How do problem gamblers morally manage their identities while in therapeutic conversation?

1. Position C: Taking ownership (++)

1.1. It is not their job to make me better (gambler F)

1.2. I got myself into this mess. I told the therapist it was important for me to dig myself out, and I needed their help (gambler F)

1.3. Not any different that my issues with money or relationships. Once I reached a point, I knew how to get better. I remember telling the counsellor I had reached this point. I had to ‘step-up’ and take responsibility for my actions. I asked the counsellor how I could put this into practice, not just talk about my gambling (gambler A)

1.4. My daughter has a hard time with some of her classmates. I talk to her about taking charge, talking to the teacher. Part of the responsibility in stopping things, I believe, is stepping up. Same thing here. I need to step up, own up, whatever (gambler C)

2. Position A: Conversational Agency (++)

2.1. I wanted to be part of the solution. I told the therapist we should talk more about ways to help me deal with the present, and less on my past (gambler B)

2.2. Well, as far as I can recall she (the counsellor) sort of got quiet, her mood changed for sure after I asked if we could work on some skills. The other stuff was ok, but I needed to walk out of there with something I could put into practice. I am not sorry I said that (gambler F)

2.3. I challenged what the therapist was saying. Really, ill? There is no way, and I told him so (gambler A)

2.4. It became clear early into the session that what I thought was going to happen in terms of therapy just was not going to happen. I remember asking for a time out (gambler D)

3. Position I: Missing Position II - Colaboration (+++)

3.1. Collaboration

3.1.1. Sure, maybe delay would be a better word than avoidance. I know at some point I will have to talk about these difficult topics, but on occasion, I decide to postpone, to talk about something else. Maybe with my clients who gambled I have the tendency to steer a bit more…maybe (counsellor C).

3.1.2. At times it felt like my words were falling on deaf ears. You have an issue that is taking you down with it, something needs to happen. Frustrating (counsellor A).

3.1.3. After many years in this profession, perhaps I am jaded. It is hard at times not to oversee a client sitting in front of me that doesn’t want to engage. This is why private practice is harder. When I am at the clinic, we can go slower, no pressure. But in my own practice, if it is not a free ½ hour consultation, then I feel as if things need to be moving along. Perhaps I lose trust in the client in some way (counsellor A)

3.1.4. Sometimes taking a hard line with clients is important. The same as other professions, people will come in, and they want help. I went out for coffee with my sister a few weeks ago, and she asked me about the study. She also told me that in her first marriage she lost a lot of money on a trip to Vegas. Now, she is a good person. If it can happen to her…(inaudible). This makes me rethink how I will work with gamblers in the future (counsellor F).

3.1.5. I guess I didn’t understand what gambling was all about. I struggled with clients who had families relying on them for food and shelter spending their paycheques at the casino, lottery, whatever. I don’t think my perspective of telling the client they needed to change did much good. I believe engaging with the gambler in a way that is much more empathic, more relational would be beneficial (counsellor E).

4. Position E: Deference (- -)

4.1. You could describe me as a thinker. I often will pause before speaking. My counsellor was always talking. Sure, interesting stuff. But I need time to pause and reflect. I was still digesting what they said about addiction, and they were off onto something else. The whole process was a bit infuriating (gambler E).

4.2. I was angry. Honestly, I was taken aback, and I didn’t know what to say. I was more upset later on. I thought about bringing it up at the next session, but somehow it just sort of escaped me. I never forgot it though. Still haven’t. Obviously (laughs) (gambler F).

4.3. This client was agreeing with everything I said. They had a true problem with gambling, so I even stopped the session to ask them if everything was ok. They looked as if they wanted to tell me something (counsellor A).

4.4. They (the counsellor) seemed ‘off’ somehow. Different than in our two previous sessions. For starters, they used the word “addiction”, a word we had talked about not using previously. I chose to bite my tongue and not call them on it (gambler C)

4.5. I did not feel like it was the right place or time to tell the counsellor I saw my problem with gambling in a different way. In GA, I was able to talk about how much I loved to gamble, that it was normal to have these thoughts. My counsellor told me it was important to push those thoughts aside, and instead focus on positive things. I chose not to bring this up, as there were other things going on that I felt were positive (gambler D)

5. Position G: Enactment (- -)

5.1. My client kept talking about the importance of the serenity prayer, how they were powerless to help themselves (counsellor A)

5.2. Something about the narratives they offer, and what they hear from others seems to resonate more than what I could offer this client in my office (counsellor B).

5.3. Yes, it (the gambling) was an issue. Yes, it was a problem. But it was not like I had a cancer, an inoperable tumor. I wanted the counsellor to smile, to use some levity. There were so serious about it all. Things got better on their own, or at least improved (gambler B).

5.4. The prayer…the serenity prayer was really powerful. After the meeting, I was having a smoke with one of the group members outside, and he had been coming to meetings for the past couple of years. I related to this man, who saved his marriage by admitting he was powerless, and needed help (gambler B)

5.5. Hearing from others about being in “recovery” in GA was helpful. The word was not dirty. For me it symbolized putting something in the past. I don’t think the counsellor I saw through the health authority understood why my outlook had changed so fast (gambler E).

