at Proctor Hospital
Journey to Recovery
Leave Well Enough Alone
Helping People Change:
Make or Break Denial
Humility — The Key
PERMIT NO. 135
MIDLAND, MI 48640
Table of Contents Winter 2005
Rick Zehr, M.S., C.S.A.D.C., P.C.G.C., MISA II
Steven Ingalsbe, M.D.
Ameel Rashid, M.D.
Chauncey Maher III, M.D.
Addiction Medicine Loses a
Randee McGraw, C.S.A.D.C., N.C.G.C., C.E.A.P,
C.A.D.P., MISA II
Pioneer, Advocate, Friend
Angie Moore, L.C.P.C., C.M.A.D.C., C.C.G.C., MISA II
On the evening of October 29, 2004, the addiction medicine field lost an innovative pioneer,
Patricia Erickson, R.N., C.A.R.N.
patient advocate, and friend when James D. Bowman, M.D. unexpectedly passed away. Dr.
Bryan DeNure, M.A., C.A.D.C., MISA II
Addiction Medicine Loses a Pioneer
Pamela Hillyard, L.C.P.C., C.A.D.C., P.C.G.C., I.C.G.C.
Bowman had been co-medical director of the Illinois Institute for Addiction Recovery at Proctor
Phil Scherer, C.S.A.D.C., C.C.G.C., MISA II
The Littlest Christmas Tree
Julia Ford, L.P.C., C.A.D.C.
Hospital since 1979. He helped the center grow from a chemical dependency treatment
A tale of growing and becoming
Lisa Brooke, R.N.
By Janie Jasin, CSP
Director of Communications:
program to one of the world's leading addiction treatment and training centers specializing in
At the Heart of Every Problem
the treatment of chemical, gambling, spending, shopping, food, sexual, and Internet addiction
2005 Targeted Publications Group, Inc. All rights reserved.
PARADIGM magazine is published quarterly by the Illinois Institute for Addiction
as well as the treatment of chronic pain with addiction.
By Abby Shields, M.Ed.
Recovery at Proctor Hospital with general offices at 5409 N. Knoxville Ave., Peoria, Ill.
61614. Bulk Rate postage is paid at Moline, Ill. and additional offices. PARADIGM is a
registered trademark of Targeted Publications Group, Inc. and is licensed to the
above publisher. No article in this issue and no part of this publication may be
Helping People Change
reproduced without the expressed written permission of the Publisher and Targeted
Publications Group, Inc. SUBSCRIPTIONS: Subscriptions in the United States are
What families can do to make or break denial
Dr. Bowman received his certification in Addiction Medicine in 1986, becoming the first physician in
$18.00 for one year and $36.00 elsewhere outside the United States. Back issue rate
By David Mee-Lee, M.D.
is $9.00. Send subscriptions to Eric Zehr, Proctor Hospital, 5409 N. Knoxville Ave.,
the Peoria area to be recognized as a specialist in addiction medicine through certification. While his
Peoria, Ill. 61614. Allow 6-8 weeks for new subscriptions. Allow 6-8 weeks for
change of address. For more information, phone Eric Zehr at 1 (800) 522-3784.
daily responsibilities at the Illinois Institute for Addiction Recovery included medical evaluation of
POSTMASTER: Send address changes to:
patients, management of acute intoxication and withdrawal of patients, and treatment of other medical
Alcoholism and families
problems or diseases while patients were in treatment, his special interests included withdrawal
By Robert W. Mooney, M.D.
5409 N. Knoxville Avenue
Peoria, Ill. 61614
management for not only chemical addicts, but also process addicts, the use of newly tested
medications for relapse prevention, and optimal use of the American Society of Addiction Medicine
A contemplative perspective
Patient Placement Criteria to support appropriate utilization of inpatient and outpatient care.
Cover Titled "The Littlest Christmas Tree"
By David J. Powell, Ph.D.
Book Peddlers — Bookpeddlers.com
Illustration by Pam Kurtz
In the early 1990's, he helped pioneer a comprehensive treatment approach to treat those addicted to
gambling, shopping, spending, food, sex, and the Internet. More recently, he helped develop the nation's
Page 8 Untitled by Ines
The Children's Art Project at The University of
Journey to recovery
most comprehensive chronic pain with addiction treatment program including a team comprised of a
Texas M. D. Anderson Cancer Center
By Roula Ghantous, M.A., N.C.C., L.P.C., C.A.D.C.
For a free catalogue of the Children's Art Project holiday
neurologist, anesthesiologist, physiatrist, psychiatrist, psychologist, certified addiction counselors, and
cards and gift items, featuring young cancer patients'
art, or to volunteer, call 1 (800) 231-1580 or visit our
registered nurses, all trained and experienced in treating chronic pain patients.
Web site at www.childrensart.org.
Profile • 4 My Life, My Choice
Page 4 Untitled by Aranda Michaels
By Lisa Goldblatt Grace, L.I.C.S.W., MPH and Debra E. Grollman, L.I.C.S.W.
Dr. Bowman was board-certified in Family Practice and maintained an active, full-time primary care
medical practice along with his active care of patients at the Illinois Institute. He deeply cared for his
On Track • 6 A Thermostatic Approach
A Non-Profit Organization
By Mark Gorkin, L.I.C.S.W. and Joan Marshall, SPHR
personal patients and the tens of thousands of addicts that he admitted and treated in his twenty-fiveplus years at the Illinois Institute. He passionately advocated for each Illinois Institute patient to receive
Note & Holiday Cards
Silver Ribbon Products
Perspectives • 10 A Case for Leaving Well Enough Alone
the most appropriate level of care to meet his or her needs.
By Gene Boylan MS.Ed. and Matthew Berger, M.D.
NARSAD Artworks products showcase the art of talented
artists who happen to suffer from mental illness. NARSAD
Lighten Up • 19 Humility — the Key to Humor
Artworks supports and promotes the Silver Ribbon
Dr. Bowman's love for his family, friends, golf, tennis, and all of his patients was immense. The same can
Campaign for the Brain. All sale proceeds go to fund mental
By Linda Hutchinson
be said for our feelings of grief and loss. We miss him deeply, but his spirit will always remain at the Illinois
illness research. For information or a free brochure call
1 (800) 607-2599. You may also visit the Web sites
Calendar • 23 Workshops and Training Information
Institute as an inspiration to provide the best, most compassionate patient-centered care possible.!
The sessions include information on sexual health, understanding the
Intervention services with girls currently being prostituted:
link between substance use and prostitution, and an overarching
emphasis on improving self-esteem. In addition, the participants hear
A Way Back
both written and live testimony from women who have been in "the
Under the umbrella of a well-known urban child welfare agency,
life" throughout the ten weeks. The sessions include engaging
Roxbury Youth Works, A Way Back was created to intervene with
interactive activities, art, music, reading and journaling.
young women at risk for or involved in prostitution. A Way Backworkers strive to build relationships with teen prostitutes in an attempt
by Lisa Goldblatt Grace, L.I.C.S.W., MPH, Consultant Ch
oice The group-work model combines an educational emphasis with a to offer resources to youth so that they may choose a safer lifestyle.
relational/clinical component. While learning a tremendous amount of
Workers receive referrals from DSS of young women who are involved
information, participants simultaneously develop a relationship with
in prostitution, or are at risk. Further, workers drive or walk the streets
the facilitators who keep close tabs on their emotional state via weekly
of Greater Boston one night/morning per week looking for referred
journal writing. Participant write their reactions to the group as well as
youth or any other youth prostitute.
any feelings they have had over the course of the week that are relevant
The victimization of adolescent women through
who have sex with them are not just illegally involved in prostitution;
to the group. When needed facilitators follow up with participants
The Bandeli Project
prostitution and other forms of commercial sexual
they are engaging in a systematized, commercialized and disturbingly
regarding any salient clinical issues.
Denise Williams founded the Bandeli Project in July 2001. Having
exploitation is an unacceptable form of child abuse
unacknowledged form of child abuse. Of great significance is that the
experienced the pain, degradation, loneliness, despair and isolation that
that is prevalent throughout the United States, as
majority of girls who get involved in prostitution have no idea of the
Facilitators conduct ongoing case consultations weekly. Residential
results from living on the street, she decided to organize a group that
well as internationally. The vulnerability of girls
kind of life they are entering into.
staff uses teachable moments to bring up important issues regarding
would address the factors that prevent women from participating in
involved with child protective services in general, and
exploitation on a day-to-day basis within the milieu. Clinical staff uses
the legitimate economy. As well as reaching out to young prostitutes,
group care in particular is not being systematically
The literature review revealed a profile of an adolescent girl at greatest
individual therapy to explore any personal issues being triggered for
they provide weekly groups giving women the opportunity to build self-
addressed in most states and municipalities.
risk for prostitution: girls who have been chronically traumatized, and
participants. Finally, facilitators meet with all of the program staff mid-
esteem, mutual respect and strength.
therefore, equate sex with love; girls with low self-esteem and a
way through the ten weeks, and once again at the end of the program
In the spring of 2001, 17 year old Nancy* was found murdered in a
pervasive sense of shame; and girls whose experiences lead them to
to insure continuity and an ongoing impact.
Volunteer staff, many of whom are former prostitutes, act as positive
wooded area off of a major highway in the Boston area. She was
believe that they are only worth violence and humiliation. Pimps target
role models and mentors. These mentors are in a position to share their
reportedly killed while involved in prostitution. Nancy had been in the
these girls, and these girls become trapped in prostitution. This profile
Initial evaluations have shown a positive impact on the young women
experiences, their non-judgmental attitude, and their hope for recovery
custody of the Massachusetts Department of Social Services (DSS)
overlaps significantly with the profile of girls in the care of the child
involved. Participants complete a questionnaire at the first group and
to these young women. It is hoped that the participants will be
and had been living in a DSS-funded group home at the time of her
welfare system, currently living in group homes or foster care.
once again at the tenth. These questionnaires illustrate a significant
encouraged through this work to leave street life. This journey is
death. Nancy's murder set off a chain of events that would go on to
increase in their understanding of prostitution. For example, at each
recognized as extremely difficult as economic constraints, drug
support and/or save the lives of countless vulnerable girls: The
A Plan for Action
program there was a great change in participants' answers to the
addiction, and the control of a pimp may keep these young women in
Massachusetts Prostitution Prevention Project.
In addition to continuing their work on the Child Exploitation
a kind of servitude.
Working Group, The Home, in collaboration with DSS, began a
coordinated approach to prevention and intervention in the realm of
What are the signs that someone is trying to recruit you for
In an effort to discover whether Nancy's death was the tip of the
prostitution? Name three.
Child welfare providers, law enforcement, and other adults who care
iceberg in terms of teen prostitution, the DSS convened a summit in
about and for vulnerable girls must address this exploitation head
the winter of 2001. Out of this conference grew the Child Exploitation
• Prevention programming with girls at great risk of being
At one program, the number of participants answering this question
on, through a coordinated safety net of prevention and intervention
Working Group, charged with the goal of trying to develop a
correctly went from 30 to 90 percent. 70 percent answered, "I don't
services. In Massachusetts, the commitment to this change continues
comprehensive strategy to address the teen prostitution problem in
• Training of DSS workers and group home providers regarding
know" on the pre-questionnaire. Of those in the 70 percent, all but one
to grow with the affirmation that Nancy's death will not be in vain.!
Boston. The group decided to focus on the needs of adolescent
answered correctly on the post. (The individual who got it wrong on
women in the care of DSS who are involved in or at risk for
both the pre- and post-questionnaires missed the session that explicitly
*The victim's name has been changed.
involvement in prostitution.
