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
Illinois Institute Institute Addiction at Proctor Hospital Young Adolescents Journey to Recovery Leave Well Enough Alone Helping People Change: Make or Break Denial Humility — The Key NON PROFIT
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 Madge White 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 Steve Wilson 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 Art Credits
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 Young Adolescents 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. ollman, L.I.C.S.W.
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 following question: 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 teen prostitution: 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 teen prostitution.
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 are threefold: 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 Thermostatic Analogy 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 project unfolds.
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 and flexibility.
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 hurting heart.
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 Ines
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 Patricia A. 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 their behavior.
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. Rollnick, 2002).
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 motivational tasks 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 giving, generosity." 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 ADOLESCENTS JOURNEY 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 .C., C.A.D.C.
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 the disease.
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 APRIL 29TH
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 and frustration.! 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.
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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.