6. Position B: "Resistance is not resistance" (++)

6.1. I wanted to say "hey this is my life and I have a right to disagree". I can’t remember exactly what I said, but I was just tired of feeling as if I was a bad person. It helped in the end I think, me being gently oppositional (laughs) (gambler C)

6.2. I didn't want to upset him (counsellor), but I was not accepting the diagnosis. I wanted to agree, but it didn't feel right. That was awhile ago now. I know more about therapy today than I did then, but I still think it was important for me at the time. I like to think that was a turning point for me (gambler E)

6.3. I can appreciate how clients do not agree with things I say in sessions. One of my recent sessions with a gambler was quite lively in this regard (counsellor D).

6.4. I know if a client is resistant they are engaged in their own therapy, and that is good. Maybe not easy for me at times (laughs), but good all the same (counsellor A).

7. Position F: Masking/Unmasking (- -)

7.1. When I went to the public clinic, there is a waiting room where everyone sits for their sessions that all start on the hour. I sat across from a young lady who looked rather anxious, and I could smell some sort of alcohol mixed with a heavy scent of wet tobacco. It makes me feel shitty about myself thinking about it now, but at the time there was no way I was going to go into my first session telling a complete stranger that I was a closet drug fiend and had a huge appetite for playing cards. Instead, I told the counsellor I had issues with sleep, and could not relax (gambler C)

7.2. Even walking out of that first session I had some regrets about not coming clean. It stayed with me for days, that feeling. The next session was two weeks away, so I had lots of time to think about it. My counsellor was glad I brought it up (gambler C).

7.3. It was a big deal for me. This is stuff I kept to myself for years. Therapy was scary. It took me awhile to warm up to the process. My counsellor was insightful and kind, so this helped me relax. I was able to loosen up and talk (gambler D).

7.4. I didn’t want anyone to know about what I was doing. Can’t think that I would be the only gambler to feel that way (laughs). I recall almost stuttering when the counsellor asked me to talk about it. It was embarrassing. It took a while, but he (the therapist) helped me relax, and then I could talk about it (gambler F)

7.5. Surrounded by so much negativity, it is crucial to take away the pain and hurt. Sometimes it starts with the first session, sometimes it comes later. But with gamblers, helping them understand they have a choice not to gamble, that seems to change things for the better. That is why I tend to use the words such as ‘clean’ and ‘choice’ as they alter how gamblers think and feel about themselves (counsellor F)

8. Position D: Choosing to End Therapy (++)

8.1. I got a message from a client stating they felt we had gone as far as we could go (in therapy) together. They didn't mention if they were still gambling or not, if the addiction was still in play (counsellor A)

8.2. I wanted to feel different, than how I felt talking to the therapist. I felt better not going than I did going (laughs) (gambler A)

8.3. So, with this guy (the counsellor) things were framed in a way that I had to change to become a certain type of person, or that was my read on it at that time. In GA, I just show up. I could even have come straight from the casino, no worries, just show up (gambler A)

8.4. My choice was to walk out. It left me feeling empowered, that I took control of life in some way. I didn’t mean to hurt the feelings of the counsellor, and I did leave a message on their machine a few days later (gambler D).

9. Position H: Ritualized Utterance (- -)

9.1. I liked to be able to stand outside, have a smoke and a coffee, just connect with others and relax. Sometimes I would talk to the others about the topics discussed earlier, and it was comforting have others talking it in ways that made sense to me. I couldn’t really have similar talks with other people in my life (gambler F).

9.2. My counsellor asked me why I chose to say that I was ‘in recovery.’ She said, “will you ever be able to say you are recovered?” I told her that in many ways I was a ‘dry-gambler’, just like a ‘dry-drunk’; something we talked a lot about in the step meetings (gambler F).

9.3. The hall is cold and dank. Just like my home (laughs). But I know that my story will be heard, others will respond, and I will not have to listen to anyone, regardless of their years of abstinence give me their opinion about my life. They frown on this in meetings, and I guess it works for me because when others try to talk over me at work or social settings or whatever, I just clam up. This way, there is a pattern, and I know how it works (gambler E).

9.4. I think it is challenging to provide gamblers, or alcoholics with a suitable framework when it is just the two of you in the room. I can definitely provide empathy, relaxation and coping skills, but I don’t have the background that another 20 plus gamblers in the room could offer (counsellor B)

10. Position J: Missing Position II - "Calling it like it is" (+++)

10.1. After the last focus group, I remembered seeing a young man of Asian descent a couple of years ago. His family was coming to visit, and now he had to figure out a way to tell them he had to sell the house to cover his gambling debt. When I think about our conversation, I wonder if I could have approached it differently. I don’t think I really understood, or asked him about what it was like being from a different culture, how that impacted his view of self, of gambling, or being responsible for his family. If he came through the door tomorrow, I would want to ask him about these things (counsellor A).

10.2. I have a new appreciation for what it is like for counsellors. In hindsight, when I was talking to a counsellor, I may not have been ready to talk about the stigma I felt, and in some ways that changed what good I was going to get out of therapy. Having taken some time to think about this, I believe this is really important for any gamblers who come to counselling, to know their stigma will be discussed (gambler B)

10.3. I think problem gamblers are viewed a bit differently than others. What I mean is although they are categorized under the same heading, addict (emphasis in original) it is not understood in the same way as, say drug and alcohol issues are. I think gamblers are more likely to be held accountable for their actions, and maybe this needs to be talked about early in the counselling process (counsellor C).

10.4. Yes, but is it enough? I think what we are getting at here is that an increase in public awareness into the stigma felt by problem gamblers is important, yes…but I feel we could all look at how we deal with the stigma with the client in front of us. We are all counsellors, right, it is what we do (counsellor E).