The My Life, My Choice Program
talked about recruitment techniques.) Of the 30 percent who got their
In an effort to reach the girls most at risk for recruitment into
answer technically right on the pre-questionnaire, all expanded their
Lisa Goldblatt Grace serves as a consultant to The Home for Little Wanderers on the
In June 2002, The Home for Little Wanderers (The Home), a
prostitution, The Home decided to focus prevention efforts on young
answer on the post. Given the data that the majority of girls who get
Massachusetts Prostitution Prevention Program. She has worked with adolescents for fifteen
nationally renowned, private non-profit, child and family service
women in DSS-funded group care. The Home hired two principals to
involved in prostitution did not know what they were getting into, this
years, running a shelter for pregnant and parenting teens, as well as a diversion program for
agency, was awarded $60,000 in bonus money from the DSS. As the
spearhead the writing and the presentation of a prevention curriculum:
shift in knowledge is dramatic and important.
violent youth offenders. In addition, she has worked in outpatient mental health, youthdevelopment and residential treatment settings. Grace is a licensed independent clinical social
lead agency for Boston Commonworks, The Home is charged with
Denise Williams, the founder and Executive Director of the Bandeli
worker and holds masters' degrees in both social work and public health. She may be reached
providing a continuum of residential, specialized foster care and
Project, and Lisa Goldblatt Grace, L.I.C.S.W., MPH, a consultant
Program staff offers additional anecdotal evidence of the group's
via email [email protected].
community based services for youth in the care and/or custody of DSS.
working nationally in curriculum and program development for
impact. Early data clearly reveal the importance of this type of
With the vividness of Nancy's death, the momentum of the task force,
vulnerable adolescent girls.
preventive intervention. Follow up evaluation is needed to determine
Debra Grollman is a Network Director at The Home for Little Wanderers in Boston. She
and the certainty that girls in their care were being systematically
the longitudinal impact of the program in terms of the participants'
oversees 5 programs that serve DSS and DMH youth. One of these programs is Boston
NARSAD recruited, The Home and the DSS decided to use this money to The "My Life, My Choice" Program utilizes a 10-week curriculum that
ability to avoid involvement in prostitution.
Commonworks. Before coming to "The Home" she was the Clinical Manager of Child and
of address the unmet needs of DSS children victimized by prostitution.
is presented in weekly 1 1/2-hour modules to meet goals:
Adolescent Services for the Massachusetts Behavioral Health Partnership, a managed care
Similar to the ten-session program, the goals of the provider training
company. Grollman has worked both as a therapist and an administrator in social service
Courtesy In order to develop an appropriate plan of action, The Home conducted
1) Decrease teens' perception of prostitution as innocuous or
organizations serving children and adolescents for the past 30 years. She is licensed as anindependent clinical social worker in Massachusetts. She may be reached via email
a thorough literature review to begin to understand the national profile,
glamorous and increase teens' perception of prostitution as
Michaels as well as local needs assessment. This review revealed that the average
dangerous and debilitating;
1) Increase providers' understanding of "these girls";
age of entry into prostitution nationally is 13-16 (Silbert, l982;
2) Increase teens' understanding of all aspects of prostitution,
2) Increase providers' concrete understanding of teen prostitution;
Aranda Weisberg, l985). Though any girl is at risk of recruitment, 85 percent
including recruitment tactics; and
by of women involved in prostitution have a history of childhood sexual
3) Increase teens' ability to avoid involvement or if involved, stay
3) Improve providers' ability to assess a teen's involvement, work
Silbert, M.H. & Pines, A.M. (1982). "Victimization of Street Prostitutes." Victimology: An International
Untitled abuse; at least 70 percent report incest (Silbert & Pines, 1982;
safe on the street and increase the likelihood that teens can find
with her to improve safety while she is involved, and assist in
Journal, 7: 122-133.
Art Dworkin, 1997). The pimps who recruit teen girls, and the "customers"
the resources to leave when they are ready.
her debriefing and recovery.
Weisburg, D.K. (1985). Children of the Night: A Study of Adolescent Prostitution. Lexington, MA.
Paradigm • Winter 2005
Paradigm • Winter 2005
standard needs to be raised or lowered or allow your reports to makeadjustments to your initial setting and then build into the process your
The Littlest Christmas Tree
feedback of their performance.
A Thermostatic Approach to Communication and Leadership
"As I walked through the rows of seedling
Over time and with trust both parties can more fully participate.
A Metaphor for Aligning Messages, Understanding, and Behavioral Responses — Part I
Christmas trees at a time of personal pain, grief and
Ultimately, the power (and responsibility) is in the manager's hands; but
loss some years ago, I saw a small pine tree barely
in most circumstances there should be opportunity for the employee tonegotiate the thermostatic and output standards.
surviving and wrote this story. I sent the story on
by Mark Gorkin, L.I.C.S.W
one sheet to my clients the Christmas of 1996.
. and Joan Marshall, SPHR
"My employees just don't seem to understand what I say to them. Are
adaptive behavior and b) a social agreement on "good enough"
Never did I dream that it would grow into a best
Once a setting has been established, for example, the mutual
we speaking the same language? When I make assignments or give
comfort and stimulation levels and degree of goal achievement.
understanding and agreement of objectives and timelines, expect
seller. When in recovery we walk the walk most
them goals, they give me back work that's different than what I had
ongoing feedback. Both parties need to buy into the thermostatic
miracles truly are the serenity prayer in action."
asked. The work is late, incorrect, or sloppy. What's wrong with them?"
Thermostatic Definition and Assumptions
process. One approach for being on the same thermostatic page is
Thermostatic Leadership is a negotiation process between the supervisor and
achieved by saying, "If you don't come back to me, I will assume you are
Have you sung these lyrics before? You are not alone. Why does this
the employee that encourages input, discussion, and the mutual
comfortable with the setting." An even better approach, build in a
A Tale of Growing and Becoming
behavior occur? Where do we place blame? Maybe neither party is
establishment of role and responsibility expectations, performance objectives,
routine checking-in time. It will be easier for an employee to come back
solely responsible; maybe it is a matter of reaching a different level of
as well as ongoing, two-way feedback that positively influences the quality
and inform you that the assignment will not be completed on time. It is This is a tale of a young tree seedling growing into a tall and strong
understanding between employer and employees. Of course, the
and productivity of the working relationship and the work output.
also easier to "Practice Safe Stress" when the employee gives you grown up tree, and also the story of a world of possibilities all woven
obvious question: how to reach a level of understanding and effective
feedback regarding problems with the initial thermostatic/task setting or together through the belief of an almighty creator.
communication that has both parties working together to achieve the
While the supervisor or manger has ultimate responsibility for the
his projected timeline a few days ahead of the due date as opposed to
desired outcomes — from meeting (or exceeding) performance goals to
process and outcome, the importance of identifying needs and concerns
giving you an eleventh hour heads up.
The young seedling has her sights set on becoming the tallest, strongest
experiencing job satisfaction? A new management problem-solving tool
means that both parties contribute to or may even take the lead in
and most beautiful Christmas tree. As the seedling starts to grow, she
and process called Thermostatic Leadership (TL) will help the
initiating or adjusting thermostatic settings. This mutual, feedback-
If a deadline is missed or the assignment was not started, there is learns to appreciate the things around her and understands how her
manager/supervisor and the employee strengthen the working
driven leadership approach is based on three working assumptions:
thermostatic error. Try to determine the problematic factors in an environment affects her growth. Eventually she comes to realize that
relationship and help meet their performance objectives.
objective and non-judgmental manner. Was your initial temperature
1. Need for Openness.
there are endless opportunities and that her creator will be there for her
Both parties are comfortable listening and
setting objectively realistic? Clarify and provide the instructions for the
through it all.
asking questions and sharing genuine concerns, or are working
assignment. Does the employee truly understand your expectations?
When we think of leadership and the importance of communication, a
toward this level of safety and openness. This give and take
Ask the employee to repeat back the instructions and to paraphrase the One Day at a Time
thermostat analogy is both easy to visualize and seems to have intuitive
includes defining the project problem, articulating expectations
procedures if there are questions or confusion.
"There are so many possibilities to think about," said the littlest tree
appeal, especially when flexibility and feedback are operational
regarding the problem-solving process, acknowledging resource
requisites. In general, most of us know a thermostat as an instrument
barriers and knowledge gaps, and agreeing on measures of progress,
Of course, there are times when managers must exercise their right to
that adjusts the warmth or coolness of a room when ambient conditions
successful (or unacceptable) performance, and project completion.
engage in one directional communication. An example would be when Then, pausing, she said, "But today I can only grow and become my very
are at variance with the current baseline temperature setting. Consider
Initial baseline settings may well be recalibrated as the process and
the employee's safety is at risk. The manager in this case sets the best right here where I am planted. I will feel the Sun and the Sky and
the example of several people living in the same house. These people
temperature and whether the employee likes the feel of it or not, he or the Wind and the Rain and I will think about how wonderful it is to
may discuss, negotiate, and decide what the temperature setting should
2. Need for Uncertainty. Thermostatic setting is often seen as an
she cannot change it. Perhaps at a later or safer point, dissatisfaction grow.just for today."
be. They set rules about who can adjust the thermostat. Sometimes the
experiment regarding eventual comfort levels and outcomes. Rigid
can be expressed and the manager and employee can re-start the
process is not democratic but is based on who pays the bill. Many
expectations or unduly trying to control (micromanage) the process
At last, the littlest tree understood the joy of being a Christmas tree can
thermostats even contain programming features, so the temperature is
will likely inhibit rapid and honest feedback, employee initiative,
be found in each and every day.
raised and lowered according to the pre-set program. (This article does
not focus on unilateral, pre-set and "outside" control systems.)
3. Need for Error. Today's "anytime, anywhere," "crisis management,"
Because a thermostatic leadership or management process may take Recovery
and "do more with less" business climate means few plans and
more time, why should a manager consider this procedural paradigm?
Leadership and Thermostat Connection
Standing patiently in her row of seedling trees, The Littlest Christmas
prototypes are extensively tested. Time and resources may be in short
By involving your staff early on in the thermostatic process you will gain Tree looked up into the dark, starry night and whispered,
With this basic description, now comes the foundational question: why
supply. Under these conditions, some performance deviation from
the most employee buy-in to and understanding of the company's
are we comparing and designing a leadership approach that has
initial baseline expectations and standards is inevitable if not natural.
mission as well as your specific goals and objectives. Your employees "Thank you, Dear Creator, for Life. Thank you, for Ideas and
parallels with a thermostatic setting process? The answer is that both
will more likely believe they are part of the big vision and daily Thoughts and Feelings. Most of all thank you for choosing me to grow
play vital roles in person-situation and sensor-driven feedback systems
Absent a dysfunctional or mistake-riddled pattern of performance, error
operations with more meaningful input and a greater sense of control in — just for today — and to know the Wonder of Your World and its
that influence adaptation, performance levels, and social behavior.
is first and foremost seen as a vital source of input for strengthening the
their job performance. Do not be surprised if they report greater job many Possibilities."
Consider these common components and operational dynamics:
effectiveness ("do the right thing") and efficiency ("do the thing right")
satisfaction. Also, being on the same page with employees often yields
of the thermostatic settings. Engaging with errors helps modify
new levels of comfort and trust.
