant. Just using that term resistant to describe a patient to another professional limits the whole person and telling the story of the real person that sits before you. The term resistant could be used to describe a patient who feels like there is no chance of them ever getting sober. They’re so desperate, they have no hope, they’ve tried before, and they just think that there’s nothing you can offer them that’s going to work.

You could also use the term resistant when you meet a patient who says they don’t have a problem. There’s nothing wrong here except something that maybe cutting back couldn’t help. You could also use the term resistant when you’re talking about a patient who thinks, “Okay, I definitely have a problem but the solution is very simple. Just stop drinking and using.” What I encourage us to do in the industry is stop labeling with those type of words that immediately put the patient on the defense, and us as the one that knows more about them than they do.

Just really hear the story of what is the barrier to them seeing the truth about what’s able to happen in their life with recovery. A patient that has tried the 12 Steps multiple times and says, “I don’t want to go to AA meetings. I don’t believe in AA. I don’t connect to that.” Most often, the intervention there is to say, “Well, when you’re ready to get sober, then you want it, you just come on back to treatment.”

They see the inability to connect with 12 Step program as some sort of fault or dishonesty that the patient has towards himself. I don’t see it that way. I can’t imagine the terror that they experience when they’re hearing every single day, “The only solution for alcoholism is AA.” Yet, they know AA is not available to them. Imagine if you had diabetes and you knew for a fact insulin wasn’t going to work for you.

For these people, the fact that they’ve made it this far and held on waiting for something that’s going to work, again, I see that as courageous. Somebody that’s open and willing to find another way. We start to talk about what are the barriers to accessing a 12-Step program? What are the barriers to working that 12 Steps in their purest form without connecting them to a group of experiences that you’ve had before? Literally just having conversations with them about, “Tell me about the 12 Steps, about what in here doesn’t feel right for you or doesn’t feel like it’s going to work for you?” Most of the time, just reframing those words alone can open that and act up for them.

David: It sounds like you really have to understand the reasons why the resistance, or whatever you want to call it, is manifesting itself before you can figure out how to help them because it could be any number of things happening underneath.

Jennifer: It simply just to listen to their story. I had a mentor a long time ago that told me that I don’t know more about them than they do. There’s this feeling that so many patients have of not being listened to, of not, “You don’t even know who I am.” All along, they’re just asking for somebody to listen to what they’re struggling with. Also, it lights them up. For so many of our patients, they’ve lost a connection to what fuels them, even if it’s baseball or gardening. There’s so much information in that about who they are as a person and what they can hope for.

David: Now, another thing that you talked about in that presentation was describing what it means to walk through the resistance with patients as opposed to fighting it. Could you tell us about what that means to you?

Jennifer: For me, it’s a privilege. I was just sitting with somebody in our call center. They were overwhelmed by a call that they were just experiencing with somebody, where they were talking about the loss of their child and the loss of their brother, and that the only person they had left was their sister who was looking for treatment. Just to be on the other end of that call and to be the person that gets to hold that fear and that willingness of that person is such a privilege and an honor.

Just recognizing the responsibility of the role, I think, is the first thing that we have to do. Then to be able to see along the way how that person is making tiny little pivots and changes in themselves and to stay current with that. The conversation that may have worked with one patient doesn’t work with another. The conversation that may have worked with your 6-year-old isn’t going to work with your 12-year old. As that person grows, and their spirituality, and their understanding, they need something different.

David: Another thing related to this is how you said that that point of resistance is actually a great opportunity for treatment providers or people who are helping them along this journey. Why is that? Why do you say that?

Jennifer: I love it when somebody just comes to that place of desperation where their solutions aren’t working, and you’re certainly aren’t enticing her or working at all. Abraham Lincoln, I think, described it so beautifully. He said, “I’ve been driven to my knees many times by the overwhelming conviction I had no place else to go.” One of the things that patients may struggle with, that they hear in recovery, is that you have to hit your knees, right? You have to pray on your knees. They’re told if they don’t do it, that they’re not showing a willingness towards spirituality.

I don’t know that it ever really made sense until I read a book called Spiritually of Imperfection. What he said is, “It’s not a directive of a God that we have to hit our knees. It’s where human beings go when they have no other answers. They just fall to their knees.” We can connect spiritually when we do that, but we also connect to the collective unconscious of all those who’ve come before us that didn’t have an answer. That pinnacle, that place of resistance, I think, brings us back to humanity, which is for alcoholism, one of the places we exit first. We close up those connections to people. To me, that place is a reconnection to that.

David: Like how you’re saying, all the reasons behind hitting your knees, it made me think of — It’s also just a posture of humbling yourself and saying, “I don’t have all the answers right now. I need some outside help.”

Jennifer: Where do we go when we don’t have answers? We’ll go to a library to look, we’ll google it, we’ll look, we’ll ask. When it comes to our own mental health, when it comes to the devastating disease of alcoholism, I’m so intrigued by how many people show up and think that the answer has to be completely within themselves. We don’t do that with anything. We don’t bake cookies without most of the time somebody teaching us or asking how. I find the person that is standing in front of me terrified to be extremely courageous. I want to help them to recognize that that person blindly not seeing a way, just being here in this moment is more courage than most people ever have.

David: Another thing you mentioned was the concept of the stories that people tell themselves during this journey to maybe justify their addiction, and then how those stories have to keep getting more sophisticated as the addiction continues to fool themselves or whatever that might be. Could you unpack that idea little bit more and explain how that plays into resistance and what we’re talking about?

