Finding Hope in a Marginalized Population


One Trainee’s Experience Working with Pregnant, Drug Addicted Women
by: Lara Windett, M.A.
(November/February 2004 The Therapist)

When entering a Masters program with the intent of becoming an MFT, I was uncertain about what population of clients I would work with, or how my journey to become a clinician would unfold. As I was supporting full time night classes with my day job, I jumped at an opportunity to volunteer evenings for the county of Santa Clara in their Department of Drug and Alcohol Services. After being accepted into the county’s “Discovery” program for MFT interns/trainees and some onsite training with the county, I began to run groups and see individual clients on Friday nights. I saw first hand with each client’s individual story how abuse/dependence on drugs and alcohol decimated an individual’s life on multiple axes.

After a few months with the Discovery Project, I interviewed for a part time position at the Perinatal Substance Abuse Program. I knew that I wanted this chance to work with a very marginalized population and after a sleepless night or two, left my high-tech marketing job for good and was hired by the county.

I started out running groups as part of a treatment team that included a physician specializing in women’s addiction medicine, a Public Health Nurse, a Heath Educator, four counselors who ran groups and carried client caseloads, and an overall program manager. There are a number of classes and support therapy groups daily at the clinic, with clients typically attending twice a week for 3 hour blocks. This intensive outpatient approach coupled with on-sight daycare, free transportation, and a kitchen with food for the clients adds a nurturing touch that helps the clients feel welcome. The staff works well together while each clinician has their own style and therapeutic approach. I continue to be impressed by the physician’s and nurse’s willingness to answer my medical questions, as well as their compassion and patience with the clients. I have had two excellent supervisors with different perspectives that each enrich my learning and the client’s experience. The psychic as well as physical collapse that my clients experience envelopes their lives. Multiple medical issues are prevalent, hepatitis C being frighteningly common among needle users and very poor dental care running rampant. Many clients began having children in their early teens and are on child number three or four by the time they get to this county program. While my clients are motivated to get medical care for their children, part of my role is encouraging them to engage in self care and get medical attention after years of neglect.

Much of what I loved studying in graduate school-object relations theory, attachment, and specifically Winnicott’s notion of the “nursing couple”-took on experiential meaning. Often, the threat of losing or having lost a child to “the system” (social services) motivates women to make some very big changes in their lives, of which staying clean from drugs and alcohol is one step. Part of being a “good enough” mother means maintaining sobriety or containing a relapse. In addition to achieving sobriety, the program focuses on helping women gain tools to become the mother they never had themselves.

Now, reflecting on client progress, I realized that my first client has been with me for almost a year. When I met 25 year old Amy, three of her five kids were in foster care, her mother had adopted her eleven year old son and she had her four month old daughter with her after delivering the baby in a residential care center for pregnant addicts. Losing her children was the pivotal moment in her life when she knew she needed to make some very significant changes. In one family session with her youngest daughter she said that this baby gave her back her life because she stopped using methamphetamines when she found out she was pregnant, shortly after the removal of her other children. She cried and said that her other kids weren’t active as babies like this one, and she now realizes that she had neglected them while getting high. As she put words to her worst life experiences and lifted some debilitating shame, new strength and resiliency was uncovered. Over the past nine months, she has lived in a county run clean and sober transitional housing unit and recently reunified with her three removed children. This client helps me see potential in what first may appear hopeless and unmanageable. While I am excited about my job and talk with my classmates, I now rarely discuss the population I work with in mixed company; I have become tired of defending against the common response of “how depressing.” That is the opposite of how I see my work! What is “depressing” is when clients drop out and never come back to treatment. Many have had very sad lives, but are not chronically sad and find new hope in getting clean and parenting their children. When they are engaged, there is nothing more alive and positive then sitting with a client and watching them move towards health. If I can help hold the door open for a client to experience feelings and attempt change, then I am present when someone else starts to become a real person.

What I have learned in the past year besides the efficacy of “harm reduction” is that each client wants-with some small or large part of themselves-to be a mother to their children. Drugs and alcohol get in the way of their ability to parent. If clients can begin to connect with others and talk about past wreckage and poor choices around substance abuse, they can begin to heal. Progress is made in the moment when a client feels heard and when he/she creates space between the thought of using and the action of getting high. Tolerating the urge to use can be a moment to moment accomplishment and the staff as a whole gives a lot of support to clients who relapse and come back and talk about what happened.

As I spend this year in Practicum, I am fortunate to have the supervision by SCU as well as group and individual supervision at the county. Multiple perspectives help me build my clinical skill and I plan to continue to expand my knowledge and experience in the disease of addiction.

Lara Windett completed her practicum at Santa Clara University’s Masters in Counseling Psychology. She works for the County of Santa Clara in their Perinatal Substance Abuse Program. Her interests include women’s issues specific to addiction and applications of object relations theory. Lara can be reached at

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