1. Person-Situation — people able and willing to assess and discuss
expectations and generates ongoing adaptive responses that will
Ms. Janie Jasin is a highly sought
their current and desired comfort, energy and attention levels and
increase the productivity of performance effort and the quality of
This article has provided a conceptual framework for comparing a new after speaker and author, a mom of three
goal-directed behaviors in a particular environment (for example, a
outcomes. In addition, a supervisor perceiving employee error as a basis
leadership approach to the workings of a thermostat. Part II will apply grown children, a grandmother of two
supervisor and an employee involved in a common project within an
for learning curve opportunity and growth will likely enhance
Thermostatic Leadership using a case example.!
and has celebrated her own sobriety one
interpersonal comfort and trust levels.
day at a time since 1976. She can be
2. Sensor — a self-regulating and adjustable feedback mechanism
reached by calling (952) 443-3086,
Mark Gorkin, "The Stress Doc,"™ is an internationally recognized speaker, training
(thermostat) or procedure (in the TL model, supervisor and
How to Start the Process
emailing [email protected] or visiting the
consultant, psychotherapist, syndicated writer and author of Practice Safe Stress: Healing
employee assessment and dialogue) that targets optimal baseline
As a manager, you can start by setting the project startup thermostat
Web site www.janiespeaks.com.
and Laughing in the Face of Stress, Burnout and Depression. He is America Online's
standards and ongoing adaptation levels for maximizing productivity
at seventy degrees. (For example, a seventy degrees temperature
"Online Psychohumorist" and his USA Today Online "HotSite" — www.stressdoc.com, is •Cover art Illustration from The Littlest
and achieving effective social-work relations.
reflects a report due in a week; a report due overnight might feel like
cited as a workplace resource on a National Public Radio program. For more information call Christmas Tree, by Janie Jasin ( 1996),
3. Systems Feedback — based on participant input, the thermostatic
ninety degrees to an employee.) Then discuss what this setting means
(202) 232-8662 or email [email protected].
Illustrated by Pam Kurtz ( 1996 Book
baseline, and performance feedback rapid mid-course corrections
to each of you. Perhaps try for empowerment: ask employees for their
Peddlers). Reprinted by permission of Book
in baseline/output settings result in: a) a "goodness of fit" between
preferred thermostatic setting (e.g., on project timelines and
Peddlers, Minnetonka, MN. This book is
Joan Marshall, is President of the. Society for Human Resources Management (SHRM), available in bookstores,www.janiespeaks.com
the individual's perception of the ambient conditions and his or her
deadlines) and maintain open communication when a baseline
Montgomery County, MD. She can be reached by email at [email protected].
Paradigm • Winter 2005
Paradigm • Winter 2005
what better way to heal the heart than to teach patients
and clients to look to the one who created the"product." It is the very first step to mending our
Wrong Actions (coping behavior)
2. Teach them to Focus! On August 20th 1995, our
three-year-old foster daughter fell into our backyard
2. False belief systems that are believed to be true.
pool and drowned. My grief was inconsolable. For
False belief systems may sound something like: "I'm
months, I focused solely on the loss of my dear sweet
devalued," "They don't care," "This is too hard," "I'm a
Beverly. After almost a year of shutting myself off from
failure," "I'll never.," "I'm lonely," or "I must be perfect."
friends and family, my two biological children came to
The list could go on and on. When we begin to believe
me and said "Mom, you still have us!" Oh how God
these lies as truth, they become strongholds on our
used two small children to teach me this concept.
heart that cause us to have wrong thoughts, which lead
What we focus on is what we see and often times
to wrong emotions, which lead to wrong actions.
become our "reality." I was focusing on what I lostinstead of what I still had. I was focusing on the negative
What are some of the wrong actions that develop?
instead of the positive. Teaching people to focus on
Worry, comparing one's self and not measuring up,
what is pure, lovely, admirable and worthy can help
blame, fault finding, and apathy, hardening of the
heal a hurting heart. I know because it certainly helped
"oughteries," addiction, depression, and anger. The
me change my perspective on life.
false belief systems and the actions that ensue lead tothe third cause of "heart failure."
3. Teach them to seek the invisible. We have
become a nation fixated on acquiring possessions,
3. Fears. It is inner fears that develop from false belief
popularity, pleasure, and power. It seems that our
systems that cause the heart to stop beating. Some
attitude is one that says, "He with the most toys wins!"
by Abby Shields, M.Ed.
people believe that it is safer to do nothing than to take
The more we have, the more we get an identity that is
a risk and fail. It is better to say yes to everything than
based on things that are so fleeting. I know all too well
to say no and risk not being liked. Some believe that I
how fleeting these things are. In 1998 my husband
It was two AM in the morning. I was awakened out of a
The inner heart holds the core of potential, and is the seat
am what I am, I cannot change; therefore, I will be
made a horrible business decision and we lost every
A person is deep sleep by a tiny hand tugging on the sleeve of my of emotions. From this heart is where humans do their
openly defiant and use humor to hide my real feelings.
possession we had worked for over the past thirty years.
pajama top. As I rolled over, there stood my two year old
deepest thinking. Statements like "I know in my heart," "I
To not be perfect means one is not in control, so they
Along with the loss of possessions, came the loss of all
foster child, Beverly, with tears rolling down her face
have a willing heart," or "I have a troubled heart," show
will find fault with others or live by the "shoulds,"
the rest of the things that we held onto so tightly such
in as little time explaining to me that she was scared, and wanted to crawl that this heart is truly a vital, living part of every
"musts," and "oughts," so that people will think that
as our position in the community, and our popularity
in bed with my husband and me. I could have comforted
individual. Unfortunately, when this heart becomes
they are in control. These are all belief systems that
with friends. Our "hearts" told us that as long as we had
Beverly, taken her back to her room, and tucked her back
hardened through rough trials, wounded relationships, or
lead to fears. Fear of failure, fear of rejection, fear of
these things we were somebody; that we mattered.
years they into bed. Instead, I was the irritated mother who wanted tired, aggravated mothers, it can take years, if ever, to
being controlled, and fear of losing control.
When you learn to seek the invisible you come to
her sleep, so gruffly I said, in a tone more like Godzilla,
notice that this heart has died. This kind of "heart
understand surrender, forgiveness, joy, peace, patience,
"Beverly, it's two in the morning, get back to bed RIGHT
trouble" may remain undetected until teenage years or
So how can "heart surgery" be preformed to help
kindness and most of all, love. Agape love for yourself
NOW! NO. You can not sleep with us!"
even adulthood when the effects of a hardened heart
individuals wake up from the "dead life" they are
and others. It is love that can cover a multitude of hurts.
shows its ugly face through self-destructive behaviors of
experiencing? The following are ways to help people have
As Beverly walked away feeling scorned and
addictions, depression, and anger — to name a few.
life that is truly life.
One of the biggest tragedies of today's times is that there
rejected, she turned and looked at me and said,
Because of this, many people are walking around dead
are so many people functioning but not loving, and existing
"You hurt my heart!"
from the neck up. A person is born, and even in as little
1. Teach them to look up! There is a story told of a
but not living. They have no passion. Their heart is dead.
time as five or ten years they experience emotional
man whose car broke down on a country road. When it
Counselors, practitioners, parents, and teachers goals
As I reflected on that statement, it dawned on me that she
wounds and unmet needs that cause their emotional
sputtered and stopped the man, who was a car
should be to perform an inner type of heart surgery; a type
heart to stop was not talking about her physical heart. By physical heart, heart to stop beating. Their heart has died, but they are
mechanic by trade, said, "No problem, I can fix this!"
of surgery that lights the fire back in that inner most place
I am referring to the hallow muscle in the chest about the
not buried yet. Their physical heart keeps them
He got out of his car, went about his usual routine of
where children and adults alike need it most. To heal a
size of a fist; the heart that weighs from about 9 to 11
functioning; going through the motions of each day with
trying to figure out what was wrong with the car, so the
hurting heart is one of life's most important jobs. May your
ounces. Throughout the course of a day, the heart
no heart and no passion.
necessary repairs could be done. Unfortunately, he was
own heart be encouraged as you encourage the hearts of
circulates about 5 quarts of blood through the body, and
not able to find the root of the problem, and so resigned
others, so that no heart will be left behind™.
beats over 100,000 times per day. You do not have to be a
So what causes our "heart" to stop beating?
himself to the fact that he would have to wait for
doctor to know that our heart is of utmost importance to
someone to come by to help him. After several hours of
Abby Shields is an international speaker, counselor
our physical well-being. Without it, of course, the body
1. Unmet intrinsic needs. All humans are born
waiting, a limousine finally stops, and out steps a
and author of Little Bits of Wisdom (1996). Her work
would die, and if the heart were to suddenly cease working
with intrinsic needs: the need to be accepted,
gentleman in a tuxedo. Asking if he could help, the
focuses on living a balanced life, self-sabotage;
s Art ' for some tragic reason, it would not take long for someone
accomplished, and acknowledged. People need to be
mechanic said, "Yea right! Go ahead" (a bit sarcastically
embracing change and value based communication.
needed, to have peace, and to be loved. To sum it up in
thinking to himself that there would be no way this guy
Some of her recent clients have been the South Carolina
one sentence; people want to matter. When these
dressed in his fancy duds would be able to do
Victims Assistance Network, Department of Navy, and
However, Beverly was not talking about her physical heart.
needs are not met, people do not think they matter, and
anything). To his amazement though, the gentleman
the Social Security Department of the country of Belize.
I realized, as I stared across my dark room at Beverly with
when that occurs, people become disconnected and
found the problem, and the engine purred signaling to
Shields has traveled to numerous schools and associations across the United
Courtesy her bottom lip hanging lower than her chin, and eyes fixed
discouraged. This discouragement can take away a
the driver that they could get back on the way. The
States where she encourages both teachers and parents. She also created the
by on the floor, that she was talking about her other heart; her
person's confidence, hope or spirit. The struggle can
mechanic was dumbfounded and said, "It's a miracle!
sought after communication training program "Directionality" that teaches
inner heart. This heart cannot be seen, weighed, or
become so intense that one feels drained of energy, and
individuals about the Law of Potential™. She attended the University of
You are wonderful! What is your name?" The
Southern Mississippi where she earned a Masters Degree in Education. Ms.
Untitled measured, but the heart that Beverly was talking about is
loses motivation to carry on. It is these unmet intrinsic
gentleman said, "Oh, I am sorry, I forgot to introduce
Shields can be reached by calling 1(888) 586-8356 or email at
Art the very center of inner life.
needs that lead to the second cause of "heart failure."
myself. My name is Henry Ford." The point is that
Paradigm • Winter 2005
Paradigm • Winter 2005
In October of 2003 she had a pacemaker inserted and at
admitting diagnosis was Bipolar disorder, manic with
that time was taken off of the Melleril. It was not restarted
psychotic features. She had not been taking her
due to concern for her cardiac condition.
psychotropic medication, Stelazine, for some time and
indicated that she was allergic to it. To regain control
Initially, she did fairly well until February 2004 when
over her psychotic and manic symptoms, she was placed
Matilda began to experience an exacerbation of psychiatric
on Zyprexa Zydis 10 milligrams and slowly titrated to 30
symptoms, particularly agitation, confusion, mood labiality
milligrams daily. She had no symptomatic relief, so
and hallucinations. She would call her daughter with
Depakote 500 milligrams were added to her medication
bizarre stories about people entering her home, and she
regimen. She continued to show no improvement over
would also call the police to protect her. Her family
the course of 3 weeks and her behavior remained out
medical doctor admitted her to a medical/surgical unit of
the local general hospital with a diagnosis of "Change inMental Status" and after a completely negative metabolic
Because she was not responding to the Zyprexia and
work-up, ordered a psychiatric consult. After reviewing her
Depakote combination, the Zyprexia was discontinued,
history of bi-polar disorder, the consultant placed her on
and the Depakote was titrated to 500 milligrams twice a
Seroquil 25 milligrams at bedtime; however, after a few
day and 1000 milligrams at bedtime with close monitoring
days of continuing symptoms, including the need for
of the Depakote level, which at 48.9 was at the lower end
A Case for Leaving
physical restraint, the consultant suggested that she be
of the therapeutic range. A decision was made to
transferred to an inpatient gero-psychiatric unit for more
reintroduce Stelazine as an option and monitor her for
side effects since she previously indicated that she was When returning
Well Enough Alone
allergic to it. Interestingly enough, the hospital pharmacy to their original
Upon admission, she continued on the dose of Seroquil
could not obtain Stelazine informing us that it was no
started in the general hospital, which was then titrated up
longer marketed in the United States. The generic, conventional
gradually to 100 milligrams twice a day. She did not
trifluoperazine was obtained as a second choice. As this antipsychotics
improve and continued to have ongoing manic symptoms
was gradually titrated to a therapeutic dose, along with the
of severe agitation, hallucinations, and impulsivity where
Depakote, she gradually showed improvement with they returned
she would run up and down the hallways, singing. After
control over her behaviors.
