Creating a Vision for Recovery Steven W. Hart MHS, MSOD, MSTD, CRADC

1. Creating a Vision for Recovery Steven W. Hart MHS, MSOD, MSTD, CRADC Executive Director – The Recovery Village Ridgefield, WA

2. Agenda • Identify Goals • Review perspective on inpatient and outpatient treatment • Evidence Based Treatment • Review Developmental Tasks • Models • Counseling/Coaching/or a Combination

3. Agenda (continued) • Creating a Vision • Exploring the Process of visioning • Setting the Stage/Personal Learning • The 12 Steps and 12 Step Principles • Goals/Skills for 12 Step Integration • Conclusion • Review • Questions and Answers • References

4. Goals 1. Demonstrate how the philosophy of care is integrated into the process of care planning and care. 2. Demonstrate how the clinical staff partners with patients’ to help identify strengths that will support and facilitate a vision for recovery.

5. Goals (continued) 3. Show how the 12 Steps and the 12 Step principles are integrated into the patient’s vision of recovery. 4. The patient’s ownership of their vision of recovery increases their commitment and compliance to treatment, which often includes extending their length of stay.

6. Historical Review • Treatment – Inpatient - Outpatient • Define Outpatient Treatment • Review treatment components for residential and outpatient program

7. Residential Treatment • A residentialtreatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance abuse, mental illness, or other behavioral problems.

8. Residential • Abstinence based • 24 hour medical monitoring • Medication Management • Assessment and treatment planning • Group/Individual counseling • Co-occurring Mental Health • Therapeutic Community (Healing Environment) • Holistic – Body, Mind, Spirit

9. Outpatient Real life changes Scheduled activities Longer length of stay Behavior orientated Supportive Gradual changes “Coach” model Residential/Outpatient • Residential • Controlled Setting • Controlled activities • Limited length • “Insight” orientated • Confrontational • Rapid Changes • “Counselor” model

10. Outpatient Treatment A collection of therapeutic activities, designed to teach and support abstinence from drug and alcohol use delivered in a non-residential setting by addiction treatment professionals.

11. Residential Treatment Components • Abstinence based • 24 hour medical monitoring • Assessment and treatment planning • Group/Individual counseling • Co-occurring Mental Health • Therapeutic Community • Holistic – Body, Mind, Spirit • Elements of Programs • Education • Therapy • Fellowship

12. Education • CBT • Disease model of care • Skill building/behavioral changes • 12 Step model of recovery

13. Therapy • Develop skills to work in a group • Learn how to ask for and give feedback • Challenge system of denial • Provide mirror for the patient

14. Fellowship • 12 step model of recovery (the steps) • Self-help (AA/NA/CA) • Home group • Sponsorship

15. Additional Components of Treatment • Urine drug screen • Breathalyzer • Medical/Psychiatric/Psychological Service • Pharmacological Therapy

16. Case Management • Mental Health • Financial • Housing & Transportation • Vocational • Educational • Legal • AIDS/HIV Risk • Family

17. Evidence Based Practice There is much talk in healthcare about“evidence based practice”, and for good reason. Evidence based practice, whether it is a surgical procedure, medical protocol, or psychological therapy signifies not only safe treatment but also effective treatment.

18. Evidence Based Practice (defined) • “A treatment practice that has been proven effective via well designed and controlled clinical trials” • “Interventions that show consistent scientific evidence of being related to preferred client outcomes” (Addiction Technology Transfer Center) • “Conceptually sound and internally consistent; program activities related to conceptualization; reasonably well-implemented and evaluated” (Center for Substance Abuse Treatment)

19. Current Issues with EBP • What is a “well designed” study? • Who decides how much scientific evidence is needed to clarify an approach as evidence-based? • What does “reasonably well-implemented and evaluated” mean, exactly? • Good News • Currently, a number of state and federal agencies are tackling these issues in an effort to establish standard criteria for identifying evidence-based practice. • Bad News • Agencies are working in relative isolation to each other.

