Chris Mushadu

Therapeutic breathing is not a magic trick — it’s a fast way to downshift the body so your brain can think again. A registered counsellor will teach paced, diaphragmatic breathing and simple breath‑holding or box‑breath protocols that reduce sympathetic arousal, lower heart rate and calm panic symptoms. In practice we pair those skills with cognitive and behavioural work: you learn to use a breathing technique at the first sign of craving or dissociation, then name the trigger, test the thought, and use a coping plan. It’s evidence‑based as a regulatory tool but only an adjunct: breathing reduces intensity and gives you time to apply coping strategies, it does not treat severe withdrawal, underlying trauma, or uncontrolled psychiatric illness on its own.

A competent, registered counsellor will escalate quickly when safety or medical complexity is present. Red flags include severe alcohol or benzodiazepine withdrawal (tremors, seizures, confusion, hallucinations), suicidal intent or psychosis, pregnancy, major medical comorbidity, or repeated failed attempts where medication‑assisted treatment is indicated. In those cases the counsellor should liaise with GPs, emergency services or inpatient units, provide a clear safety plan, and document referrals. If you’re in a low‑resource area, the counsellor should still make a medical referral and help navigate public hospital admissions or sheltered care rather than asking you to manage acute risk alone.

Yes — but it’s skilled work, not moralising. A registered counsellor will coach family members on concrete behaviours: how to stop paying debt, how to refuse transport when someone is intoxicated, how to keep medication and firearms safe, and how to separate compassionate support from enabling. They’ll map relapse triggers specific to your household, run role‑plays for difficult conversations, and help set legal and safety steps for high‑risk situations. Confidentiality and consent matter: adults decide their own treatment, but counsellors can work with families to manage safety and support without violating ethical boundaries.

Evidence‑based therapies — CBT, DBT skills, motivational interviewing, trauma‑focused work and, where appropriate, EMDR — are flexible frameworks, not imported scripts. A registered counsellor in Johannesburg will tailor examples, homework and relapse plans to local patterns: dealing with peer networks where tik or nyaope is common, managing house parties with heavy drinking, or navigating informal housing and transport barriers. Treatment often blends individual work with community resources: group therapy, peer support, and practical case management. Expect realistic, context‑sensitive goals (stabilise sleep, reduce binges, manage triggers) rather than one‑size‑fits‑all programmes.

Ask for credentials, scope of practice and who clinically supervises them; an honest counsellor will explain what they can and cannot do, and when they will involve doctors or inpatient services. Demand a clear, measurable treatment plan with short‑term goals, crisis procedures and regular reviews. Red flags: promises of quick fixes, refusal to coordinate with medical or psychiatric providers, pressure to buy long, expensive packages without clinical justification, or no plan for withdrawal management. Finally, check experience with local substances and community resources — clinical skill matters more than marketing, and a registered counsellor should be able to explain how they’ll adapt evidence‑based therapies to your family’s reality in Johannesburg.