by Matthew Berger, M.D. and Gene Boylan MS.Ed.
discussions with her family about her longstanding stabilityon Mellaril, a decision to reintroduce Mellaril was made
After a period of 10 days with the reintroduction of symptom free
after additional review by her medical attending physician.
trifluoperazine, she was symptom free and was able to and fully able
With the advent of new generation atypical antipsychotic
After his clearance Seroquil was discontinued and she was
return home with her family and appropriate outpatient to function.
restarted on a low dose of Mellaril 25 milligrams twice a day.
medications, it is tempting to change patients who have been onconventional antipsychotics for long-term care to this newer
The patient had a history of hypertension and was taking
These above cases clearly illustrate that adherence to
medications for it. When the Mellaril was reintroduced,
the old adage "do no harm" is still paramount to keep in
class of drugs. The atypical antipsychotics with their clearly
she developed orthostatic hypotension causing her blood
mind. Whether the fact that these two patients did
superior side effect profile and greater impact on the negative
pressure to drop. The blood pressure medications were
better on conventional antipsychotics was due to receptor
adjusted and eventually discontinued. The patient
site morphology or a variety of other unknown factors
symptoms of schizophrenia and psychosis seem the logical
continued to have low blood pressure so she was closely
are unclear. What is clear is that both of these patients'
monitored and not given the Mellaril if her systolic blood
when switched to a new generation antipsychotic did
choice to therapists. In a review of the literature, there is a
pressure dropped to less than 80. The Mellaril was slowly
poorly and in fact required hospitalization. When returning
great deal of support for switches to the newer agents;
titrated up while closely monitoring her blood pressure and
to their original conventional antipsychotic medications,
sometimes splitting the morning dose over a two to three-
they returned to a baseline symptom free and fully
however, there are certain instances when this may not be the
hour time period.
able to function. Thus, supporting a case for leaving well
most prudent course. Although anecdotal, it has been our
She slowly responded to the Mellaril with a return to her
experience that if a patient has been switched after long-term
premorbid functioning. Her family was very pleased with
Dr. Matthew Berger is the medical director of Senior Medical MentalHealth at Moses Taylor Hospital, Scranton, Pa, and the administrative
use of conventional antipsychotic medications, their response
her progress and indicated that she was "back to her oldself." The discharge dose was Mellaril 25 milligrams at
director of Behavioral Health Services for Mercy Hospital, Wilkes-Barre and
may be poor at best and non therapeutic at worst.
9:00 A.M. and 25 milligrams at 11:00 A.M. if her systolic
Nanticoke Pa. He maintains a private outpatient practice in Scranton and
blood pressure was above 80. She was given Mellaril 100
Kingston, Pa. Dr. Berger attended Southern Methodist University and received his Doctor of Medicine degree from Universidad Central
milligrams at bedtime while continuing to have her systolic
Consider these two case scenarios:
Del Este, Dominican Republic. He has published articles on ECT and
blood pressure monitored for orthostatic hypotension. She
Behavioral Management in various medical journals and is a national
was discharged to an assisted living program and continues
speaker for numerous pharmaceutical firms. Dr. Berger can be reached by
to do well in outpatient care.
email at [email protected].
Matilda is an 84-year-old white female living innortheastern Pennsylvania. She had been fairly
Mr. Gene Boylan is the program director for the Senior Medical Mental
independent, living at home and functioning well
Patricia A. is a 78-year-old white female who was admitted
Health at Moses Taylor Hospital, Scranton, Pa for the past 8 years. He has a
for her age with the support of her daughter who
to the gero-psychiatric unit on an involuntary commitment
30-year career working in inpatient psychiatric care settings at First HospitalWyoming Valley, Geisinger Medical Center both in Wilkes-Barre Pa. and
checked in on her regularly. She was psychiatrically
after being brought to an emergency room by police
Muhlenberg Medical Center, Bethlehem Pa. He graduated from Marywood
managed and monitored through treatment from her
because of severe and uncontrolled behaviors manifested
University in 1974 with a Masters Degree in Humanistic Education. Senior
family physician, with a small dose of Mellaril and
by paranoia, delusions that people were stealing her Medical Mental Health recently won "Program of the Year" for Horizon
remained free of any bipolar episodes or hospitalizations.
money, sexual preoccupation and hyper-alert babbling. Her
Health. Mr. Boylan can be reached by email at [email protected].
Paradigm • Winter 2005
Paradigm • Winter 2005
by David Mee-Lee, M.D.
Martin was "good" for a month, and the parents were
coercion; could benefit from non-threatening information
problem than he thinks. While his parents continue to
hopeful. Then it happened.again. True to their limit,
and information to raise awareness of a possible "problem"
fund, feed and support him, he genuinely does not
they changed the locks while he was away on his cocaine
and possibilities for change.
experience any problems with his drug use. He is aware of
binge. Two days later at one o'clock in the morning,
his parents' nagging and frustration, but he can mostly
Martin banged on the door and wanted to get in. His
Contemplation is ambivalent, undecided, vacillating
write that off as their problem.
parents were firm that he was not allowed in and would
between whether he/she really has a "problem" or needs to
not open the door. But then they slipped him under the
change; wants to change, but this desire exists
Similarly, to an outside observer, it seems obvious that the
door, the keys to the family yacht. He could now sleep at
simultaneously with resistance to it; may seek professional
parents should see how they send mixed messages to start where
the boat marina. All their good intentions to set a limit
advice to get an objective assessment; motivational
Martin. They ban him from returning to the home after each family
and take care of themselves and their property melted in
strategies useful at this stage, but aggressive or premature
the cocaine binge, yet then give in and let him stay on their
the midst of parental concern for their son. It is not easy
confrontation provokes strong resistance and defensive
boat in the marina. How could they not know that they are member is in
for families to find the balance between making or
behaviors; many contemplators have indefinite plans to
enabling and that their inconsistent limit setting increases his or her
breaking addiction denial.
take action in the next six months or so.
his denial that his addiction has not really caused anyproblems? This is where understanding the stages of readiness to
A Different View of Denial and Resistance
Preparation takes the person from decisions made in the
change can help to compassionately join both parents and change, we can
Rather than thinking of people as being unmotivated,
contemplation stage to the specific steps to be taken to
Martin. It is not that they are resistant, unmotivated or in
resistant or in denial, it is more productive to remember
solve the problem in the action stage; increasing
denial. It is just that they are in contemplation and attract people
that resistance is an interactional process. How the family
confidence in the decision to change; certain tasks that
ambivalent about how to resolve the dilemma of setting a into recovery
or counselor reacts to what the identified client says or
make up the first steps on the road to action; most people
limit but risk losing the love and safety of their son. Martin and "break
does is as important as the actual behavior itself. The
planning to take action within the very next month;
is either unaware of how badly his addiction affects the
family or the counselor can actually increase or decrease
making final adjustments before they begin to change
family (pre-contemplation), or has mixed feelings about the through
resistance depending on how they respond to the so-called
advantages and disadvantages of abstinence and recovery denial"; rather
unmotivated or resistant behavior. For example, if the
family continually nags their son for not attending AA
Action is intended to bring about specific change; overt
meetings, he is likely to tune them out and either lie that
modification of behavior and surroundings; the busiest
Helping people change, whether family or identified client, resistance and
he is going, or outright refuse to go. A client may believe
stage of change requiring the greatest commitment of time
involves a process that honors the stage of change in the
that he can cut down and control his drinking. If the
and energy; action should not be equated with actual
client/family. Starting there, the counselor's task is different "make denial"
counselor responds by saying that is "stinking thinking" and
change; support and encouragement are still very
for each stage of change. The guide below points the way worse.
that the client is in denial and will only fail again, the client
important to prevent drop out and regression in readiness
to focus the work with the client and family (Miller and
is likely to drop out of treatment until the next crisis.
In other words, rather than viewing resistance as some
Maintenance sustains the changes accomplished by
pathology that resides in the unmotivated person, it is best
previous action and prevent relapse; requires a different set
seen as an opportunity to understand a person's stage of
of skills than were needed to initiate change; consolidation
readiness to change and to respond accordingly. Helping
of gains attained; not a static stage and lasts as little as six
Pre-contemplation Raise doubt — increase the
client's perception of risks and
families understand stages of change provides them the
months or up to a lifetime; alternative coping and problem-
problems with current behavior
structure to actually live the Serenity Prayer more
solving strategies are learned; replace problem behaviors
effectively — to be able to know what they can change and
with new, healthy life-style; work through emotional
Tip the balance — evoke reasons
have control over; and what they cannot change and should
triggers of relapse.
to change, risks of not changing;
the client's self-efficacy for
Relapse and Recycling are expected, but not inevitable
change of current behavior
Understanding Stages of Change in Families
setbacks; avoid becoming stuck, discouraged, or
The identified client and the family are not only likely to be
demoralized; learn from relapse before committing to a
Help the client to determine the
at different stages of change, but usually are. For example,
new cycle of action; comprehensive, multidimensional
best course of action to take in
the parents may well be ready for their son to be in
assessment to explore all reasons for relapse.
recovery, growing in abstinence and responsibility. The son,
The Dilemma for Families Affected
Help the client to take steps
however, may well see no problem with his drugging as he
Termination stage is the ultimate goal for all changers;
still has a roof over his head, food in his belly, and money
person exits the cycle of change, without fear of relapse;
Martin was a 22-year-old son who currently lived with his
in his pocket — compliments of his parents' hard work.
debate over whether certain problems can be terminated or
Help the client to identify and
parents. They loved him, but they were equally frustrated
Furthermore, the parents may well be ready for their son to
merely kept in remission through maintenance strategies.
use strategies to prevent relapse
with him. Martin would borrow the family car to "run out
change, but not so sure that they are ready to actually set
briefly" for a pack of cigarettes at the local convenience
the limit about whether he can keep living with them. So
Applying Stages of Change to Families
Help the client to renew the
processes of contemplation,
store. However, he would end up on a cocaine binge, taking
to ensure a common language on stages of change, here is
To outside observers, it seems obvious that Martin should
the car for three days inconveniencing the family and
a brief review of a one model of stages of change, the
see what he is doing to his family. How could he not know
action, without becoming stuck
worrying them about his safety. To add insult to injury, he
Transtheoretical Model of Change (Prochaska, Norcross,
that his behavior is totally irresponsible and that he needs
or demoralized because of relapse
would sneak back in the house and sell the family crystal
and DiClemente, 1992, 1994).
to accept his cocaine dependence and embrace recovery?
and silverware for money to buy drugs. Finally, they were so
But Martin is at a pre-contemplation stage of change or at
The Case of Tracy
fed up that they set a limit: if it happened again, they would
Pre-contemplation is not yet considering the possibility of
best in the contemplation stage. If he is to move to a more
Tracy, is a 16-year-old high school student brought to the
change the door locks, and he would not be able to live at
change although others are aware of a problem; active
active stage of change, he will first need his consciousness
emergency room of an acute care hospital by the police.
home any longer.
resistance to change; seldom appears for treatment without
raised to the point of seeing that he has more of a drug
The teenager was taken into custody following an
Continued on page 22
Paradigm • Winter 2005
Paradigm • Winter 2005
by Robert W. Mooney, M.D.