20. Importance of EBP • Effectively treat disease and improve patient outcomes • EBP ensures that the best possible care is being provided • Accountability with federal and state funding sources • Private treatment centers will need to comply with new mandates. • Third party payers will require documentation of EBP • Agencies will be held accountable for treatment results as well

21. Principles of Effective Treatment 1. No single treatment is appropriate for all. 2. Treatment needs to be readily available. 3. Effective treatment attends to the multiple needs of the individual. 4. Treatment plans must be assessed and modified continually to meet changing needs. 5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

22. Principles of Effective Treatment(continued) 6. Counseling and other behavioral therapies are critical components for effective treatment. 7. Medications are an important element of treatment for many patients. 8. Co-existing disorders should be treated in an integrated way. 9. Medical detox is only the first stage of treatment.

23. Principles of Effective Treatment(continued) 10. Treatment does not need to be voluntary to be effective. 11. Possible drug use during treatment must be monitored continuously. 12. Treatment programs should assess for HIV/AIDS, Hepatitis B & C, Tuberculosis and other infectious disease and help clients modify at-risk behaviors. 13. Recovery can be a long-term process and frequently requires multiple episodes of treatment. NIDA (1999). Principles of Drug Addiction Treatment. Available on-line: http://www.drugabuse.gov.

24. Active Ingredients of Effective Treatment for Alcohol Problems • Early detection and brief intervention (for problem drinkers) • Comprehensive assessment and individualized treatment plan • Case Management • Individually delivered, proven professional interventions • Contracting with patients • Social skills training

25. Active Ingredients of Effective Treatment for Alcohol Problems (continued) • Medications • Specialized services for medical, psychiatric, employment or family problems • Continuing Care • Strong bond with therapist/counselor • Longer duration of care • Participation in support groups • Strong patient motivation Source: Ensuring Solutions to Alcohol Problems, Primer 4: The active ingredients of effective treatment for alcohol problems. Available online: www.ensuringsolutions.org .

26. Evidence-Based Addiction Treatment • ** Twelve Step Facilitation • **Cognitive-Behavioral Therapy • **Motivational Enhancement Therapy • Community Reinforcement • Contingency Management • **Pharmacological Approaches • Systems Treatment • Matrix Model

27. Review of Developmental Tasks

28. Developmental Tasks Erickson's Stages of Development 1 Oral/Sensory - Trust vs. Mistrust 2 Muscular-Anal - Autonomy vs. Shame, Doubt 3 Locomotor-Genital - Initiative vs. Guilt 4 Latency - Industry vs. Inferiority 5 Puberty and Adolescent - Identify vs. Role Confusion 6 Young Adulthood - Intimacy vs. Isolation 7 Adulthood - Generativity vs. Stagnation 8 Maturity - Ego Integrity vs. Despair

29. Developmental Tasks • Learning to Trust/Trusting the Process & Others • Building Self-Esteem and Esteeming Others • Learning to Express Feelings/Emotions Openly • Developing/Establishing/Maintaining Personal Boundaries • Relationship Interaction Skills

30. Models • Counseling • Coaching • Counseling/Coaching Combined

31. Counseling Defined Counseling is to consult; the act of providing professional guidance; advice given as a result of consultation; to utilize psychological methods or various techniques of the personal interview to guide in a constructive direction; an exchanging of opinions and ideas. Counseling tends to look to your past and focuses on understanding and resolving deeper emotional issues.

32. Coaching Defined Coaching is the process of inspiring, encouraging, motivating, and instructing an individual to unlock his/her greatest potential so as to achieve their ultimate goal.

33. Process

34. Traditional Therapy/Counseling – CoachingPrimary Life Focus Counseling • The focus is on a person’s past, which usually includes some form of trauma. • The focus is on healing emotional pain or conflict within an individual or in a relationship between two people. • Note: Some forms of therapy, or individual therapist, do focus on the future. Coaching • The focus is on an individual’s present, in order to help them design and act toward the future. • While positive feelings may be a natural outgrowth, the primary focus is on creating actionable strategies for achieving specific goals in one’s work or personal life. • The emphasis in a coaching relationship is on action, accountability and follow through.