Jennifer: I use the term stories when I talk about what The Big Book of Alcoholics Anonymous described as the alcoholic mind. Most professionals use the term denial, which I have found to be a completely useless term when I’m trying to help somebody understand. A story is what I tell myself to justify the drink. A story is what I tell myself to explain the dissidents and what just happened. It doesn’t make sense why we do what we do. It doesn’t make sense to live the way that we live.

When I was using, I didn’t have a cocaine problem, I had a money problem. I kept running out of money, there was no cocaine problem. If I had money, I wouldn’t have a cocaine problem. That was the story. I knew there was something wrong, so it’s not completely lying to yourself, it’s just moving the needle a little bit over towards what we can see the problem is.

There’s a line in The Big Book of Alcoholics Anonymous that says, “It’s the thinking that precedes the drink.” That, we think, is the crux of our problem. They don’t say it’s the drinking that’s the problem, they don’t say it’s the drunkenness that’s the problem. They say it’s the thinking that precedes the drink. That thinking that precedes the drink is what I describe as the story. The problem with those stories isn’t just a face value that they keep us from knowing the truth about our drinking, they keep us from knowing the truth about who we are. We believe them fully, completely 100%.

David: The more you hear it, the more it becomes reality.

Jennifer: That’s who I am. The ability to tell those stories through the eyes of truth is not an easy process. That’s why I believe, personally, in being surrounded by others during that time. To be able to to look back at your drinking and say, “I stopped breastfeeding my child so I could drink. How did I justify that? I didn’t go to my child’s soccer game, I left him there.” There was a story that made it okay, and it’s just simply not okay.

All of a sudden the stories have no sway, and it’s devastating. Truly, the work of recovery is to be able to see the truth about all of it. Usually, the first truth is, “How did I miss this? How could I have not known this was happening to me?” I try to describe what I believe stories to be, and most alcoholics and addicts that I’ve worked with connect to that. They relate to that. They’re able to see because for so long, they’re being just told that they are lying. We do lie, but the story is the justifying of the lie.

David: Moving back to the 12 Steps, specifically. Now, how can treatment providers maybe do a better job of making the 12 Steps accessible to everyone? I know you’ve touched on that a little bit, but could you just talk about some of the different pathways you’ve seen to be effective for different types of patients?

Jennifer: I think the first is to find out where they feel the resistance. Let them tell you that, and then try to help them see how something that they do on a regular basis is mirrors, the work of the steps. Back to the professional. Look at different ways that they take inventory in their profession. That without an inventory, they wouldn’t be able to function professionally. Ways that they rely on, something bigger than themselves and their profession.

David: It makes me think like a pilot. They know how to land the plane, but they still need the air traffic controller in there telling them that the lane’s open, they’re not going to crash another plane. They still have that example of relying on someone outside yourself.

Jennifer: They don’t just stop and say, “Well, that air traffic control is not nearly the pilot, I am. They’re eyes and ears, but they can’t see there are, at that moment, a power greater than themselves. A cardiac surgeon is going to know a lot about the heart, but you get down to the nitty-gritty of it, they’re still going to step back and go, “That is a heck of an instrument,” and have that little piece of awe. It’s there, it’s in them. For me, the 12 steps are about moving everything out of the way so we can have access to the truth. Clearing the runway [chuckles] so that plane can land safely. Then teaching somebody else how to do it, and that’s a pretty simple concept that most people grab hold of if you just hear what will work for them.

David: All right. To wrap up, I know you’ve given a lot of yourself to this world over the last couple decades in many different capacities. Could we close by having you just say a bit about why helping people find recovery is so important to you?

Jennifer: I don’t know where to put all of this. I don’t know that would fit in any other type of work. It’s just what I’ve been built and gifted to do. I get way more out of it than I will ever be able to give. I’ve been given more from people, mentors, guides, than I’ve ever, ever even given. I’m just really grateful every day that I get to do it.

David: All right. Thank you for your time, Jennifer.

Jennifer: Thank you.

David: Thanks again to Jennifer for joining us. Now, I’m happy to welcome Will Hart from the Life Challenge team. He joins us each month to give us an update from their community, which is the aftercare support network for those who have gone through foundations treatment programs and anyone else up for accepting the challenge of living life in recovery. Last month’s challenge was to choose a word to live by. Now, Will’s back to share the new challenge for this month. Welcome, Will.

Will Hart: Thanks for having me.

David: How are you doing today, man?

Will: I’m pretty good. Typical Monday. Just moving forward.

David: Excellent. Tell us about the new challenge here for February.

Will: All right. Well, we’re going to do treat yourself. Pretty straightforward. We thought February is like love month with Valentine’s Day and everything.

David: Don’t forget to love yourself.

Will Hart: Exactly what we were thinking.

David: Nice. You got some ideas? Some things to get people started?

Will: Yes. For me, I just got a haircut. Haircut was a good way to treat myself. The girls on the team were saying getting their nails done. It could really be anything. A massage, just taking some time out of your day, reading a book or something. The options are endless.

David: Cool, man. Well, like always, they can share it on your website.

Will: Yes, lcaccepted.com. We love seeing everybody’s pics and you guys doing awesome stuff.

David: Cool, man. Well, thanks for being with us today.

Will: Thanks for having me.

David: This has been the Recovery Unscripted podcast. Today, we’ve heard from Jennifer Angier of Talbott Recovery. To learn more about their work, visit talbottcampus.com. Thank you for listening today. If you like what you hear, please leave us a rating on your podcast app. We’d love to find out what you think. See you next time.