The gently rolling blue grass fields of Kentucky were not as
psychiatrist to psychiatrist. As often is the case with
soothing seen through the barred windows of the Federal
addicts, his salvation arrived in the form of a relationship.
Public Service Narcotic Hospital in Lexington, Kentucky.
A relationship that virtually no one in the community
Inmate #58520 had left behind a respected medical
supported including the preacher who had to be convinced
contributed to the deception that the Mooney Family was
Having just had my sixth birthday, we were thrust into a
practice in a small South Georgia community, a practice his
happy, prosperous and well adjusted.
new existence that would forever change the lives of the
father had passed down to him as one of a handful of
children. I have come to understand that parents who are
physicians. He also left behind a wife and 3 sons for an
This defiant country nurse who would become my mother
The deception ended in 1958 when the sheriff walked next
dealing with their own alcohol or drug problems face a
involuntary commitment for opioid addiction. It was 1959
was absolute in her conviction that she was the missing
door to my father's office and arrested him for forging
decision as to the role to be played in the lives of their
It was 1959 and inmate 58520 was my father, Dr. John Mooney, who ingredient needed to salvage this slightly damaged —
narcotic prescriptions. For the first time, he was held
children. Are they to be protected from the reality of I have come to
had been sentenced to Lexington for forging patient names
although very promising — young physician. She
responsible for his actions during his addiction. This time
addiction, a rather large and unwieldy skeleton to be
on prescriptions for Demerol.
subsequently sacrificed her career as a nurse to devote her
there would be no justification, no negotiating, and no
stuffed into an already crowded closet? Or do they get
full attention to becoming the perfect housewife and
quiet arrangement for another hospitalization in an
dragged kicking and screaming into a child's nightmare of that parents
Lexington, as the hospital became known, was the East
mother. Within a year of marriage, they produced the first
exclusive sanitarium for the sensitively disturbed. He was
recovery purgatory, rooms of strange men and women
Coast repository for junkies, pill heads and dope fiends
of three boys, but the drinking and the drugs continued.
committed to Lexington and given a number — 58520.
smelling of cigarettes and coffee while inanely relating
Mooney, who from the alleys and avenues of New York to the mud roads
This was a place that would not even grant him the
stories of past calamities? I have witnessed the former time dealing with
of Mississippi. This prison hospital for addicts was to be
In fact, not only had his addiction continued but also the
decency of calling him Dr. 58520.
after time with ultimately disastrous results.
sentenced to the last in an odyssey of psychiatric facilities that would redeeming wife and mother began to lose control. This loss
span almost15 years.
of emotional control quickly evolved into a nervous
This was a place that would introduce him to a new way of
Several years ago I met a young man who, in his late alcohol or drug
condition, which naturally accompanies having to put up
life without asking why he had become an addict. They
thirties, had just been introduced to the fellowship of problems face
Dr. John had come out of World War II with a bad case with a drunken, insane husband who is also a physician.
said that it did not matter why; they told him that he had
Alcoholics Anonymous. He had been drinking alcoholically
forging patient of "war nerves" that responded well to bourbon and The good news was that her nervous condition responded
an illness that manifested itself as though he had an allergy.
for over 15 years and had come close to drinking himself to a decision as
names on morphine. What was not common knowledge was that he very well to alcohol, narcotics and tranquilizers. By the time
Alcohol and drugs created a chain of events beyond his
death when AA found him. He had made efforts to to the role to
had entered the war with a bad marriage made worse by
I came along, the last of the boys, the insane behavior of
control. The problem was not the sixth martini or the tenth
reestablish communication with his family and discovered
early alcoholism and the war provided the perfect
both parents had become a normal pattern of our family life.
pill; it was the first. Fellow inmates and even a few staff
that his father had died during his drinking. His mother
for Demerol. opportunity for him to drink himself through the service
volunteers shared similar experiences with alcohol and
was glad that he had found AA because as it turns out his the lives of
and out of a wife. After the war, the drinking and drug use
Dr. John was being sent off to the best psychiatric hospitals
drugs with the common hope of recovery. Sobriety had
father had been alcoholic and had gone to AA when he was their children.
quickly brought an end to the marriage but it began the
on the East Coast, but we were always told that he was
always been someone's theory of last resort; it had now
still a child. But no one in his family had ever mentioned
cycle of psychiatric hospitalizations that would end in the
attending some medical convention. As children, we could
become a practical fact of life.
it. His mother had always told him that his father was
stark confines of Lexington.
never quite understand why we would receive toys in the
working late when he would be at an AA meeting. This
mail that were made in therapeutic craft class!
"Trouble is an alcoholics' best friend," is an old saying. Well, I
young man grew up ignorant of the very solution he would
In the 1950's, psychiatrists wielded a limited array of
now understand that trouble for the alcoholic can be a
desperately need to save his life.
pharmaceutical therapeutics. These were generally
My mother, who everyone knew as Dot, would take us to
family's best friend, because everything that happened gave
confined to sedatives and the first antipsychotic
her psychiatrist an hour away where she would undergo
our family the opportunity to also find a new way to live
Fortunately for us, my parents made it impossible for
(thorazine). As a result, the psychiatric community relied
shock treatments. She would then drive home with us
together. As my father wrote home about what was
anyone to hide from the illness that had come so close to
heavily on analytical techniques descendent from Freud
having to give her directions. She would later say that she
happening to his life, my mother began to question her
destroying our family. As a physician in a small town, Dr.
and other pioneers in psychiatry. These techniques were
loved getting shock treatments because she would get
own alcohol use. When he returned home in the summer
John readily accepted that how he faced his recovery in the
dependent upon pathological behavior, i.e. drinking, drug
loaded up with intravenous sodium pentothal and be in
of 1959, he no longer wanted to hide the wreckage of his
community would have a far-reaching impact. As a result,
abuse, anxiety, depression, etc. being secondary to
a state of pure oblivion for at least a little while. During
addiction from his family or his community. From that
the story of his addiction was shared openly when others
underlying emotional or mental conflicts.
this time Dot and Dr. John were viewed as upstanding
point on, his sobriety took precedent. He understood better
approached him. Addicts and alcoholics from not only
members of this small community. They would contribute
than any one around him that if he stayed sober he could
surrounding communities but also surrounding states
In the case of Dr. John, it was felt that the lack of children
to the church, attend the occasional PTA meeting, and
be a better father, a better husband, and a better physician
began to come looking for the "Drunk Doctor." What
from the first marriage and the expectations of a family
support various civic groups. She was even a den mother
but only if his sobriety came first.
began with a few drying out beds in his office ended up
from his parents and the community contributed to his
with our home being converted into a pseudo-hospital. The
"irrational" behavior. Therefore, the solution to this conflict
Several months after his return, my mother flushed the last
dining room was filled with detox beds and every other
was to remarry and produce a family. Although those who
The trail of deception was kept well groomed by a host of
of her pills and acknowledged her own addiction. She
corner of the house played host to as many as 25 drunks,
have some experience with addictions recognize this as
enablers; the loyal office nurse who took care of the
began to work as tirelessly as he did to build a foundation
pill heads and dope fiends. At one point when my two
having no practical significance, it is important to realize
patients, the hospital medical staff that would always cover
for a return to sanity for herself and her children. This need
older brothers were off at college, I was living in a cabin in
that almost a half-century later this orientation is still
for one of their own, the next door neighbors that would
was made abundantly clear by the fact that the fourth
the backyard, and my sister was sleeping on a cot in a
prominent. Not only is it prominent within society, but it is
take us home with them when it would get to be a little bit
Mooney child was born within a year of her recovery. The
corner of the living room.
also prominent within psychiatry itself.
too much at our house, the uncles and aunts who blamed
stage was set for the next act. If the genetic predisposition
other family for not doing enough and even the milkman
to addiction is indeed accurate, what will it mean for a
Delirium tremens and grand mal seizures were sometimes
The search for the cause of my father's drinking and drug
who continued to deliver milk despite an outstanding bill
family with four kids and two addicted parents who
not even the most exciting parts of a day! Although growing
use would plaque him from hospital to hospital and from
of over 700 dollars. In some way the whole town
themselves are in recovery?
up in this environment was at times chaotic, I was given Continued on page 18
Paradigm • Winter 2005
Paradigm • Winter 2005
future rather than past, to solutions vs. problems. The higher the
head. It seeks to offer questions and not always answers. It means
therapeutic alliance with the therapist, the more powerful the
identifying not what the counselor thinks the person needs but what
by David J. Powell, Ph.D.
the person already has, accommodating to the client's state of readinessfor change and goals.
What does not work is a sense of hopelessness or nocebo effect:
C o u n s e l i n g
where the counselor does all the work, is rigidly wedded to a particular
Contemplative counseling does not offer answers to the client, because
therapeutic paradigm, and focuses on the client's weaknesses.
the client already has the answers, buried beneath layers of pain.
Instead, the counselor offers compassion, wonder, openness, and
from a Contemplative Perspective
4. Thirty years of research shows that the techniques of the counselor
simple presence. The counselor need not know everything. The best
have a relatively small influence on treatment outcome. All
phrases a counselor can learn are "I don't know. What do you think?"
approaches seem to have equal effectiveness. The key is matching
and "I could be wrong." It is freeing to not need to be an expert for the
the right therapy approach to the right patient at the right time in the
only expert in the counseling room is the client. Therefore, an
right dose. Counselors must choose a model that fits with each client
unanswered question is a fine traveling companion.
Welcome to the Clinic.
What works in counseling? According to Duncan, Hubble, and Miller
and reflects these common factors. The therapist's interventions need
I'm a Counselor and I'm Here to Help.
(1999), there are four common factors that contribute to change in
to match the client's stage of readiness for change. "Isolating specific
Contemplative counseling is about intimacy. At the heart of "in-to-me-
techniques without greater attention to basic skills is misguided if not
see" is vulnerability and connection. Counseling is as much about love
After great pestering from his wife, John arrives at
completely illusory" (Duncan, Hubble and Miller, 2001).
as it is skill. Technique is what a counselor uses until the real counselor
1. The quality of the therapeutic alliance is 30 percent of the change.
shows up. Counseling is about the quality of attention given by the
an addiction clinic. He does not want to be there
Does the client feel heard, cared for, supported, respected, and
Research shows that these common factors are what influence change
counselor to the person. The greatest gift to give to others is wholeness
— he does not believe that he has a drinking
genuineness, not judged? The quality of the client's participation in
in counseling. The earlier change happens in treatment, the more likely
and listening, respecting silence.
problem, but his wife does. John comments, "She's
the therapeutic relationship is the single most important
there will be a positive outcome. It is not the counselor that makes the
the one who needs help. Besides if you lived with
determinant of counseling outcome. A good working relationship is
client work, but the client that makes the counselor work! Change
Expertise cures but healing comes from shared experiences. Before a
her, you'd drink too."
the heart of effective counseling. The non-specific factors that
happens the moment the client makes an appointment for help.
session, the therapist should take a moment to remember his humanity.
contribute to this alliance are having a time/safe place to talk, feeling
They can ask, "What's the rush? What are the storms I am trying to
Mary, a counselor, who invites him into her office,
understood, a sense of encouragement, coaching, and teaching.
weather? How can I be fully present with the next client?" Moving into
Counseling is as much about love as it is skill.
greets John. After being informed about
What does not work in counseling is attributing failure to the patient,
sessions in silence allows space for the spirit to reemerge, seeking
confidentiality, Mary asks, "So why are you here?"
arguing with the patient, passivity, hostility, negative confrontations,
Technique is what a counselor uses until the
stillness of heart and mind.
