are your clients a pain?
TRANSCRIPT
Are Your Clients a Pain ?MI , SFT, Brene’ Brown, Parallel Processes & Pain Recovery Strategies
July 21, 2016 Core Conference
Louise Stanger Ed.D, LCSW, CIP
With James Flowers PHD, Director Kemah Palms, Houston Texas and a Pain Recovery Expert
Dr Stanger is An Author, Educator, Writer, Clinician and Interventions and Thought Leader on Families
ObjectivesIdentify, Describe & Explain Resistant Clients
Learn alignment strategies using MI, SFT, Daring way & Rising Strong strategies
Practice Crucial Conversations
Identify Role of Shame and the Practice of Empathy and Compassion
Show how these strategies may be integrated into practice using case examples
How Do Our Clients arrive ? Substance Abuse
Mental Health
Chronic Pain
Legal Issues
Money Problems
Relationship Failures
Sex, Shopping, Gambling
Intergenerational Wounds
Attributes of Healthy Families McMannis PHD & MacMcMannis MSW
Talking and Loving Balancing Closeness & Difference
Expressing Language Accepting Difference
Adapting to Change Seeing The Positive
Sharing Time together Effective Problem Solving
Who’s in Charge Parenting Together
Keeping The Status QuoSA. MH, CP etc . Organizing structure
Unconscious and Consciously Gratification
Strategies must be employed that change usual ways of relating, categorizing , and thinking
Family and Confabulations
Before Treatment CONFUSED
BEWILDERED
CONFABULATORS- DENIAL
MINIMIZE
FEAR DRIVEN
FRAZZLED
SHAME and GUILT
What Kind Of Families do You Meet
AGREEABLE
ANALYSIS
INVISIBLE
QUESTIONER
KNOW IT ALL
COMPLAINER
TALKER
WORRIER
MICO-MANAGER
BOOMERRANG
HAVE YOU EARNED THE RIGHT TO HEAR ANOTHER’S STORY ?
ASSUMPTIONS ABOUT FAMILIES THAT SEEK OUR HELP
HURTING EXPERTS
MOTIVATED
SEEKING SOLUTIONS
WOUNDED FAMILY OF ORIGIN
BEEN UNSUCCESSFUL IN SEEKING SOLUTIONS
THEY MAY NOT SEE THEIR PART IN THE PROBLEM -want you to FIX LOVE ONE
AUTHENTIC- VULNERABLE- COURAGEOUS
BRAVING - BrownAm I clear in helping client accept own boundaries ?
Am I reliable ? Do I do what I say I will do?
Do I hold myself accountable-Ethics, professional standards &, seek collaboration when necessary
Confidentiality
Nonjudgemental
Am I generous in my interpretation of self and others ?
Motivational Interviewing Miller and Rolnick
NOT a Curriculum
ROLLING WITH RESISTANCE
DIRECTIONAL-GOAL
MOTIVATION IS BOTH EXTRINSIC AND INTRINSIC
SCALING QUESTIONS
DECISIONAL BALANCE
CHANGE TALK
START WHERE YOUR CLIENT IS
Different Ways of Talking- “MY Mother is driving crazy”
SIMPLE
AMPLIFIED - Exaggerate
“It would suck to lose my job or my parents support because of my partying but I do not want to quit just because of that .