35. Counseling Subject Focus: • Feelings Model: • Medical or clinical, relying on diagnosis of pathology or relationship conflicts Nature of Issue: • Identifiable dysfunction Coaching • Action and outcomes • Learning/developmental focusing on attainable goals and possibilities • A generally functional client desiring a better situation

36. Counseling Treatment of the past: • Understand and resolve the past Client/Patient Goals: • Help patients/clients resolve old pain and improve emotional states Coaching • Understand the past as the context in which future goals are set • Helps clients learn new skills and tools to build a more satisfying successful future: focuses on goals

37. Counseling Accountability for Goals: • The goals of therapy are often necessarily vague or intangible, or not easily measured. It can be difficult (even undesirable) to identify success with much particularity. Relationship: • Doctor-patient relationship (The therapist/counselor is the expert) Coaching • Coaching goals, like business goals, usually have to do with one’s external world and behavior, and therefore can be measured. • Co-creative equal partnership (The coach offers perspectives and helps the clients discover their own answers)

38. Counseling Function: • The therapist/counselor diagnosis, then provides professional expertise and guidelines to provide a path to healing Style: • Patient, nurturing, evocative, indirect, parenting, cathartic Coaching • The coach stands with the clients and helps him/her to identify the challenges, then partners to turn challenges into victories, holding clients accountable to reach desired goals • The same, except parenting, but also catalytic, challenging, direct, straight talk, accountability

39. Counseling View of Patient/Client: • Something is missing in you • You have some major deficiencies • You really don’t have the brain to put it together • Counselors know more than you do • Counselor is responsible for your well-being • Counselor is the resourceful person • Counselor has all the solutions for you Coaching • You are whole and complete • You don’t have any problems • You have the brain • You are the person who knows yourself the best • You are creative and resourceful • You can find you own best solutions and strategies

40. Which is Best for Me? • Counseling: • Is accessed because of unresolved issues • Is delivered in person • Encourages talking • Often looks at the past • Addresses symptoms • Promotes emotional health • Coaching • Is accessed because of dissatisfaction • Is delivered via telephone or in person • Encourages action • Mostly looks at the present and future • Identifies the source

41. Counseling • Focuses on problems • Is nurturing and supportive • Is defined by the session • Answers the questions “Why”? • Moves the individual out of pain • Coaching • Focuses on solutions • Is warm and direct • Focuses on the work one does outside the session • Answers the questions “How”? • Moves one from good to great

42. Counseling/Coaching Model Combined • A responsible counselor/coach knows when it is useful to look at the past, precisely because the past informs the present, as well as in order to help extinguish limiting belief systems.

43. Coaching/Counseling Model Strategies for coaching: 1. Forge a partnership/Lead • Build trust and understanding so that people want to work with you 2. Inspire commitment/Lead • Create insight and motivation so people focus their energy on objectives that matter 3. Lead by inspiring

44. Coaching/Counseling Strategies (continued) 4. Promote Persistence/Lead • Build stamina and discipline to make sure learning lasts 5. Grow Skills/Lead • Build new competencies to ensure people know how to do what is expected 6. Shape the Environment/Lead • Build supports to reward learning and remove barriers

45. Process

46. Creating a Vision

47. Vision: A Definition • The noun vision has 5 meanings: • a vivid mental image • the ability to see; the faculty of vision • the perceptual experience of seeing  Synonym: visual sensation • the formation of a mental image of something that is not perceived as real and is not present to the senses  Synonyms: imagination, imaginativeness • a religious or mystical experience of a supernatural appearance

48. verb • To form mental images of: conceive, envisage, envision, fancy, fantasize, image, imagine, picture, see, think, visualize. Informalfeature. Seethoughts.

49. What is a Vision? • something seen in a dream, trance, or ecstasy; especially: a supernatural appearance that conveys a revelation • the act or power of imagination; unusual discernment or foresight • the act or power of seeing

50. Helen Kellerwas asked, what would be worse than being born blind? She replied, "To have sight without vision."