John explains his wife's perception of his drinking
mechanical responses, and ignoring the client's feelings.
real counselor shows up. Counseling is about
problem. "I am only here to get my wife off
Fundamental to the therapeutic relationship is the client's
The great cellist Yo Yo Ma says, "The number one task of a musician
perception of that relationship. It is not how the counselor sees it,
the quality of attention given by the counselor
[and a counselor] is to find the right way to communicate [therapeutic
but how the client sees it.
to the person.
alliance]. My teachers always told me, ‘You have fine technique, great virtuosity, but you have not found yourself yet. I finally saw
Mary asks John about his drinking "problem."
2. Extratherapeutic factors are what the client brings to the session and
that musicianship [and counseling] is not about technique but love,
Although he answers yes to several questions, John
account for 40 percent of the change. These include the client's
Implications for Counselor Training
still asserts that he has his drinking under
strengths and capacity for growth, the client's support systems and
Given this research, counselors need to be able to quickly establish
control. For an hour Mary seeks to convince John
the setting to which he returns after rehabilitation, and his stage of
therapeutic alliances with clients. They need to learn to encourage
Finally, counseling begins with an inward journey, exploring what gives
that he needs to do something about "his problem."
readiness for change. Prochaska and DeClemente's Stages of
clients to see their own gains, conveying positive expectations. They
one meaning in what he does. Counselors should reflect on how they
John leaves the clinic disgusted and frustrated
Change model is helpful in addressing what the client wants in
need to know the vast network of social support and community
want to be remembered by a client.
because he felt unheard and unsupported. Mary
counseling. The most important question a counselor can ask a
resources to build on positive extratherapeutic factors. Counselors
client is, "What do you want and how can I help you get there?"
need to be able to walk a client through the stages of change, promoting
notes in the chart, "John has a drinking problem
the client's sense of personal control, focusing on the future, especially
but was resistant, defensive, not motivated, and
Counseling has moved through its adolescence into a more mature
Other client/extratherapeutic factors are underlying, contributing
the client's ability to overcome the past, be attuned to the client's
phase. Therapists are integrating spirituality into counseling, from the
personality disorders, chronicity, complexity of diagnosis, coping
feelings, and learn to be comfortable with silence.
work of Abraham Maslow, Gordon Allport, Carl Jung, Viktor Frankl,
styles, persistence, faith, a sense of personal responsibility, career
and Rollo May, Eric Fromm. Now, supported by outcome studies,
This scenario is too common in addiction programs,
stability, the length of time the disorder has persisted and fortuitous
Counselors need to help clients find their own solutions, and expect
counselors know that the essential qualities of change have to do with
which utilize the conventional wisdom that when
events. The key is to identify not what the client needs, but what the
the client to get better. How often has a counselor given up on a
compassion, the therapeutic alliance, what the client wants, and
therapy succeeds, because the counselor's actions
client already has in their life that can help them to reach their goals.
patient? Counselors reflect this feeling when they say, "They (clients)
ultimately, in helping the client to find meaningful answers that help
of asking probing questions and providing
are not motivated, not ready yet, in denial, haven't hit bottom."
him live as he was created to live. Counseling has "come of age" as it
insightful reflections to the client. When therapy
Therapists want motivated clients, or find ways to motivate clients.
Counselors need to learn collaborative vs. combative approaches in
moves into integrating contemplative approaches.!
fails, the patient was unmotivated, resistant, or
Yet the therapist cannot motivate patients, because everyone is
treatment, helping the client find their own solutions. Counselors need
perhaps a borderline personality disorder.
already motivated, by something. The counselor's task is to find out
to better monitor the therapeutic alliance and repair ruptured alliances,
Dr. David J. Powell is President of the International Center for Health Concerns, is
what motivates them. A therapist needs to be change-focused,
perhaps caused by poor prior treatment experiences of the client.
currently an advisor to the Asia Pacific Institute on Addictions, and is based in Singapore. His
Does Therapy Work and Why?
mindful of the client's contribution to change.
Therapists need to adapt the relationship to different clients, and learn
most recent book is Playing Life's Second Half: A Man's Guide for Turning Success into
The data is clear. The good news is that some therapy is better than no
more subtle interpersonal aspects of that therapeutic relationship.
Significance. Dr. Powell has 39 years of clinical experience in the addictions and mentalhealth field. You may contact Dr. Powell by email at [email protected].
treatment for most problems. The treated client is better off than 80
3. Hope and expectancy combine for 15 percent of the change. Hope
percent of those who go untreated (Miller, 1997).
is how people think about their goals, providing the patient with
Counseling from a Contemplative Perspective
optimism, self-efficacy and expectancy (Bandura, 1977), the belief
Traditional counseling has addressed the efficiency of functioning and
The bad news is that counseling is not about the counselor; it is about
that he can successfully perform a behavior, i.e., staying sober. The
how one should live. Contemplative counseling looks at the dynamic
Bandura, A. (1977). "Self Efficacy: Toward a Unifying Theory of Behavior Change," Psychological Review,84, 191-215.
what the client wants. In John's situation, Mary tried to convince John
counselor contributes to the placebo/hope effect by providing the
process of what one wants and why one would live. It involves the
Hubble, M.A., Duncan, B.L., and Miller, S.D. (1999) "The Heart and Soul of Change: What Works in
that he had a problem but never addressed why he came to the clinic
client with support, partnership, empathic communication,
integration of the heart. The only way to connect with clients is to
Therapy." Washington, DC: American Psychological Association.
— to get John's wife off his back. John was motivated but not about
empowerment, and a "holding environment" where the client feels
experience them, not think about them. It seeks integration vs.
Miller, S.D., Duncan, B.L., and Hubble, M.A. (1997) Escape from Babel: Toward a Unifying Language for
what Mary thought he should be.
cared for and supported. Treatment needs to be oriented to the
compartmentalization. It means listening from the heart as well as the
Psychotherapy Practice. NY: Norton.
Paradigm • Winter 2005
Paradigm • Winter 2005
Humility — the Key to
Continued from page 13
the opportunity to witness countless demonstrations of
origin of addiction. These philosophies by their nature are
how the unconditional love of one alcoholic or addict for
diametrically opposed. First, alcoholism and drug addiction
another produces healing beyond that of medical
are viewed as behavioral symptoms related to some deep
knowledge alone. I became part of a greater family, a family
underlying emotional or mental disorder. This tends to
that extended into countless smoke and coffee filled rooms
coincide with traditional psychiatric approaches and its
across the country. I firmly believe in children of all ages
acceptance is more widespread.
from alcoholic homes having that same opportunity. The
by Linda Hutchinson es
healing, which occurs in adults, is absorbed like sponges by
Second, the addiction may be seen as a primary illness;
the children. Taking the kids to open speakers meetings,
meaning that it is not secondary to some mental or
Humor is a tool for transformation, a
to humor is humility. The ideas, the opportunities for
birthday celebrations, conferences, anything related to
emotional problem, rather it exists as any other medical
tool for thriving — not just surviving
adding lightness to your life, are about doing. Humility is
recovery may put them in touch with someone who can
illness. More and more research indicates that within the
about being. I see it as an exploration in relational trust.
become a template of sobriety in their home.
brain of the alcoholic exist neuropathological markers that
— as we create a world that works
are not present in those without alcohol or drug addiction.
II first heard of the connection between humor, humility
When the local recovering community took in my parents,
Thus, mental health and substance abuse professionals
and being human while facilitating workshops with Ernie
without hesitation they automatically adopted the Mooney
cannot be entirely certain which theory is correct.
By transforming our current paradigms, humor becomes a
Kurtz, co-author of The Spirituality of Imperfection and
kids. I guess they knew how
However, it is assured that whichever theory one believes
tool for building bridges across cultures and educating each
author of Not God: The History of AA. Kutz writes about the
much we longed for some sane
to be correct will have enormous impact on subsequent
other about peace and justice issues. Learning about
importance of embracing our humanity. We are neither you are too
parenting from somebody. The
generations within a family.
humor in other cultures is an adventure, whether it is
beast nor angel, but both beast and angel. When we forget small to be
relationships forged during
through reading, traveling, or shared conversations. Often,
this, we are often hard on ourselves, thinking we should be
those years have extended
For instance, if an underlying emotional conflict has
when I ask, "What makes you laugh?" people respond with
perfect or more than we are.
beyond my childhood and have
resulted in aberrant substance abuse, then subsequent
laughter. Sometimes, with people from a different culture,
accompanied me on my journey
generations have nothing to fear unless perhaps the conflict
there is a language barrier or details get lost in the
According to the dictionary, humility is the feeling or
of stumbling into becoming an
is reproduced in following generations. However, if the
translation. Even though we do not always understand
attitude that you have no special importance that makes been in bed
adult. Our extended family
second theory falls within the scope of possibilities, then
every word, the question is worth asking just to see their
you better than others. The understanding of humility is with a
provided a blueprint of sanity
one must also accept the possible genetic implications of a
faces light up as they recall funny times from the past.
about gratitude and appreciation of who we are and are not
for us to follow, as the genetic
primary disorder. In actuality an addiction track for genetic
and who others are. It is about integrity and accepting mosquito.
predisposition became a reality.
counselors already exists. In attempting to determine how
Use humor as an opportunity to get to know
ourselves as whole. It is a paradox — to be complete and to (On 500,000 Web sites)
Although the experience of
best to protect subsequent generations from repeating the
others. Initiate a conversation about humor and
be continuing to develop as human. It is about owning and
being exposed to a vast
cycle of addiction, it begins with an in-depth evaluation of
culture. Ask them how their culture expresses
celebrating our gifts and recognizing them as gifts. It is Those who get
knowledge of addiction was
personal beliefs in regards to addiction. Start with asking,
or encourages humor.
about knowing our place in the grand scheme of life.
sufficient to alter one's
"What is it that I believe about addiction?"
perception of the illness, it
Humor has long been a tool for surviving and thriving while
Humility is not only about accepting ourselves; it is also their britches
became apparent that knowledge alone was insufficient to
Although my father died before the birth of any of my three
dealing with the stress of oppression. Humor can help to
about creating who we are, having the courage to be will be
grant full immunity toward it. In other words, youthful
sons, they were able to spend countless hours with
create a world that works for everyone. According to
authentic. The word for "authentic" is "author," which I
substance experimentation combined with gene theory
"Grandma Dot." They would listen to her, as she talked
comedian Carol Burnett, "Humor is tragedy plus time."
interpret as being the "author of our lives."
produces a nut that does not fall far from the tree! Of the
about her recovery with other women. They went with her
four children, three developed addiction to alcohol and
to birthday meetings when she would celebrate her
When you consider the amount of time we spend on what
It is my belief that those of us with privileges based on our (On 2,760 Web sites)
drugs, including myself.
anniversary. They never tired of hearing her share her story
is wrong with the world, and listening to bad news, we can
gender, race, class, education, and other forms of status,
at various gatherings. The unconditional love she expressed
become stuck in a paradigm of tragedy. Our openness to
are to use the privileges to connect with others. One way to
As tragic as that may be, the most amazing part is that all
to them was a direct reflection of the life she found in
see reality from a new perspective offers us the ability to
do this is through humor. The ability to laugh at ourselves
.youthful three are now sober with sobriety ranging from 19 to 27 sobriety. When Grandma Dot passed away this past
place our lives in a greater context — a context where
with others levels the playing field especially with those
substance years! In comparison, my father was 49 years of age when January, it represented the passing of a remarkable
making a difference is a priority. People who are able to
who have fewer privileges. Consider how to use humor as
he faced his addiction at Lexington; I reached that same
generation. The path taken by that generation had very
laugh in the face of hardship, even death, are often the
a contribution and means to create a greater sense of
experimentation turning point when I was 24. He had used alcohol and clearly lessened the impact of addiction in the subsequent
ones who live to tell about it.
belonging, especially among those who feel left out
combined with drugs for over 25 years compared to my 12 years of use.
generation. In addition, the third generation of childrenmay be totally spared from harm resulting from alcohol or
It is vital to lighten up in order to appreciate the funny
Humor and humility are about
Three children were born during my parent's active
drugs. At the very least they know that there is an illness
aspects of our humanity. One of the crucial lessons is
accepting our humanity — loving each
produces a nut addiction with ages at the time of their recovery from six to that runs in our family and the use of alcohol or drugs may
learning to distinguish healthy laughing at one's self from
eleven years old. Of their nine grandchildren, none have
set off an irreversible chain of events. If that is the case,
caustic self-deprecation. Some of us learned to make fun of
other and ourselves as we are and as
that does not ever known what it is like to have parents who are actively they also know where they can turn to for help.!
ourselves as a defense mechanism with self-deprecating
we are not. It is about knowing our
fall far from using alcohol or drugs. In only one full generation,
humor as a shield. The key to this distinction is accepting
place in the Grand Scheme.!