DOUBLE SIDED
SOLUTION FOCUSED InSoon Young & Peter Berg
HERE & NOW
NOT NECESSARY TTO KNOW DEEPER CAUSE
COUNSELOR EXPERTISE CALL
SMALL CHANGE Can Lead To Big Change
SFT STRATEGIES PROBLEM TALK
SEPARATE THE PERSON FROM THE PROBLEM
MIRACLE QUESTION
EXCEPTIONS
SCALING QUESTIONS -CONFIDENCE
GOALS -FEEDBACK
COMPLIMENTS
TASK SETTING
The DARING WAYSHAME-GUILT - HUMILIATION
COURAGE -asking what you need, seeking support, owning your story , setting boundaries
Vulnerability
THESE AE NOT THERAPUTIC STRATEGIES
STORY
INDIGENOUS TO ALL OF THIS IS
GRIEF
LOSS
INTERGENERATIONAL
TRAUMA WORK
Parallel Processes Krissey Pozak
Families Grow Alongside of Identified Loved One
Letting Go
Reflective Listening
Learning How to Speak
Shifting Responsibility Back to Your Loved One
Separated but coordinated processes bringing in our Clients motivators
INTERVENTION- BAR RELATIONAL ATTACHMENT
The TEAM
3 Sisters
2 Attorneys
Family
Friends
Relatives
Security
Modalities USED MI- Rolling With Resistance
SFT- In A Perfect World what would life look like
Brown- You Can Write Your Own Story
Family MAPPING
Parallel Processes-
You Can ALL FALL UP
Paradigm Shift
Moving From Passive :Cure me Doctor to
Being an ACTIVE PARTICIPANT
Meet Harriet - 62 y.o Female
How Harriet’s Lights Went OutSmall Tumor on Cervical Spine- Operation-Radiation & Chemo
Oops clipped a nerve- INTENSE PAIN = OxyContin, Xanax , Ambien on and on and on
Finally ended with a Actig Fentanyal Lollipop
Losses
Lost Family Business Lost Insurance Lost Family Money Lost Self Esteem Lost Ability to Walk Lost Her Smile
Strategies15 day detox- Pain still 20% due to Hyperalgesia
Education
Cognitive Behavioral Therapy
Mindfulness
Mediation
Yoga etc
Peer Support
OutComesREDUCED PAIN
45 days later lightly jogging 3 miles
SMILE REMADE
BUSINESS BACK ON TRACK
MARRIAGE BACK ON TRACK
GRANDMOTHER DUTY
MEET KING BABY and His Parents
MULTIPLE TREATMENT EPISODES
ANXIOUS PARENTS
NO BOUNDARIES
2 years of work with one
9 months with another
Meet JAVIER
Car Accident- 8 years ago
Previous Experience with AA
Intergenerational
Stylist for Major Stars
Meet Jack 50 yo male
Previous TreatmentPrevious TreatmentsLaminectomy L3/L4, L4/L5
Outcome – increased pain, radiculopathy
Lumbar fusion and Lysis of adhesionsOutcome – failed fusion, pain
continuedPhysical therapy
Outcome – moderate but temporary
Jack Presupposed Treatment: Drug Delivery with morphine
Behavioral Assessment ; Clinical Interview , MMPI-2, MPI,BAI/BDI , Chemical use questionnaire
RESULTS:: Activity < 3, Reported 10/10 constant pain, Sleep < 3, Used Alcohol to increase drug effect, Severe Anxiety/Depression, Results of the MPI indicate that the patient is experiencing average pain severity, above average interference (+2 SD), below average life control (-2 SD) and an above average level of affective distress (+1 SD). These findings are compared with other chronic pain sufferers. A significantly reduced general activity level (-2 SD) was endorsed. These findings are consistent with many chronic pain sufferers
Goals
May not be the Abolition of pain but adaptation to Pain
ACCEPTANCE CAN BE KEY
Treatment Plan
Biofeedback and relaxation therapy
Psychophysiological education
CBT , MI, Group Therapy
Postpone implantable drug delivery
QUEEN BABY and her MOM
Intergenerational
Change Agreements
Treatment for Whole Family
ResourcesThe Daring WAY & Rising Strong- Brown
Crucial Conversations -Patterson et al
Parallel Processes- Prozatek
Journey of The Heroic Parent-Reedy
Motivational Interviewing- Miller & Rollnick
http:www.motivationalinterviewing.org
Solution Focused Therapy - Young & Berg
Dr. Louise Stanger http://www.allaboutinterventions.com
Are You A Helicopter or Submarine ? Sober World -, Spring 2016 Stanger
Pain ResourcesCenter for Disease Control, March 2016
Scientific America -Crucial Conservations , May, 2016
ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction and Opioid Use,2016
Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Int Med. 2015;162(4):276-286.
Centers for Disease Control and Prevention. NCHS Data Brief. Prescription opioid analgesic use among adults:United States 1999-2012 , Number 189, February,2015
2013 National Drug Student Data Bank
Kemah Palms Recovery https://kemahpalms.com
An Intervention Guidebookfor Loved Ones and Their Families
LearnThrive:to
LOUISE STANGERED.D., L.C.S.W., BRI II, CIP