Dr. Robert W. Mooney
the tree! the devastating cycle of addiction, which is generally multi-
serves as Medical Director of Willingway
ourselves, making a conscious choice to laugh at ourselves
generational, has been altered such that the third
Hospital, a privately owned 40-bed facility, that services alcohol and drug
and let others in on the joke. Part of the choice has to do
generation may very well reach adulthood with no evidence
addicted patients. He completed his residency training at East Tennessee State
with confidence, having a certain amount of healthy self-
Linda Hutchinson, CFO (Corporate Fun Organizer), has a Masters of
of alcohol or drug use much less a repeat of University in the Department of Psychiatry.
esteem and self-acceptance. When we are lacking humor,
Arts and Theology, is an adult educator, consultant and author with 30 yearsof professional experience. In addition to her company, Hutchinson and
the debilitating illness that was present in their parents and
Prior to completion of his formal medical education, Dr. Mooney served as
it is time to check our level of confidence, self-esteem, and
Associates, ha!, Ms. Hutchinson also teaches college courses on humor and
Associate Director of Willingway from 1983-1987. In addition, Dr. Mooney
humility. Self-criticism and harsh judgment interfere with
spirituality. She recently completed writing Laugh and Live, Reclaiming our
helped develop and is the primary psychiatrist for the Assertive Community
humor. Learning to accept ourselves as we are is a lifelong
Sense of Humor — her book and programs are practical, pithy and
Because the total cause of addiction is unknown there
Treatment Team (ACT Team). For additional information on Dr. Mooney visit
process. After living fifty-five years and collecting over 110
playful. She can be contacted by email at [email protected] or visit her
exists essentially two commonly held beliefs as to the the Web site www.willingway.com.
ways to give and receive humor, I figured out that the key
Web site www.haha-team.com.
Paradigm • Winter 2005
Paradigm • Winter 2005
to see the benefits of changing behavior asoutweighing the benefits of maintaining
In recovery, young adults struggle with multiple issues
negative behavior. Through this process,
relating to their addiction. After inpatient treatment,
by Roula Ghantous, M.A., N.C.C., L.P
the recovering individual starts to believe
that they are capable of changing
clients believe they can return to their old ways of
problematic behaviors. The therapist
living. When they discover that these old ways need
assists the individual in making their ownchanges by facilitating the individual's
to be changed, they become more depressed and
movement through the stages of change.
hopeless. They refuse to allow their chemicals to get
The stages of change revolve around confusion, fear,
between their using friendships. They believe they can
conflict and finally understanding with clarity. This
maintain the same friends and control their chemical
becomes the foundation for clients to begin to believe in
relapse process. This process encompasses the utilization
their abilities and have faith in their own higher power in
use. During a short period of time in recovery, young
what I call M.A.T.B. This acronym represents change in
times of struggle and uncertainty.
adults become more resentful to therapy and recovery
mood, attitude, thoughts and behavior. M.A.T.B.
symbolizes the friend that leads to relapse. These changes
because they blame their negative feelings of
In working with adolescents, the practice of trust, safety,
symbolize the initial stages of relapse and using chemicals
unconditional regard and respect are the foundation of
depression, loneliness, and boredom on treatment
becomes the final step of this relapse process. In order to
the therapeutic relationship. After the therapist and
help adolescents discover their self-awareness and internal
and not the disease.
client build a trustworthy relationship, the tools of
conflicts, the utilization of behavioral cognitive therapy
confrontation and discrepancy must be utilized to
will aid them in managing and modifying their cognition,
challenge their cognition. This can be accomplished
which is the primary place that ignites the addiction
by implementing cognitive behavioral therapy and
leading to relapse.
motivational enhancement therapy. Throughout this
The journey of self-discovery, uncertainty, autonomy, and
As a therapist working with adolescents in aftercare,
process, the young adult will need to be reminded of the
acceptance are a few of the challenges that young adults
treatment presents many challenges. In recovery, young
For a therapist, there is a fine line between building a
addictive friend M.A.T.B., which enables the addictive
are confronted with in the course of their development. As
adults struggle with multiple issues relating to their
trustworthy relationship with young adults and holding
thinking process, exemplified by relapse. It is very
adolescents pursue this journey of identity evolvement,
addiction. After inpatient treatment, clients believe they
them accountable to their actions. A therapeutic
rewarding for a therapist when recovering clients come
there are many factors that contribute to a healthy
can return to their old ways of living. When they discover
relationship has to be established on trust and security, yet
back to visit and share their new life experiences without
development. The majority of teens strive to be valued,
that these old ways need to be changed, they become more
has to address discrepancies and confrontations
dependence on chemicals. Lastly, recovering young
respected and loved members of our society.
depressed and hopeless. They rationalize that addiction
accordingly. Taking a holistic approach in recovery is
adults understand that their disease is never cured but
disease will not limit their relationship with friends. They
crucial to successful outcomes. There has to be an
can be managed. The most important discovery is that
In general, teenage years can present a period whereby
believe they can maintain the same friends and control
integration of body, mind, and spirit working
they have the abilities to live enriched lives and achieve
the existence of relationship conflicts with family
their chemical use. During a short period of time in
simultaneously. In the first phase of recovery, client's
many goals without chemical dependency.!
members, peers and authority can be exasperated by
recovery, young adults become more resentful to therapy
struggle with good eating habits, sleeping and exercising,
many negative consequences. In addition, young adults
and recovery because they blame their negative feelings of
which directly affects their mood. The mind has to be
who are diagnosed with addiction disease can be
depression, loneliness, and boredom on treatment and not
challenged, so distorted thoughts are brought to awareness
Roula Ghantous began working for the Illinois
overwhelmed and struggle with the acceptance and
and this would aid to reframe their cognition. The final
Institute for Addiction Recovery in October of 2001.
understanding of this disease. Hence, those who are
step of the holistic approach believes in a higher power.
She specializes in working with adolescents in
often most painfully affected and need the most help are
Early in recovery, young adults will exercise control over
This is a very abstract and complicated phase for clients to
aftercare and also provides therapy for young adults
our children and adolescents.
their use. They begin to convince themselves as long as
understand and accept. By believing in a higher power, it is
dual diagnosis group. As a therapist, she strives on
they do not use, then they do not have a problem. The
easier to surrender to recovery and treatment. It is the
the challenges that encompass the young adults and
Most chemically dependent adolescents believe they are
reality of the matter is that urges and cravings do not
relationship, which is developed through spirituality that
their families in recovery. She attended Bradley
normal drug/alcohol users. They believe they are using just
subside. The cravings and urges cause more irritability and
enriches life and provides hope and inspiration. Individuals
University where she received her B.S. in Psychologyand Sociology. Shortly thereafter, she received her
like everyone else. This becomes the norm that they are
frustration whereby young adults blame recovery for their
suffering from the disease of addiction strive to be treated
M.A. in Human Development and Counseling. She is a licensed professional
identifying themselves with and this norm becomes the
lack of coping skills that are essential in dealing with the
with respect, dignity and a sense of self worth.
counselor (LPC), national certified counselor (NCC) and a certified alcohol
set-up for enormous challenges in the road to recovery for
onset of intense feelings. Conversely, young adult clients
and drug counselor (CADC).
young adults. The distorted thinking is that the only
are resistant to 12-step support groups because they
Another beneficial therapeutic approach is the
problem present is being caught and the consequences
rationalize that older people in recovery do not understand
motivational enhancement theory. This theory "focuses on
become the driving force for treatment. They do not
them. Teens early in recovery have limited teen support
resolving a clients ambivalence surrounding their
Schaefer, Dick (1996). Choices & Consequences. Johnson Institute, MN.
believe or accept that the norms that they have established
groups because of the high rate of relapse.
substance use and the major changes that are involved in
Giordano, John, & Geiss, Trina (2004). "Taking a Holistic Approach to Drug Addiction
need to be modified in order to have a life of sobriety.
moving from using behaviors to abstinence." (The Dual
Treatment." Addiction Professional, Vol. 2(3), p. 50.
Furthermore, the distortion of controlling their chemical
In my therapeutic process, I have developed an effective
Network) This theory expands on the concept that change
Bride, Brian, Womack, Bethany, & Macmaster, Samuel (2001). "Promising Treatments
use will enable them to continue in their identified norms. approach to helping young adolescents understand the
occurs through an internal process where a person begins
for Dual Diagnosis." The Dual Network, Vol 2(2), pp. 12-14.
Paradigm • Winter 2005
Paradigm • Winter 2005
Continued from page 13
argument with her parents that culminated in her throwing
By being sensitive to start where each family member is in
ILLINOIS INSTITUTE FOR ADDICTION RECOVERY
a chair. Both the police who responded, and Tracy's mother
his or her readiness to change, we can attract people into
who called 911, believed that she was under the influence
recovery and "break through denial"; rather than increase
2005 TRAINING AND WORKSHOP SCHEDULE
at the time of the incident.
resistance and "make denial" worse. Counselors may be inthe action phase awaiting change, but the client or family
FEBRUARY 23RD – 25TH AND
MAY 19TH – 20TH
When interviewed by the emergency room (ER) physician
may be at action to change someone else. The family may
FEBRUARY 28TH – MARCH 1ST
and a nurse from the hospital's psychiatric unit, Tracy
be very ambivalent or even unready to make the changes in
Problem and Compulsive Gambling: Counselor Training
Randee McGraw, CSADC, NCGC, CAS, CCGC, CEAP and Angie
reported that this latest episode was one of many their life that would improve not only their sanity, but also
Presented by the Staff of the IIAR
Moore, MS, MHSA, LCPC, CMADC, CCGC, PCGC, MISA-II
recent clashes at home, typically starting whenever her
that of the identified client.
9:00am – 4:30pm
Workshop cost: $200.00 (must attend both days)
parents–especially her father–complain about her drinking,
Workshop cost: $600.00 (must attend all 5 days)
late hours, or her friends. She freely admitted to being
Families in Recovery
Utilizing didactic lecture, video case vignettes, role-plays, and interactive group
discussion, this workshop will:
angry with her parents noting, in particular, that they treat
When families see a loved one driving, as it were, towards
This training will consist of a 30-hour course delivered throughout a five-day series.
1. Describe the underlying philosophy and principles of Transitional Family
her "like a toddler rather than a teenager." When asked, she
the cliff, it is hard not to jump in and rescue him or her. It
It will provide participants with the requisite knowledge for the State of Illinois
written certification exam for counselors of problem and compulsive gambling. It
Therapy and the use of the ARISE (A Relational Intervention Sequence for
said she had been drinking "some" earlier that evening, but
is even harder to healthily detach and let the natural
also meets the coursework requirements for the national gambling certification. At
Engagement) as a collaborative model for engaging substance abusers/those
denied using alcohol or other drugs regularly. "The
consequences of ones actions happen — whether that be
the end of this workshop, participants will have developed a strong clinical base for
suffering from addictive behaviors (such as gambling) in treatment through their
problem," she maintained, was her parents. "They are
to spend the night in prison; or to get suspended from work
compulsive gambling issues as well as cultural competencies and client-centered
families and support systems;
2. Increase familiarity with the 3-stage ARISE protocol for coaching "Concerned
always on my back and don't trust me."
for tardiness; or to be kicked off the football team because
treatment for compulsive gamblers and their families.
Other" members of the family and support system who contact them concerned
of poor grades. Helping families to know when and how to
about an addicted individual;
About the speakers: Licensed and certified staff from The Illinois Institute for
While both the ER physician and the psychiatric nurse
intervene; what limits to set and what behaviors to tolerate
3. Develop proficiency in the telephone coaching protocol (Stage 1) using
Addiction Recovery (IIAR) will be providing the training. The IIAR provides a full
Concerned Others as collaborative link therapists and natural change agents for
families were initially tempted to admit Tracy to the psychiatric or not can go a long way towards helping families to
continuum of care for the treatment of chemical dependency, as well as gambling,
mobilizing the network;
unit-at least for the night-a review of her needs and the
recover. Even if the identified client is not ready to
food, Internet, sex, compulsive spending addictions and chronic pain with addiction.
4. Gain practice in Stages 2 and 3 protocols of ARISE; and
stage of change of Tracy and her parents suggested a
embrace recovery, the rest of the family can begin to have
5. Increase understanding of the relevance of the results of ARISE and its
difference different approach. While Tracy threw the chair when she a life of their own. The wife can clean up the husband's
implications for utilizing ARISE.
was intoxicated, she was no longer "under the influence,"
throw up and put him in clean pajamas so that he wakes up
Dual Diagnosis and Pathological Gambling
between and the incident appeared to be directly related to the next morning as if nothing happened, or she could
Phil Scherer, CSADC, PCGC, MISA II and
About the speakers: Randee McGraw is currently the Administrative Director
of the Illinois Institute for Addiction Recovery at Proctor Hospital with centers in
making and problems at home. In addition, there was no evidence of leave him passed out on the floor with his face in throw up,
Ken Search, CSADC, MISA II, PCGC
Peoria, Bloomington, and Springfield, Illinois, where he has been employed since
Workshop cost: $100.00
breaking denial severe or imminently dangerous detoxification, so that he wakes up the next morning with his mouth
November 1979. Mr. McGraw has been treating clients diagnosed with Substance
biomedical, or mental health problems requiring the
feeling like the bottom of a bird cage. This event is not
Dependence, Mental Illness, and Process Addictions since 1978.
is the resources of an intensive hospital setting. Finally, and most about the wife punishing her alcoholic husband. It is about
This training will offer information about the interaction between the pathological
gamblers' addictive illness and other mental disorders they frequently suffer from.
Mr. McGraw developed and implemented the first comprehensive treatment
difference importantly, Tracy viewed her parents as the problem and her detaching to allow her husband to experience the
Differential diagnostic issues will be addressed and practical suggestions offered to
the parents viewed Tracy and her choice of friends and
connection between his drinking and the consequences of
program for Pathological Gambling in Illinois; a consultation service to implement
the clinician about how to help those suffering from gambling addiction and dual
treatment for Pathological Gambling in other agencies and hospitals; a treatment
activities as the problem. As such, hospitalization was
out of control drinking. When she breaks that connection
diagnoses limit negative interactions between and among these illnesses, making
program for family members or concerned persons of people diagnosed with
attracting more likely to evoke opposition and defiance than by cleaning up, she deprives her husband of the firsthand
their recovery more solid and complete.
addiction; a treatment program for Adult Children of Addicts and survivors of
engagement and cooperation.
experience of what his drinking is doing to himself and to
childhood trauma; a comprehensive treatment program for all process addictions;
About the speakers: Mr. Ken Search is an addictions counselor at The Illinois
and a gambling counselor training program.
Institute for Addiction Recovery at Proctor Hospital in Peoria, Illinois and has been
into recovery; The physician and nurse recognized that both Tracy and
on staff there since June of 1998. Mr. Search has been employed in the counseling
Mr. McGraw is currently the President of the American Compulsive Gambling
her parents were in an early stage of change. Tracy did not
When counselors help families to embrace recovery for
and human services field since 1978 and also has taught on the high school,
Counselor Certification Board and is the current President of the Association of
have any interest on working on her substance use or on
themselves, not only do they gain back their own lives, but
undergraduate and graduate school levels. He has had extensive experience
them to anger management; and her parents had no interest in also the change in the family dynamics just might bring
working with a wide variety of family constellations, counseling people on an
working on their inconsistent limit setting, the father's
recovery to the identified client. Helping families
individual basis, and leading a wide variety of educational programs and seminars,
Angela Moore is the Manager of the Illinois Institute for Addiction Recovery at
both for clients and professionals.
alcohol use and their marital problems. It would only
understand the difference between making and breaking
Proctor Hospital with centers in Peoria, Bloomington, and Springfield, Illinois as
well as the Counseling Center at Proctor Hospital where she has been employed
rescuing increase resistance and denial to immediately make these denial is the difference between attracting families
Among his professional presentations was co-leading one of the Compulsive
for ten years. Ms. Moore received a Master's Degree in Clinical Psychology from
and frustration. issues the focus of treatment. The treatment team instead, into recovery; or dooming them to continued rescuing
Gambling Training Programs provided to Illinois addiction treatment professionals
Illinois State University and a second Master's Degree in Health Services
arranged for Tracy to spend the night with a trusted aunt
in 2001 and 2002. In addition to his current work with gambling and other
Administration from the University of St. Francis in Joliet. She is a Licensed
and to have a family meeting in the morning with the
addicted clients in the Intensive Outpatient Treatment Program at Proctor, Mr.
Clinical Professional Counselor, a Certified Master's Level Alcohol and Other
Search provides therapy to appropriate clients from all levels of primary treatment
expressed focus being appropriate to this family's stage of
Dr. David Mee-Lee is a board-certified psychiatrist and is certified by
Drug Counselor, a Certified Compulsive Gambling Counselor through the
in a weekly dual diagnosis group. His credentials include certification of expertise
American Compulsive Gambling Counselor Certification Board, a certified
readiness to change.
examination of the American Society of Addiction Medicine (ASAM). He is
in gambling addiction treatment and working with dually diagnosed clients.
Problem and Compulsive Gambling Counselor through the Illinois Alcohol and
based in Davis, CA and is involved in full-time training and consulting. Dr.
Other Drug Professional Counselor Association, and a MISA (Mental
Tracy agreed to work with the counselor on how to get her
Mee-Lee has over twenty-five years experience in treatment and program
Mr. Phil Scherer is the Clinical Coordinator for the IIAR at Proctor Hospital. Mr.
Illness/Substance Abuse) registered clinician.
parents off her back; and the parents agreed to family
development for people with co-occurring mental and substance use
Scherer oversees the day-to-day clinical direction of the IIAR's adult and
disorders and has authored a number of book chapters and papers in a
adolescent inpatient units. He is certified through the Illinois Alcohol and Other
therapy to see how they could get help to make Tracy
Above trainings will be held in Classroom III, in the Proctor Professional
variety of professional publications. He is Chief Editor of the Revised Second
Drug Abuse Professional Certification Association at the supervisor level and as a
Bldg., Peoria, IL. from 8:30am – 4:30pm unless otherwise noted. For
behave. Such family work accepted all members at their
Edition of the ASAM Criteria, ASAM PPC-2R, which includes criteria for co-
Problem and Compulsive Gambling Counselor. Mr. Scherer is also certified
registration and lodging information, call 1 (800) 522-3784 or visit the
stage of readiness and engaged them in a focus for
occurring mental and substance-related disorders, published in April 2001.
through the American Compulsive Gambling Counselor Certification Board as a
Web site www.addictionrecov.org. Refreshments will be provided, but
treatment that they could immediately buy into. Of
Dr. Mee-Lee may be contacted by email at [email protected] or by visiting
counselor of problem gamblers.
lunch will be on your own for all workshops.
course, helping Tracy get her parents off her back would
the Web site www.DMLMD.com.
invariably lead to a discussion of what she does that gets
Mr. Scherer has been with the IIAR since 1991; he has worked in all areas
of treatment from Inpatient counselor, Adult Intensive Outpatient, Adult and
them upset and would involve an examination of her
Adolescent Continuing Care and Adult and Adolescent Family Programming.
grades, friends, curfew, substance use and her impulse
Miller, W. R. and Rollnick, S. (2002). Motivational Interviewing — Preparing People for
control — issues we would want to talk about anyway.
Change. (Second ed.) New York, NY: Guilford Press.
Mr. Scherer is a trained interventionist and a member of the Association of
Helping the parents to get Tracy to behave would also lead
Interventions Specialists, a member of the Illinois Institute's speaker's bureau
Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. (1994). Changing For Good.
to a discussion on what limit setting works and does not
New York, NY: Avon Books.
providing community education and a member of the Compulsive Gambler
If you have questions regarding addictions, call 1 (800) 522-3784, or
Counselor training team. He has been involved as a trainer in the Illinois statewide
write to Eric Zehr at Proctor Hospital, 5409 N. Knoxville Ave., Peoria, IL
work with Tracy and how well or not the parents are
Prochaska, J.O., Norcross, J.C. and DiClemente, C.C. (1992). "In Search of How People
initiatives in training other professionals in the identification and treatment of
61614. On the Internet, contact: [email protected]. For more
together on how to handle Tracy.
Change: Applications to Addictive Behaviors." American Psychologist, 47, 1102-1114.
people with compulsive gambling problems.
answers, visit our interactive Web site at http://www.addictionrecov.org.
Paradigm • Winter 2005
Paradigm • Winter 2005
Addiction devastates lives.
We can rebuild them.
Our professionals are uniquely qualified to help men, women andadolescents live without addictive chemicals or behaviors. We offerinpatient and outpatient treatment for addictions to chemicals,gambling, food, spending, sex, and the Internet, as well as treatment
Call today for a confidential consultation.
for chronic pain with addiction, all with options for extended care.
800-522-3784 or 309-691-1055
Pick up the phone, and start picking up the pieces.
Con la colaboración de Amalia García-DelgadoMiguel Ángel Gastelurrutia Garralda Editora:María José Faus DáderGrupo de Investigación en Atención FarmacéuticaUniversidad de Granada GUÍA DE SEGUIMIENTO Amalia García – Delgado MorenteLicenciada en FarmaciaFarmacéutica Comunitaria. SevillaMiembro del Grupo de Investigación en Farmacología Experimental y Farmacoterapia (CTS-259). Universidad de Sevilla
For Alumni potlight And Friends Of East High January 2009 East High Alumni Heritage Hall: Angels Making History Newly inducted "Angels" prepare to cut the ribbon on the Heritage Hall dis-play, left to right, Anthony Ortega, Barry Hirschfeld, Philip Bailey, Allegra The Alumni Heritage Hall display is on the third floor outside of the East library.